Pathways to Helping Troubled Children in the Netherlands

It has often been found that many children with mental health problems do not receive professional help for them. The reasons may include unavailability of services, financial obstacles, parents’ lack of awareness or motivation, lack of appropriate referral pathways, and use of alternative kinds of help. In the Netherlands and several other countries, general practice physicians are expected to provide initial evaluations of children’s mental health problems. If necessary, the physicians then refer the children to mental health services, which have no financial barriers to care.

To identify the actual pathways for help-seeking in this type of system, a team of Dutch researchers assessed the mental health problems of 1,319 4- to 11-year-old participants in the Dutch National Survey of General Practice (Zwaanswik et al., 2005). The children’s parents completed the CBCL and their teachers completed the TRF.

A structured diagnostic interview (the DISC-IV) was administered to parents of children whose Total Problems scores were in the borderline or clinical range (T scores >60) on the CBCL or TRF. The parents were also asked about their efforts to seek help for the children’s problems during the preceding 12 months. Help was sought from friends or relatives for 48% of the children who were considered to need professional mental health services because they qualified for diagnoses and met impairment criteria. For 52% of the children, help was sought from teachers.

Help was sought from general practitioners for only 27%. (The percentages exceed 100% because help was sought from more than one source in some cases.) For the children who ultimately received professional mental health services, 43% were referred by general practitioners, whereas 57% did not come through general practitioners.

The general practitioners thus provided help for only a minority of children who were judged to need services and were the referral agents for only a minority of those who ultimately received professional mental health services. Although some family characteristics were associated with help seeking, the strongest predictors of help seeking were the CBCL and TRF ratings. The authors concluded that access to mental health care could be enhanced by educating parents about child psychopathology and about care, improving general practitioners’ skills in detecting child psychopathology, and promoting direct contact of mental professionals with general practitioners and schools.

Reference: Zwaanswijk, M., van der Ende, J., Verhaak, P.F.M., Bensing, J.M., & Verhulst, F.C. (2005). Help-seeking for child psychopathology: Pathways to informal and professional services in the Netherlands. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1292-1300.