In the Netherlands we need a better balance between the participation society and the welfare and health state. Participation is done by the extended family and in the health and welfare state the government acts as our mother and father. Both in health (somatic) and psychiatric patients are neglected. That leads to visible confused people in the streets of the Netherlands. Unfortunately helping these people became a task of the police (13% of their time is lost because of these efforts). The number of visible confused people might increase if this unbalance between participation state and welfare and health state remains. My advise for the Taiwanese delegation of Taipei is rely on the extended family and her collectivist competencies if one likes to prevent neglect.

1. Confused Persons:
visible & invisible
Taiwanese delegation in The Hague
26 June 2017
Dr Carl H.D. Steinmetz
Expats & Immigrants
1

2. 2

3. Reasons for the National Dutch Governmental
attention and policy for confused people
Murder of Ex-minister Borst (2016) and attack of the NOS news by Tarik
Z. (2015)
3

4. A less humane welfare- and
health system?
EXPLANATION: title of this
presentation?
 Visible and/ or invisible?
 Neglect in somatic and psychic care
 Input, throughput & output?
Change in Dutch welfare and
health system:
Less welfare- and health state and
more participation society?
4

5. Part 1:
Solution of municipality
of Eindhoven
Less visible and invisible confused
people?
5
Eindhoven: 225.020 inhabitants
(2016)
Taipei: 2.705 million inhabitants
(2016): 12 times greater than
Eindhoven

6. 6
EINDHOVEN (brainport)

7. Eindhoven: Municipality de-
escalation team (1th and 2th line)
Municipality
De-escalation
team (10,9
full-timers)
0 line:
Basic health care
like consultation
bureau and
neighbourhood
teams (free
entry)
2/3 line:
Somatic and
mental health
(hospitals):
after referral of
general
practitioner
1 line:
General
practitioner,
dentist, social
neighbourhood
teams
7
Steps:
• Information and
consultancy
(free entry)
• First signals not
safe (health,
crime, housing,
income etc.)
• Escalation and
de-escalation

8. Visible and invisible confused people
Eindhoven (2016)
 Asylum seekers AZC Eindhoven (687 personen: < 50% Syrië).
 Asylum seekers with a conditional/ temporary residence permit
(= statushouders in Dutch) (> 1.000 persons).
 Asylum seekers who have to return to their homeland,
approximately 120 people: no central governmental bed, bath
and bread regulation.
 Homeless people (2012: 479).
 Psychic urgency (2015: 1.193 registrations)
(Overlap is possible)
Total inhabitants Eindhoven: 225.020 (1 April 2016):
Approximately 1,5% visible and invisible confused
persons
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9. De-escalation team Eindhoven
Additional data:
 Responsible for 600 prisoners
(resocialization after detention)
 Total 10,9 full-timers with different
backgrounds
 Cost of a client for the municipality in
social care with an unemployment benefit
= €90.000,00 per annum
9

10. Part II: the police at stake?,
background information and risks
1. Consequences for the Netherlands of visible and invisible
confused people
2. Participation society and welfare and health care state
3. More facts and backgrounds
4. Solving problems with the scenario method
5. Discussing a possible client
6. Reviewing this presentation
10

11. Participation society versus welfare- and
health care state
Is there an in-between solution?
11
Participation society
Welfare- and health care
society

12. Participation society versus welfare- and healthcare
state
More cultural consciousness and
sensitive work/ treatment 12

13. Visible confused people: facts and figure
Care- and health institutions dump people in need of care
and health at the police (responsible local and central
government)
Number of visible confused people in Nederland per police-unity and
municipality (40.095 in 2011 – almost 75.000 in 2016). Increase
88%. More visible confused people in near future?
0
10.000
20.000
30.000
40.000
50.000
60.000
70.000
2011 2012 2013 2014 2015
Police and confused people (Abrahams et. al., 2014. DSP-group
Indicators:
1. Effort of police (E33): 6% van police-files.
2. Total time 13% van the total police labour time.
13

14. Confused people: risk factors
Trimbos Institute (2016) Confused people or acute visible
and invisible need of care in somatic health, welfare and
psychic health institutions.
Risk factors leading to confused people are poverty, debts,
unemployment, not enough affordable housing, a complex society,
care impairment, not enough participation opportunities for vulnerable
people, less tolerance, more exclusion and stigmatizing of people.
Risk factors in detail. A low income coheres with less social
employability, more crime, higher health risks, a lower (healthy) life
expectancy, more care- and health costs and less quality of living. If a
low income lasts longer, the living conditions might deteriorate. These
people might have a pile of social, economic and exclusion problems
as a result of long lasting poverty.
14

15. Invisible confused refugees and
patients in somatic care
 Confused refugees might become sicker without an interpreter.
The result is no more help because of the extra bill for an interpreter: 13
tot 25 % of the refugees do have a PTSD and/ or depression (with related
alcohol and drugs misuse and/ or aggression), Bakker 2016.
 The Dutch government did not allow a bed-bath-bread regulation.
Municipalities have to deal with confused people or traumatized refugees
who are not welcome in the Netherlands and are wandering on the street.
Municipalities are suddenly confronted with a safety and humanitarian
problem (VNG, 2017).'‘
 68 percent of health professionals claim mistakes with medication as a
consequence of staff deployment and work stress. This leads in 70% to
patients falling or dropping out off their bed and/ or conflicts between
patients. In 25% this happens on a weekly base. Other consequences
(28%) are dehydrating, and malnutrition. Finally a third of the clients are
waring filthy clothes.
15

