In the Netherlands there seems to have been a rapid rise in incidents involving "mentally confused" people. The reported number of such incidents rose from 53,000 in 2013 to 60,000 last year and the Dutch are asking why.
A phone rings and community psychiatric nurse Theo Eberson speeds to his car. The police want him to assess the mental health of someone they've just apprehended. When Eberson arrives at the police station, Brigadier Mike de Wit explains that his team has brought in an English-speaking man who banged on doors in the stairwell of an apartment block and then got into a fight with an angry resident who asked him to leave.
"We want to see if there's anything we can do for him," de Wit says. "And, if there's really nothing we can do, we have to put him back on the street."
De Wit unlocks the door of the cell and lets Eberson in. Eberson explains that he comes from the community health department and that he'd just like to talk to the man. But the man barely responds. He's lying on a bench in the cell, shivering and has difficulties keeping his eyes open.
Cases on the rise
Eberson tells the man that he's going to call an ambulance to take him to the emergency ward at the hospital. De Wit is used to this routine. He says he has seen a rise in the number of people causing public disturbances in recent years.
"My experience is that it's increasing," de Wit says. "There are more people who have to live on the streets and less help for confused people. In the end, they're on the radar and they end up here."
This kind of incident is not just common in Amsterdam. Throughout the Netherlands, police reported 60,000 incidents involving confused people in 2014, a whopping 13 percent increase from the previous year. The incidents, they say, are varied - perhaps a small house fire or a person who decided to park their car on a train or a tram line. That's the kind of slightly out of the ordinary incident that suggests that someone may have been suffering from some kind of mental disturbance. The rapid rise has sparked a national debate on what's causing the problem and how to solve it.
Cuts to mental health care
Jacobine Geel heads the mental health association GGZ Nederland and believes that one reason behind the increase in reported incidents is that the government has been making budget cuts in the field of mental health care. The Netherlands is rapidly decreasing the number of beds it has available in psychiatric units in favor of outpatient care.
"There are more people who are vulnerable and who need some form of care," Geel says. "Often these people are living in their own houses. Budget cuts mean fewer places where these people can go to have something to do or to meet people."
More problematic, Geel says, is the speed with which the system has to reorganize. Geel recognizes the need for reorganization but she is hoping the government will give health care professionals more time in which to do so.
Fred Ter Meer knows what Geel is talking about. He heads a group of mental health institutions called Yulius, based in the city of Dordrecht. The group is responsible for about 16,000 patients. Ter Meer says he's already cut 35 of 200 beds and will have to cut more.
"We've never had a waiting list, but now it's growing quite fast," Ter Meer says. "When you're on a waiting list, for sometimes three months, there's a big chance you'll find yourself in a crisis situation. Available beds for these people will continue to be cut until 2018. So, we're only halfway. And I'm very worried about how we're going to manage in the future."
Geel adds that economic problems have contributed to the increasing number of mentally confused people.
"I think the financial crisis of the past decade has caused problems for individuals, and now those problems are really coming to light," Geel says. "For instance, suppose that you're in a partnership and you lose your job and then your partner loses his or her job and you have children. When you're vulnerable to that stress, you can sink through the ice, as we say in Dutch."
Geel says constant images of conflict and wars on television screens and mobile phones have also contributed to increased levels of stress for everyone. To find solutions, Geel says, it's important to know more about those suffering from mental confusion.
"Some of these people probably do have a history of mental illness," Geel says. "But a lot of them are probably just being crushed under the weight of a very complex society. So we have to be very aware of the complexity and diversity of this group and map it first before we start thinking about solutions and how we can help."
'They don't have solutions'
The term "mental illness" can cover a very broad range of ills, and "confused people" sounds even vaguer - so what does it really mean? On the square outside her crisis center in Utrecht, community psychiatric nurse Carina Stigter says that confused people are often in deep distress.
"Suicidal thoughts, suicidal behavior, psychotic behavior and sometimes the abuse of substances like alcohol and drugs," Stigter says. "What they all have in common is that they don't have solutions to the situation that they're dealing with. Or the people around them don't have solutions."
She thinks that part of the problem - or at least an aggravation of these people's distress - is when the police arrive to deal with what they deem a public disturbance.
"They are trained to deal with criminals and offenses," Stigter says. "And they take these people into a police cell and treat them as a suspect. It increases the suffering of these patients."
That happened to 19-year-old Felix, a slim and trendy young woman. At her home, she explains in a quiet voice how she walked out of hospital for reasons she prefers to keep private. Fearing that Felix might harm herself, hospital staff called the police. She had just gotten home, she says, when two police cars drew up and six officers stormed inside.
"They jumped on me, handcuffed me and put me in the car," Felix says. "I got angry. I shouted anything that came to mind - that I thought they were idiots. I panicked. I felt I was being unfairly treated in my own home. "
Because of her reaction, Felix was put into a cell.
"I had to undress completely," Felix says. "I had to take off my wig, which I wore at the time, and I found that very painful to deal with. There was no explanation."
Felix says she had to wait half an hour before people trained to work with mental health patients came to see her.
"They made me feel better and I settled down," Felix says. "I think that if it'd been the other way around - that first the crisis service would have come and then the police or no police at all - things would have been totally different."
Stigter, the community psychiatric nurse, says she is trying to ensure that possible patients receive mental health assistance before the police engage them. A year ago she set up a program under which the police will contact her crisis service if they're dealing with someone who's mentally confused before they try to handle it themselves.
"Through a structured-risk strategy, we make sure the people come here when they don't need a police cell," Stigter says. "The relationship between the mental health professionals and the police in Utrecht is very good, and that's one of the success stories of this project."
In June, Dutch Public Health Minister Edith Schippers announced that every municipality should have a similar system in place by the end of this year. Despite this move, Eberson, the nurse in Amsterdam, thinks that the Netherlands will have to accept that mental illnesses will become more visible on the streets in to the future.
"Now we're closing down beds, which means there are more outpatients and more people with psychiatric problems on the streets," Eberson says. "The community has to get used to it and will get used to it."
Ter Meer, of Yulius, says that would mean a big change for the Dutch, who are generally accustomed to a relatively calm and quiet society.
"You see a lot more confused people on the streets of Paris or London," Ter Meer says. "But we're not used to it. So this is a big change for Dutch society."
The change is slowly altering Dutch attitudes to mental health in general - which is perhaps fortunate because, until there is an integrated strategy to tackle this problem, the reported rise in "mentally confused" patients could just keep rising.