Continue with self-management Annual Report 2010
Index
International Alcohol & drugs E-mental health Mild intellectual disabilities Mental Vitality Outstanding publications Suicide
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International Trimbos Institute named as WHO Collaborating Centre In September, the World Health Organization designated the Trimbos Institute as a WHO Collaborating Centre for the dissemination of good mental health practices. Such cooperative arrangements with selected organisations have proven a cost-effective means for the WHO to achieve its strategic objectives at regional and global levels. They also enhance the scientific validity of its work as well as the impact and effectiveness of national- and regional-level institutions.
Economic modelling study for WHO The World Health Organization in Geneva commissioned the Trimbos Institute to conduct an economic modelling study to determine whether a sizeable expansion of nationwide e-mental health interventions could improve the cost-effectiveness of alcohol prevention and treatment in the health care system. The conclusion was that wide-scale implementation of e-health interventions would substantially boost return on investment in terms of health gains – from just over 1 euro at present to 1.65 euros for every euro invested.
Healthy Nightlife Toolbox At the Club Health Conference on safe and healthy nightlife, held at Zurich on 7-8 June, the Trimbos Institute launched the Healthy Nightlife Toolbox (HNT). The HNT is an international database that supplies information to health workers active in nightlife scenes about effective ways to improve health and safety for young people. The Trimbos Institute is project leader for the Healthy Nightlife Toolbox and co-organiser of the Club Health Conference. For more information on the HNT, see www.hnt-info.eu.
‘An important step forward for research on ADHD and substance abuse’, declared ICASA Director Geurt van de Glind of the Trimbos Institute. ICASA is a network of more than 40 researchers from eleven EU countries, the United States, Australia, South Africa and Brazil. They have one shared aim: to reduce the onset of addiction in people with attention deficit hyperactivity disorder by improving detection, diagnosis and treatment of both ADHD and substance use disorders.
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Drug prevention in Bulgaria Trimbos worked with the Bulgarian organisation Solidarnost from 2008 to late 2010 to set up a drugs and alcohol helpline. It provides information and advice via telephone, webchat, a website and an online forum, as well as referral to professional help if needed. Recreational drug use and the associated problems are taboo in Bulgaria. Few services exist for drug users, and the possession or use of drugs is subject to heavy penalties, with no distinction made between hard and soft drugs. This makes it difficult to discuss drugs and provide help. The helpline is a low-threshold, strictly confidential service. It already plays a key role in the Bulgarian information, prevention, education and treatment services relating to recreational drugs. For more information, see www.drugsinfo-bg.org/en.
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ICASA international network founded The launch of the website www.adhdandsubstanceabuse.org in early September also marked the official establishment of the ICASA Foundation – International Collaboration on ADHD and Substance Abuse.
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Alcohol & drugs Call to raise drinking age to 18 In May, the Trimbos Institute, together with the association of community health services GGD Nederland and the Dutch Institute for Alcohol Policy (STAP), urged Parliament to prohibit the sale of all types of alcoholic beverages to people under 18. The appeal was prompted by an impending debate on a new Licensing and Catering Act. From 2003 to 2008, cases of emergency treatment for alcohol poisoning increased by 280 per cent in adolescents aged 15 to 19. There is conclusive research evidence that setting an age limit of 18 is one of the most effective measures to combat health damage from youthful alcohol misuse.
initiative. That broadly based campaign, conducted by a range of organisations, was launched in April to raise youth awareness of the risks of excess drinking. Happy Drinks are now advertised in Frisian bars and clubs as an alternative to alcoholic beverages. The Happy Drinks initiative seeks to boost the image of alcohol-free drinks and their availability in nightlife venues. In 2011, Happy Drinks will be part of a campaign to build personal resilience in young people, conducted by Trimbos in cooperation with STIVORO, the Dutch knowledge centre for tobacco control.
New: Monitoring System for Drug-Related Emergencies (MDI) Although GHB is not widely used, the number of GHB health incidents is relatively high. One fifth of all reported drug-related emergencies involve GHB, including a higher-than-average rate of serious poisonings. These are some notable findings from the Monitoring System for Drug-Related Emergencies (MDI), launched by Trimbos in 2009. It keeps records on the current nature and scale of health incidents involving recreational drugs in the Netherlands. Data is collected through a network of sentinel sites throughout the country, including hospital casualty departments, ambulance services, police doctors and first-aid facilities at large events. The number of sentinel sites was expanded in 2010. The monitoring data are used to improve drug prevention and harm reduction.
