Toespraak staatssecretaris Van Rijn bij de internationale bijeenkomst over demedicalisering

Toespraak | 23-05-2014

Good morning ladies and gentlemen,

 

Welcome to the Netherlands and welcome to The Hague.

 

First of all: millions of children today are alive and healthy thanks to modern medicine. And millions of children may not be cured, but they can lead normal lives – or as normal as possible. Thanks to modern medicine. That is something to be grateful for.

But like you, I am concerned that some children are being given medical treatment unnecessarily. This problem has attracted close attention – not only here in the Netherlands, but also in Denmark, Sweden and Flanders.  And so you have come here today to discuss and share the policy applied in your respective countries.

 

I greatly appreciate your interest and I am very grateful that you are willing to share your knowledge and experience. I’m sure that we can learn much from each other.

 

‘Demedicalization’ is not an isolated activity. It is part and parcel of a large-scale programme which has been ongoing in the Netherlands for some time. We are undertaking a complete overhaul of our health and welfare services for young people. Demedicalization is a key objective of the reforms, something to which specific attention is being devoted at the request of parliament.

 

I would like to tell you about how our system is changing. I shall then devote a few words to the topic of demedicalization before I hand the floor to our Head of Youth Policy, Bonita Kleefkens.

 

Last year, the Netherlands once again achieved the highest ranking in UNICEF’s ‘Child Well-Being In Rich Countries’ survey. Overall, our children are among the happiest in the world.

 

However, there are exceptions. Some children do need help and support, perhaps due to a physical disability, a psychiatric or psychological condition, or possibly their social circumstances. We wish to ensure that they receive the best possible medical treatment, counselling and protection. And we concede that improvements are necessary.

 

At present, our youth health and welfare services are too fragmented. Responsibility is divided between various ministries, provincial authorities, and municipalities. Coordination is sometimes lacking, resulting in duplication or grey areas.

 

Clearly, that is not in the best interests of the child. To rectify this situation, we are placing responsibility for youth health and welfare firmly at the local level.
Each of our 403 municipalities will be directly responsible for the relevant services within its boundaries, whereupon there will be a single point of contact working within a single financial framework.

 

The decision to implement this major reform was preceded by many years of discussion and debate. It was, however, a relatively simple decision because our objectives are crystal clear. Care must be provided as close to the child, young person or family as possible. It must be must be as ‘light’ as possible, and its duration limited by the actual requirement.

 

An act of parliament is now in preparation. It will provide the legislative basis for a new system in which the municipalities have full administrative and financial responsibility for youth health and welfare services, including child protection measures and the supervision of young offenders.

 

From next year, the local authority will be the sole point of contact for children, teens and parents who require support. “One family... one plan... one case manager.”

 

Another very significant change is that parents and children themselves will be given far greater input. We shall no longer talk about them, but with them. The full involvement of parents, young people and the social setting is a crucial component of the new approach.

In addition, we wish to take full advantage of the individual’s own talents and abilities, as well as those of others in their social network. As I mentioned, we shall pursue demedicalization as one of the key objectives of the reforms.

 

Of course, there is a place for medication and specialist care, which in some cases can help to improve the quality of life. However, I am concerned to note the sheer number of children being diagnosed as having a medical condition, and I am particularly concerned by the sharp increase in the number being prescribed pyschopharmaceuticals.

 

This is a very complex issue. Opinions are rather divided with regard to the diagnostic criteria for ADHD, for example, and hence when it is appropriate to prescribe a drug. In any event, recent years have seen an enormous rise in the number of young people who take medication for ADHD. The number of reported diagnoses has risen twofold since 2007, and in 2013 one in every nineteen children and adolescents aged 6 to 21 was taking methylphenidate.

 

I found these figures so worrying that I held talks with the relevant professional groups, parents’ associations and the education sector. We have agreed that the medical field will produce some practical guidelines, based on the perspective and interests of the child. These guidelines will ensure that appropriate help is provided by the appropriate professional when required, and hopefully only when required.

Ladies and gentlemen,

 

This was a very brief summary of current policy in the Netherlands. We all want the very best for our children. Sharing our knowledge and experience will help us to achieve that aim. In this context, I have scheduled a visit to Denmark in September to see for myself how youth health and welfare care services are organized there.

 

It only remains for me to wish you all a pleasant and fruitful meeting. I hope that it will provide some very useful insights.

 

Thank you.