This document provides an overview of the speaker's organization called 1nP, which aims to combine the benefits of private mental health practices and large institutional care. 1nP was founded in 2003 in response to client priorities for transparency, quality, influence over providers, and integrated multi-disciplinary care when needed. 1nP organizes private mental health professionals into a network to share standardized processes, language, and outcome measurement while maintaining a focus on the client's primary treatment process. This allows for seamless collaboration between professionals, quality control, and a supportive back office so clients can easily access high-quality personalized care.

1. It is both an honor and a challenge for me to speak to you today. Only 3 weeks ago I
received the invitation from your chairman, Ian Gargan, and his invitation surprised me.
What would I be able to tell you that would make it worthwhile for you? But you all know
Ian, and you know that he is quite persistent and persuasive. According to him, I should
talk about my organisation, 1nP, and the development that it has been through in the
last few years. I leave it up to you to decide if this is an interesting topic.
Let me first introduce myself a bit more: My name is Gerard van Kesteren. I am 52 years
old, a husband, and a father of 4. I started my working carreer as an elementary school
teacher, a job that I held for 7 years. In those 7 years, I went back to university to study
social studies in weekends and evenings as a part-time student. Following completion of
these studies, I started to work in the Mental Health field, and I combined this work with
study towards my Masters degree in Psychotherapy.
Until the beginning of the new millenium, I worked as a psychotherapist both in a large
organization and in a small private practice. In 2002 /2003 the frustrations from working
in the big, institutionalized organisation were starting to mount. I’ll take 2003 as the
starting point of my story of creating a vision of the future of Mental Health. In my
opinion, it is not possible to talk about the future without looking at the past.
Let me paint a picture of the situation in the Netherlands in 2003. At that time, a public
Health insurance system was providing coverage for all Health concerns, including
Mental Health, for all Nationals and residents. Mental Health was mainly provided in
two different ways.
First of all, there were the big
organisations with their
traditional management
systems: a CEO (chief
executive officer), a couple of
management layers and then
the passionate front line
mental health professionals
who, unfortunately, were
often hampered in their jobs
by organizational rules and
regulations. Management
goals were more focused on
the organisation than on the
clients they served and the
professionals who worked for
them.
These bigger organisations were often not very efficient, with lengthy waitlists and often
continuity in care provider. Because of the size of these instituations, it was often easy to
provide a 24/7 emergency service to deliver timely care to clients in crisis situations.

2. The other way of
providing Mental
Health services in
those days was
through numerous
private practices.
Psychiatrits,
psychotherapists and
clinical psychologists
were providing
Mental Health care in
these private
settings, but usually
these professionals
worked alone.
Each of these professionals could focus on his or her own specialty areas and could
provide individualized care with great dedication; they were able to be the “artisans” of
their trade.
Clients who completed treatment with mental health professionals in these private
practices usually reported high levels of satisfaction with the services they received.
We don’t know a lot about the clients who were not satisfied with their care; either
because of a bad match between provider and client, or perhaps the client needed more
support than was available.In this private practice set-up, care / help is often not
available 24/7.
If you would ask clients today what core qualities or wishes they have for professional
Mental Health services, they probably would name different things than in 2003.

3. When we started 1nP, we did research to
find out what was important to clients when
choosing Mental Health Service Provider.
We learned that:
a.. Clients would like some influence in
choosing their provider
b.. Care should be provided close to home
c.. Care should be of high quality
d.. Both the care process and outcome
should be transparent and, if neccesary,
multi disciplinary
We used these client priorities to critically reflect on the previously mentioned two ways
of providing Mental Health care. In so doing, we had to admit that, in 2003, both the
private practice and the institutionial Mental Health care systems were actually “black
boxes”.
Clients were sent by their GP (general practicioner) for Mental Health interventions, but
what happened in the treatment rooms was often unclear.There were no transparent
processes, no collection of experiences, and no collection of information about the
effectiveness of the provided care.