Happy Drinks One way to deter young people from drinking is to provide tasty alternatives. The Dutch master chef and culinologist Pierre Wind was commissioned by the Trimbos Institute to develop Happy Drinks. These cocktails without a drop of alcohol, including the Battery (like swallowing a battery) and Caipirinhee (with a buzz from sushi vinegar), caused a big splash in June at a school party at the Dalton Lyceum in Dordrecht. Happy Drinks are also promoted by the Nuchtere Fries (‘sober Frisians’)
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E-mental health Psychisch Gezien Panel An advisory panel called Psychisch Gezien (‘psychologically regarded’), a large, broadbased nationwide group of and for people with mental health conditions, was initiated in early 2010. The purpose is to better understand the life situations, social functioning and service needs of people with persisting mental health disorders and to give them a clearer voice in the public debates on mental health care. Recruitment of panel members began in June 2010 via the website www.psychischgezien.nl and via mental health services. By December, 700 people had joined the panel, rising to 800 in March 2011. The youngest member is 19 and the oldest 87. The Trimbos Institute coordinates the panel and works with the Phrenos Knowledge Centre, Landelijk Platform GGz (the national alliance of client and family organisations in mental health) and the Netherlands Institute for Health Services Research (NIVEL). The Dutch Ministry of Health provided financial support in the initial year.
GPS and dementia Informal carers of people with dementia are enthusiastic about a GPS system that enables them to trace the whereabouts of their loved ones via a secure website and to contact them by telephone. According to findings by the Trimbos Programme on Ageing, published in April, 75 per cent of carers reported that the GPS system gives them a greater sense of safety, and 61 per cent that it allows the care recipients more independence. The tracking technique still needs further refinement before it can be implemented on a broad scale. The GPS system offers a variety of options. It sends coordinates to the secure website, allowing the carer to see where the person is located and the route they followed to get there. The person with dementia can contact the carer by pressing a single button. The carer can also phone the GPS system, activating a telephone loudspeaker to make immediate contact without the care recipient having to answer the phone.
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Preventing relapse through Depressievrij.nl Is online self-help an effective way to prevent relapse into depression? That is the central question in an evaluation study of www.depressievrij.nl conducted by the University of Groningen, the Trimbos Institute, the VU University Medical Centre and the Arkin Mental Health Service. Depressievrij (‘depression free’) is a web-based therapeutic intervention based on an empirically effective group therapy model from the University of Groningen. In cooperation with the Trimbos innovation programme Mental Vitality, the therapy was adapted for online use. Users can perform it at home on their own time and at their own pace, receiving telephone or email support from a therapist if needed. SMS text messages have proven to be one way to increase therapy adherence. Clients in the recovery phase of depression are sent two messages a month asking how they are doing. Their answers are plotted on a graph. This produces an overall view of their mood patterns and helps the therapist provide targeted feedback. Recurrence of depressive symptoms can be detected more rapidly.
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Mild intellectual disabilities People with mild intellectual disabilities (MID) have an elevated risk of mental disorders as well as alcohol and drug problems. The Trimbos Institute conducted a number of projects involving this group in 2010.
Mental health care to people with mild intellectual disabilities
alcohol and drug policies. The programme has been recognised by the Centre for Healthy Living (CGL), a knowledge centre of the National Institute for Public Health and the Environment (RIVM), as a ‘theoretically sound’ lifestyle intervention suitable for the care of people with mild intellectual disabilities.
A research report entitled Licht verstandelijk gehandicapten (LVG) in de GGZ (People with Mild Intellectual Disabilities in Mental Health Care), published by Trimbos in the autumn of 2010, observed that a substantial number of clients of mental health care services have mild learning disabilities. No reliable figures are available, as generic mental health care agencies do not routinely screen or examine their clients for learning impairments. To improve services to this group, particularly in the generic sector, mental health care providers need additional training to recognise and work with people with mild learning disabilities. Research on the effectiveness of various therapeutic methods and care strategies could further the development of evidence-based practices.
