Unproven policy means less care for young women in crisis

A growing group of young women with severe mental illness are getting stuck in the Dutch mental health system, and several clinics are responding by deliberately treating them less, an investigation by current affairs programme Nieuwsuur has found.

The women, estimated to number in the hundreds and aged between 15 and 30, have serious problems including chronic suicidal thoughts, self-harm and eating disorders, for which existing treatments are not working well enough.

Many are of average or above-average intelligence and struggle with perfectionism and a fear of failing or of not meeting social expectations, said Daan Creemers, a professor specialising in suicidality in adolescents.

When no treatment helps, several institutions turn to an approach known as Autonomie Bevorderend Beleid, or autonomy-promoting policy, under which women who ask for help do not always get it – including when they ask to be admitted. The aim is to break a cycle of repeated crises and admissions and give patients back control over their own lives.

“At a certain point you end up in a pattern in which we, as clinicians, feel held hostage,” Creemers told the programme, saying the policy is intended to return responsibility for young people’s safety to them.

There is no guideline for the approach and no scientific evidence that it works. The patients’ organisation MIND raised the alarm 18 months ago after receiving more than 100 negative accounts from people who said they felt neglected, and reported that in many cases the policy did not reduce suicidal thoughts and sometimes made them worse.

The parents of a 24-year-old woman from Eindhoven who took her own life in 2024, hours after being refused help at a clinic under the policy, have begun disciplinary proceedings. The case has not yet been decided.

MIND says it is not against the policy in principle, but that it should not be used until it is properly applied. The organisation has written to the health ministry calling for urgent research into the group. Creemers said the approach requires stable teams and the same clinicians over long periods, which staff turnover makes difficult.

If you or someone close to you is struggling with thoughts of suicide, help is available. In the Netherlands, call 113 or 0800-0113 (free) for 24/7 support, or visit 113.nl, where the chat service is available in English.