4. There was no information about succesful treatment in either of the models that would
inform best practices. In hindsight, one can say that there was probably no common
language to discuss succesful treatments or interventions.
Both models for providing Mental Health care had obvious good sides, but also
significant downsides. The power of private practice is closely related to the professional
and personal commitment of the health care porfessional. The weak link is its soloistic
nature and and the lack of continuity.
Institutionalized care at least has a bigger guarantee of continuity; there are some
control mechanisms in place and the possibility to hold the organization accountable if
an individual care provider is not functioning well. The distance between CEO / higher
management and the front line care provider is a clear downside.
Just imagine . . . could it be possible to combine the benefits of both models and at the
same time, eliminate the downsides? That challenge kept me busy in 2003 and resulted
in the founding of my organisation, the professional network organisation 1nP (in full:
first networkorganisation for Professionals in the field of treating mental health
outpatients; so, now you see why we prefer the short “1nP” instead).
To achieve this vision, it was neccesary to have a strict division between the
professional domain (the primary processes) and the organisational part.
The primary process is everything that the professional mental health provider could do
under his or her scope of practice. They bear full responsibility for choices they make
together with their clients, and they have to be able to justify these choices in front of
their professional peers.
To do so, mental health professionals need a uniform language. What information are
you collecting and how are you collecting it? Such knowledge allows transparency in
the processess, and also enables professionals to collect information regarding the
result of the intervention: is the treatment working? If all care providers are speaking the
same language, is it then possible to truly exchange information? And is it possible to
use computers and to automatize processes to assist with these goals? To exchange
information by computer it doesn’t matter anymore if your colleague is beside you in
person or in a different location. All the care provider should need to focus on is the
primary process.
The secondary processes are taken care of for them. Care providers do not influence
this part of the process—that’s the domain of “the organization.”
Would it be possible to join forces with a large group of professionals in private practice,
who provide high quality Mental Health services, in a way that the end result is more
than the total of its parts?
Let’s have a look now how the organization that I just described is working from the
perspective of a client. As a starting point, we’ll take the case of a client who is working
with a Mental Health professional in private practice who is very clear in describing his

5. professional strengths. Than we have a client who can make a treatment choice that is
compatible with him/her and Mental Health professionals who - when neccesary - from
different physical workspaces can collaborate with each other to support a client.
For the client it could be an enormous advantage when the treatment of one
professional seamlessly integrates with the other professional because both use the
same standardised information about the client. Quality control is possible through peer
reviews and standardized outcome measurement.
To ensure that the Mental
Health care provider can
focus totally on the primary
process, it’s improtant to
have a well organized back
office. This is the place
where clients can call for an
appointment with a
professional of their choice,
change appointments and
get answers to all kinds of
administative questions that
are not related to the primary
process.

6. The client makes an appointment with a mental Health care professional of his or her
choice. This professional interviews the client to get a better understanding of the
problems and asks the client to fill out standardized questionnaires.
The result of this first contact could be a transfer to a different professional, perhaps in a
different location; the transition of care to the new provider should be seamless because
everything is well documented and this documetation is easily accessible.
Such cooperation regardless of time and place would not be possible without a solid
computer network system. The power of this solution is in the solid documentation of the
primary process and the following secondary processes. Because of the size of the
model it is possible to differentiate taks and to have specialized employees for the more
administrative tasks. This will ensure a high level of quality for all neccesary processes.

7. We’re now in 2011 and in the last few years, 1nP has grown to an organization with
more than 600 professionals providing Mental Health care to more than 10,000 clients a
year. Our processes are very transparent, and the possibilty remains for the practisioner
to be accountable for the care provided. The core of the organization is still is the small
private practise, where clients feel very much at ease due to the quality care that is
provided with a personal touch. Around this private practise core is a layer of added
value, which provides the benefits of the bigger institutionalized care. This layer is the
organization who guaranntees quality, continutiy and 24/7 care.
Standards of the professional organisations are part of the working processes, and new
standards can be incorporated without delay. Compliance with professional standards is
high because of automized computer-based processes.
Our next step is to connect with our clients by means of smart phones to be able register
mental health problems when the arise and intervene in a timely and responsive
manner. But that is our developmental next step.
If this way of organizing mental health has some appeal to you, it is good to get an
understanding of the necessity to team up with all the players in this field. It asks from
the clients that they take responsibility for their own choices regarding whom to consult
and a high degree of willingness to give feedback about every part of their ongoing
process.
The professionals involved should be willing to collaborate with their peers in a highly
volatile fashion, to make a multi-disciplinary treatments as a taylor made suit for an
individual client. Therefore openness about their practice and way of working, a high
level of transparency is needed. Professionals will be held accountable for the sum total
of their actions, for each individual time and again (and there is nothing wrong with that).
For the insurancecompany there is a task to achieve a greater understanding of the
added value mental health professionals bring to the lives of clients. Spending money on
mental health is a very good investment with a ROI per Euro that is very high. Proper
mental health reduces spending on somatic treatments as well.

8. Last but not least there is a task for the government. There should be centralized license
registration and legal protection of professions allowed to work with the vulnerable group
of clients in need of mental health treatments. Furthermore, there should be a
meaningful investment in e-mentalhealth since the benefit for the society is evident but
the costs are simply to high for an individual or an institution to carry it by themselves.
The proper combination in joined action is my advise for your next step in creating the
future of mental health in Ireland. I would like to call it the shamrockapproach.
Adress at the Future of Mental Health,
September 14, 2011 Dublin
Drs. Gerard C.M. van Kesteren
Contact: g.vankesteren@1np.nl