Alcohol and drug use by people with mild intellectual disabilities Which adults with mild intellectual disabilities use alcohol or drugs? How much do they use and what problems does it cause? These were questions addressed by the Trimbos report entitled Middelengebruik bij volwassen met een lichte verstandelijke beperking (Substance Use by Adults with Mild Learning Disabilities). Problem alcohol or drug use was estimated to occur in 10 to 30 per cent of the group in question. Most professionals specialising in mild learning disabilities were found to have insufficient knowledge of substance misuse; many professionals in other fields had too little knowledge of learning disabilities. More cooperation between various sectors could ensure that adults with mild learning disabilities and substance use problems will receive the services they need. Agencies for people with mild intellectual disability can call on the Open and Alert programme to enhance the expertise of their professionals as they develop
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Mental Vitality Launch of Mentaalvitaal.nl and Psyfit.nl A mind gym, not a body gym. On 8 October, Trimbos launched a portal called Mental Vitality (www.mentaalvitaal.nl) that brings together a realm of information on mental health. It is for everyone who wants to learn more about mental health and become more mentally fit. It provides information, exercises and tips for mental fitness, online courses and therapies, and referrals to other services. In the first quarter of 2011, some 77,000 visitors found their way to the portal. Mental Vitality is a joint project of the Trimbos Institute and the Netherlands Mental Health Fund. www.psyfit.nl is one of the Trimbos interventions associated with Mental Vitality. It was officially launched in November 2010. Psyfit.nl is a web-based course that helps to boost mental fitness through exercises, tests and tips. People that take the course learn what mental fitness is and how they can feel happier and more relaxed in life. The principles of Psyfit.nl also form the basis for a book entitled Mental Fitness: Verbeter je mentale conditie (Mental Fitness: Improve Your State of Mind), also published in November. NTR Television (formerly Teleac) produced a four-part series, broadcast in November, which was derived from the book and the website. It showed how people with everyday problems and stress situations put the Mental Fitness principles to work. The website, the book and the TV series were all based on research in positive psychology, cognitive-behavioural therapy, mindfulness and lifestyle recommendations.
Centre for Safe and Healthy Nightlife
high costs associated with these. Personality Disorders Knowledge Centre The Personality Disorders Knowledge Centre (Kenniscentrum PS) was established in early December to promote research on personality disorders and to improve mental health services to people with these conditions. It is a collaborative arrangement between the Trimbos Institute, the Viersprong Centre of Psychotherapy, the forensic psychiatric observation hospital Pieter Baan Centre, and the Altrecht Institute for Mental Health Care. The purpose is to bring together expertise from a range of agencies and universities, to actively facilitate practitioners in accessing that knowledge, to generate research and to encourage service innovation.
Drinking Less – best researched online intervention worldwide A report issued in May in the Effectiveness Bank Alert singled out Drinking Less (www.minderdrinken.nl) as the world’s best researched online self-help intervention for problem drinking. The report made an international comparison of studies hitherto conducted on Drinking Less with studies on other e-health interventions for problem drinking. Drinking Less has now been included the international Effectiveness Bank database. The Trimbos Institute is working with the World Health Organization (WHO) to promote worldwide dissemination of the programme.
Mastery over Dementia wins international award Mastery over Dementia (www.dementiedebaas.nl), a website developed for informal carers of people with dementia, has received an international award as ‘the most promising psychosocial intervention’. In March, Anne Margriet Pot, head of the Trimbos Programme on Ageing, accepted the award, partly on behalf of the Geriant Foundation and the Alzheimer Nederland Foundation, at the 25th annual International Alzheimer Conference in Thessaloniki in Greece. The award jury, which included representatives of Alzheimer’s Disease International and the Fondation Médéric Alzheimer, said it was impressed by the aims, design and initial outcomes of Mastery over Dementia. The prize was used to develop an international demonstration video: www.masteryoverdementia.com.
In November, the Trimbos Institute and the Dutch Centre for Crime Prevention and Safety (CCV) set up the Centre for Safe and Healthy Nightlife (CVGU). It is a collaborative venture designed to support local authorities in tackling problems in nightlife, from both a safety and a health promotion perspective. Such an integrated approach is now widely lacking. The new strategy is aimed at reducing violence and nuisance, health emergencies among young people in nightlife, as well as the
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Outstanding publications In 2010, Trimbos staff members authored or co-authored nearly 300 publications, as compared to over 200 the previous year. These ranged from peer-reviewed articles in distinguished Dutch and international journals to research reports and doctoral theses. They also conducted some 300 presentations, training courses and lectures at home and abroad. For the complete literature list, see www.trimbos.nl/jaarverslag. We highlight here some of the outstanding publications.
Exercising may reduce mental health risks People who exercise regularly are 50 per cent less likely to develop mental disorders than those who do not, according to the first Netherlands Mental Health Survey and Incidence Study (NEMESIS 1) conducted by the Trimbos Institute and commissioned by the Netherlands Ministry of Health, Welfare and Sport (VWS). The first copy of this latest NEMESIS report entitled Sporten en psychische gezondheid (Exercise and Mental Health) was presented to Health Minister Klink on 19 January. People who exercise were found less likely than others to have mental disorders such as depression, phobias, other anxiety disorders or alcohol dependency. They were also less likely to develop first-onset depression, phobia, other anxiety disorders or drug dependence.
