The Netherlands borders the North Sea and is located between Belgium and Germany. Its total area is about 41 500 km2, nearly 34 000 km2 of which is land area. The country consists mostly of coastal lowland and land reclaimed from the sea (polders). An extensive system of dykes and dams protects nearly one-half of the total area from being flooded.

The Netherlands is one of the most densely populated countries in the world, at around 480 persons per km2 of land area (total population of 16 299 000 as of 1 January 2005). About 20% of the population have a foreign background. Of the total number of jobs available, about one-sixth are in trade, one-sixth in industry, one-eighth in business and one-eighth in health and social care. Agriculture and fisheries account for only 1.5% of the workforce, so it is fair to call The Netherlands an advanced post-industrial society (Metz & Poorter, 1998).

According to the Healthcare Budgetary Framework (Ministry of Health, Welfare and Sport), the cost of healthcare was c45 billion in 2004, representing 9.2% of gross domestic product (GDP). Healthcare expenditure as a percentage of GDP in The Netherlands is on a level with the middle group of European countries.

The annual prevalence rate of mental conditions (excluding alcohol and substance misuse) in the Dutch population is 16%. Over 40% of the Dutch population have at one time had a mental condition (including alcohol and substance misuse). In the period 2000–4 one in every three Dutch adults with a mental condition sought help.

Mental health policy

Mental healthcare is part of the portfolio of the Minister of Health. Since the late 1990s, government policy has been based on principles such as continuity of care. Collaboration between clinical and ambulatory care resulted in the establishment of integrated institutes for mental healthcare.

Mental healthcare is mainly financed through the Exceptional Health Expenses Act (Algemene Wet Bijzondere Ziektekosten, AWBZ), but this mechanism is due to change over the next few years. A substantial part of mental healthcare will be transferred to the health insurance system and be financed in a manner similar to physical healthcare. Payments will be based on ‘diagnosis treatment combinations’ (diagnose behandel combinaties, DBCs). Only hospitalisation exceeding 12 months will be paid through the Exceptional Health Expenses Act.