16. Invisible confused people in
psychiatry (GGZ-Nederland, 2016)
 175.000 youngsters (about 5%) in the Netherlands suffer from psychic diseases
disabling them in their daily functioning.
 405.000 parents (per year) experience psychic and addiction disorders. These
parents have 577.000 children under 18 year, 423.000 of them are 12 years or
younger. They are called the KOPP/KVO-group. Per 10.000 inhabitants 350 children
do have a parent with psychic and/or addiction disorders. These children are running
a personal risk to develop psychic and/ or addiction disorders. This risk is three to
thirteen times higher than for children with parents without these disorders.
 A large number of children is running a high risk on psychological and personal
developmental disorders as the consequence of neglect, assault, family violence
and/or (sexual, psychic and/or emotional) abuse. On a yearly base the number of
children at risk in the Netherlands is more than 118.000 (source Augeo). Of every
1.000 children 3.4% (34).
16

17. Confused people:
who are they? How many of them are invisible?
All people in care which are hardly been taken care of:
 On the average patients are seeing a nurse during 10% of a workday
(including washing, dressing and eating). Half of the time patients are
during a day alone. They have plenty time for thinking too much (= Idiom
of Distress) and negative feelings, according to Buijck (2013).
 The number of older immigrants in the Netherlands (22% in 2015) is
increasing. Dementia among them will increase as well. The extended
family of immigrants is taking care for those who are sick or old. Even if the
care is too heavy. They postpone homecare and intramural care since it
does not fit collectivism. The consequences are that members of the
extended family are overloaded (Van Wieringen, 2014).
All persons who get lost in the bureaucracy (WRR, 2017)
 Even well-educated people with a high position can get lost in the Dutch (polder)
bureaucracy. The highest scientific board warns us that getting along with the Dutch
bureaucracy requests do-Intelligence. If do-intelligence is absent the consequences
might be severe. Effects might be high debts and other consequences, like losing ones
home.
17

18. Refugees: facts
 3% van the world population is immigrant and/ or refugee.
Untrue is the populist notion that mass immigration increases
(Professor Dr Hein de Haas, 2014)
 In particular entrepreneurs, middle social class and rich
people take advantage of immigration (Hein de Haas, 2014)
 In 2009 (Professor Dr Peter van der Heijden) estimates the
number of illegals in the Netherlands on 97.145, met a
confidence interval of 95%, in between 60.667 tot 133.624
 In 2014 SCP (Sociaal Cultureel Plan Bureau) estimates the
number of refugees in the Netherlands on 200.000 – 250.000
 In 2014 CBS (Central Bureau of Statistics) estimates the
number of asylum seekers in the Netherlands on 27.168
(corresponds with EU research)), in 2015 the number of
asylum seekers in the Netherlands was 59.000 persons
 CBS (2014): 25-33% van asylum seekers are accurately
leaving (w.o. to China, India en Irak)
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19. Conclusion part II
Definition problem: acute need of care or
confused people?
1. Are confused people “visible confused on the street and a task for the
police?”
2. Acute need of care = (in)visible in care (nursing houses, somatic- and
psychic care). Is the volunteer caregiver in charge?
3. Acute need of care = (in)visible at municipality-government offices. Who is
in charge?
4. Is acute need of care for immigrants and refugees (in)visible since care is
not cultural sensitive and conscious.
5. Is acute need of care for people with little do-intelligence (in)visible (WRR,
2017)
In the “Randstad” (almost 10 million people) the number of immigrants, refugees and expats
equals the indigenous people (Hajer, 2014)”.
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20. Part III: municipal solutions
 National Hurry-up Team (Landelijk aanjaag team) for
390 municipalities and regions: start 2015.
 National subsidy program ZonMw.
 Focus on safety and less on prevention (responsible
party is the national government).
 Connecting with Safety Homes or Municipal Health
Services (GGD) in regions and municipalities.
 Dealing with privacy issues and defining a electronic
client file (Safety Region Twente: software Sharing
Actual Knowledge (CO24 DAK) with specialized
telephonists and centralized reporting
room):https://www.youtube.com/watch?v=a3BBnnyt
mX0).
20

21. Outcomes after one year experimenting
(Final report, Doorpakken, 2016)
 Regions and municipalities are working hard.
 Providing services for people in need of care needs
many partners working together, not only welfare-
and health but also housing, agencies of
municipalities, police and public prosecutors.
 Confused people in need of care and their (extended)
families are still not-satisfied.
 The mismatch between the living world of confused
people in need of care and the bureaucratic system
world of the government is not yet solved.
 More attention is necessary for prevention and early
signalling. Improve implementation of early signals of
family, friends and neighbours.
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22. Part IV: working with
scenarios
Scenarios are carefully constructed photo’s of the future and how
the future might develop. Steps are:
1. Construct a genogram/ sociogram (with social and economic
relations in mother and fatherland.
2. Collect data (objective and subjective).
3. Use for the outcomes appealing names (like: disappearing in
illegality, the new entrepreneur). These are the names for the
scenarios
4. Appoint benefits and disadvantages of a scenario.
5. Chose with reasons one of the scenario’s.
6. Implement this scenario.
7. Evaluate the implementation of this scenario.
22

23. Applying working with a scenario
An example of a confused person in Taipei (see chapter 3 Protection of
Patients and their Rights and Interest, article 22)
23
Article 22 Patients’ personality and legitimate rights and interests shall be respected and protected, and may not be
discriminated against. For patients under stable conditions, it is not permitted to refuse their access to
schooling, examination, employment or implement any other unfair treatment for the reason that they ever
suffered from mental illnesses.
Objective data:
1. Yelling and screaming in the street
2. Man more than 45 years
3. Is not wearing shoes
4. Filthy and smells
Subjective data:
1. People in the street afraid
2. Females crying

24. Retrospect
How are you going to apply this
knowledge about confused visible
and invisible people in need of care
in Taiwan?
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