NEMESIS 2: New statistics on mental health Results from the second NEMESIS population study have delivered new figures on the prevalence of mental illnesses in the Netherlands. One finding was that attention deficit hyperactivity disorder (ADHD) occurs in 2.9 per cent of the Dutch population in childhood or early adolescence, persisting into adulthood in 72 per cent of those in question. This second Netherlands Mental Health Survey and Incidence Study (NEMESIS 2) is a representative study of 6646 adults aged 18 to 64 in the Dutch general population. It was conducted by the Trimbos Institute with funding from the Health Ministry (VWS). The new study
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was presented to the Lower House of Parliament on 23 March. The first follow-up assessment began in November.
HBSC study: Dutch youth are doing well Dutch adolescents feel good, rate their social situation as positive, and feel they are leading a good life. Yet they still engage in many risk behaviours, such as smoking, drinking and unhealthy eating. Those are some results from the nationwide Health Behaviour in School-Aged Children (HBSC) survey conducted amongst 11- to 16-year-olds. The accompanying report by Utrecht University, the Trimbos Institute and the Netherlands Institute for Social Research (SCP) was presented to the Dutch Health Minister Schippers in December. In comparison with the 2001 and 2005 surveys, Dutch adolescents now reported slightly more healthy eating habits, perceived their paternal relationship as more positive and were subject to less bullying at school; the younger age categories were drinking and smoking less. Once adolescents started drinking, they were quick to develop heavy drinking patterns.
TRIP board game for youth with mild intellectual disabilities TRIP is a board game with pawns, dice and question cards. It has been produced by the Trimbos Institute and Brijder Addiction Care for use in alcohol and drug education to young people with mild learning disabilities. The questions are divided into four categories: Knowledge (What do you know?), Skills (What would you do?), Opinion (What do you think?) and Propositions (True or False). The game for three to seven players can be played during drug and alcohol education sessions at school or in supported-living groups, led by a facilitator such as a health promotion worker from an addiction service.
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Suicide Survivors’ study on 113-Online Surviving friends and relatives of a person who has committed suicide run a greater risk of becoming socially isolated, are more likely to have health symptoms, and experience more difficulties with bereavement than when loved ones die from other causes. To improve support to the survivors, the Trimbos Institute is studying what benefits they may derive from contacting people in similar situations via the web-based forum at www.113online.nl. The website is designed both for people who are considering suicide themselves and for their loved ones or survivors. Survivors may turn to the site for information about suicide and its impact on surviving friends and relatives and they may take part in a web forum specifically focused on survivors’ peer support. The Trimbos study includes survivors aged 18 or older who have lost a child, partner, parent or other close companion to suicide, either recently or in the past. The study began on 1 March 2010 and results are expected in 2011.
Regional strategies on suicide prevention Wide regional differences exist in the Netherlands when it comes to suicide prevention. Research studies by the Trimbos Institute and the National Institute for Public Health and the Environment (RIVM) show that the greatest chance of success lies in joint strategies involving the regional community health service and mental health agencies, under close coordination of a local health authority. The study entitled Regionale aanpak van suïcidepreventie: Een kader voor opzet en voorbeelden (Regional Strategies for Suicide Prevention: A Design Framework and Some Examples) focused on suicide prevention in Amsterdam, the region of West Friesland and the province of Friesland. Some community health service interventions that have proved viable are health surveys to identify at-risk groups, public education campaigns, the training of teachers in the early detection of mental health problems, skills training for young people, and support to vulnerable people such as surviving friends and relatives.
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Improving care and aftercare to people with suicidal behaviour The Kwaliteitsdocument Ketenzorg bij suïcidaliteit (Quality Document on Continuity of Care in Suicidality) was published in July. Continuity of care is crucial for people with suicidal tendencies. Local and regional arrangements to ensure continuity are often inadequate. The quality document offers tools and guidelines for improvement. Four types of health care providers at the local level encounter people who attempt or consider suicide: general practitioners, hospital casualty departments, acute and consultation psychiatric services, and generic community health services. There is often a lack of clearcut arrangements between such parties as to who is responsible for helping people with suicidal behaviour and when. Particular problems arise when clients must be transferred from one health care provider or agency to another. The quality document was created by the Trimbos Institute and GGZ Nederland (the professional association of the mental health and addiction sector), in cooperation with the Dutch College of General Practitioners (NHG) and with financial support from the Netherlands Ministry of Health.
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