Introduction
Improving quality of care by using clinical guidelines based on well
graded research evidence has been the standard in the Netherlands for
the past 25 years, also in mental health care. In these years we have
gradually improved our knowledge about how to evaluate health and health
care related scientific results. By trial and error we learned how to
meta-analyse and integrate ever increasing amounts of scientific
findings into applicable scientific knowledge. We also discovered how to
develop, publish and disseminate clinical guidelines and how to educate
professionals in using guidelines as tools for the implementation of new
clinical practices. Comparing the training of mental health
professionals today with that of the pre millennial nineties shows a
tremendous paradigm shift from opinion expert based clinical thinking
and practicing towards structured, protocoled, multidimensional,
evidence based practice.
However, after this first promising early age a possibly too strict and
consistent utilization of evidence based medicine more recently begins
to show some of its drawbacks and possible disadvantages more clearly.
Questions about the further progress from ‘one disorder’ guidelines
towards guidelines for complex and comorbid health
conditions1,2, the appraisal and integrated use of
more diverse types of knowledge (observational, expert, experiential)3, about the financial consequences of implementing
guidelines for health care costs, about the real effectiveness of
guideline implementation for changing provider performance and/or
patient outcomes4, and about the principles for
updating of guidelines5 threaten a productive further
progress.
Different countries have shown different evidence based practices and
guideline histories and are trying to find cultural sensitive solutions
for the above named questions. In this paper we will describe the
development and current situation in Dutch mental health care. We aim to
consider three aspects: We first give information about the different
guideline programs that were developed over the past two decades; what
steps have been taken, how did we organize this, what was the output,
and what were the limitations. Second, we will elaborate on this
development in more detail and focus on the past five years during which
we executed a nationwide program to produce a set of practice guidelines
(standards of care and generic standards). The program was commissioned
by the Dutch Foundation for Quality Development (NKO). We describe how
and by whom NKO was created and how this program resulted in a set of
quality standards. Third, we want to describe an example (the standard
of care for depression) to give more detail about the way we have been
working. We value sharing our experiences with practice guidelines
program for mental health care and hope it will be inspiring for other
countries.