While working as a nurse practitioner at MET ggz, Thijs Beckers encountered two young men with similar psychiatric problems, yet very different patterns of care use. One attended mental health services once a month, while the other required treatment several times a week. Beckers discovered that social support from their surroundings helped explain why one patient used fifteen times more care than the other.
‘We tend to assume that if you have a strong social network, you will need less psychiatric care, because the people around you can listen to you and support you,’ Beckers explains. ‘And if you have very few people around you, you are thought to need more care.’ For his doctoral research, Beckers followed nearly three hundred people with mental health problems over a period of four years. ‘Surprisingly, a strong social network can actually lead to increased use of care. Family members or friends may, for instance, firmly insist on professional help when they see that someone is struggling.’ At the same time, psychiatric care is often reduced more quickly when someone with strong social support begins to recover, as their network takes over certain care tasks.
Dependent on care
By contrast, people with a small or limited social network often receive the same intensity of psychiatric care for many years. Beckers gives the example of a homeless person who sleeps in shelters during cold nights, spends the day on the streets, and becomes depressed. ‘Because they have no one to guide them or to arrange care on their behalf, a great deal has to happen before they receive appropriate help,’ Beckers says.
Receiving the same type of care for a prolonged period can make people dependent on professional support. ‘With long-term care, someone is constantly looking over your shoulder and taking on part of the responsibility for your behaviour. For example, a person with financial problems may be pulled up short by a care professional if they go too far,’ Beckers explains. ‘This can undermine self-esteem and personal autonomy, as confidence in managing things independently in the future gradually diminishes.’
Having coffee with the neighbour
In the Netherlands, buddy schemes and group-based social skills training are widely used for people with psychiatric problems. Beckers argues that strengthening social support within this group is far more effective. However, this is not easy to achieve. Many initiatives aimed at reducing loneliness, such as buddy schemes for older adults, often do not work well for people with severe psychiatric conditions. ‘Building a relationship with a new person can be difficult and emotionally vulnerable. For this group, it works better to focus on the social environment a patient already has and to build on that. For example, having coffee once a week with a neighbour you already chat to occasionally. By making use of existing networks and increasing social support, people are more likely to receive the care they need – and to receive it more quickly.’