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Annual Report 2010

Index

International 4Alcohol & drugs 6E-mental health 8Mild intellectual disabilities 10Mental Vitality 12Outstanding publications 14Suicide 16

Trimbos Institute named as WHO Collaborating Centre

In September, the World Health Organizationdesignated the Trimbos Institute as a WHOCollaborating Centre for the dissemination ofgood mental health practices. Such coopera-tive arrangements with selected organisationshave proven a cost-effective means for theWHO to achieve its strategic objectives at regional and global levels. They also enhancethe scientific validity of its work as well as theimpact and effectiveness of national- and regional-level institutions.

Economic modelling study for WHO The World Health Organization in Geneva commissioned the Trimbos Institute to conduct an economic modelling study to determine whether a sizeable expansion of nationwide e-mental health interventionscould improve the cost-effectiveness of alcoholprevention and treatment in the health caresystem. The conclusion was that wide-scaleimplementation of e-health interventionswould substantially boost return on invest-ment in terms of health gains – from just over 1 euro at present to 1.65 euros for every euro invested.

Healthy Nightlife Toolbox At the Club Health Conference on safe andhealthy nightlife, held at Zurich on 7-8 June,the Trimbos Institute launched the HealthyNightlife Toolbox (HNT). The HNT is an inter-national database that supplies information tohealth workers active in nightlife scenes abouteffective ways to improve health and safety foryoung people. The Trimbos Institute is projectleader for the Healthy Nightlife Toolbox and co-organiser of the Club Health Conference. For more information on the HNT, seewww.hnt-info.eu.

ICASA international network foundedThe launch of the website www.adhdandsubstanceabuse.org in early September also marked the official establish-ment of the ICASA Foundation – InternationalCollaboration on ADHD and Substance Abuse.

‘An important step forward for research onADHD and substance abuse’, declared ICASADirector Geurt van de Glind of the Trimbos Institute. ICASA is a network of more than 40 researchers from eleven EU countries, theUnited States, Australia, South Africa andBrazil. They have one shared aim: to reduce the onset of addiction in people with attentiondeficit hyperactivity disorder by improving detection, diagnosis and treatment of bothADHD and substance use disorders.

Drug prevention in BulgariaTrimbos worked with the Bulgarian organisa-tion Solidarnost from 2008 to late 2010 to setup a drugs and alcohol helpline. It provides information and advice via telephone, web-chat, a website and an online forum, as well as referral to professional help if needed. Recreational drug use and the associated problems are taboo in Bulgaria. Few servicesexist for drug users, and the possession or useof drugs is subject to heavy penalties, with nodistinction made between hard and soft drugs.This makes it difficult to discuss drugs andprovide help. The helpline is a low-threshold,strictly confidential service. It already plays akey role in the Bulgarian information, preven-tion, education and treatment services relatingto recreational drugs. For more information,see www.drugsinfo-bg.org/en.

International

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Call to raise drinking age to 18In May, the Trimbos Institute, together withthe association of community health servicesGGD Nederland and the Dutch Institute for Al-cohol Policy (STAP), urged Parliament to pro-hibit the sale of all types of alcoholic beveragesto people under 18. The appeal was promptedby an impending debate on a new Licensingand Catering Act. From 2003 to 2008, cases ofemergency treatment for alcohol poisoning in-creased by 280 per cent in adolescents aged 15to 19. There is conclusive research evidencethat setting an age limit of 18 is one of themost effective measures to combat healthdamage from youthful alcohol misuse.

New: Monitoring System for Drug-Related Emergencies (MDI)

Although GHB is not widely used, the numberof GHB health incidents is relatively high. Onefifth of all reported drug-related emergenciesinvolve GHB, including a higher-than-averagerate of serious poisonings. These are some notable findings from the Monitoring Systemfor Drug-Related Emergencies (MDI), launchedby Trimbos in 2009. It keeps records on the current nature and scale of health incidents involving recreational drugs in the Netherlands. Data is collected through a network of sentinel sites throughout the country, including hospital casualty depart-ments, ambulance services, police doctors andfirst-aid facilities at large events. The numberof sentinel sites was expanded in 2010. Themonitoring data are used to improve drug prevention and harm reduction.

Happy DrinksOne way to deter young people from drinkingis to provide tasty alternatives. The Dutch master chef and culinologist Pierre Wind wascommissioned by the Trimbos Institute to develop Happy Drinks. These cocktails withouta drop of alcohol, including the Battery (likeswallowing a battery) and Caipirinhee (with abuzz from sushi vinegar), caused a big splashin June at a school party at the Dalton Lyceumin Dordrecht. Happy Drinks are also promotedby the Nuchtere Fries (‘sober Frisians’)

initiative. That broadly based campaign, conducted by a range of organisations, waslaunched in April to raise youth awareness ofthe risks of excess drinking. Happy Drinks arenow advertised in Frisian bars and clubs as analternative to alcoholic beverages. The HappyDrinks initiative seeks to boost the image of alcohol-free drinks and their availability innightlife venues. In 2011, Happy Drinks will bepart of a campaign to build personal resiliencein young people, conducted by Trimbos in cooperation with STIVORO, the Dutch knowledge centre for tobacco control.

Alcohol & drugs

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Psychisch Gezien PanelAn advisory panel called Psychisch Gezien(‘psychologically regarded’), a large, broad-based nationwide group of and for people withmental health conditions, was initiated in early2010. The purpose is to better understand thelife situations, social functioning and serviceneeds of people with persisting mental healthdisorders and to give them a clearer voice inthe public debates on mental health care. Recruitment of panel members began in June2010 via the website www.psychischgezien.nland via mental health services. By December,700 people had joined the panel, rising to 800 in March 2011. The youngest member is 19 and the oldest 87. The Trimbos Institute coordinates the panel and works with thePhrenos Knowledge Centre, Landelijk PlatformGGz (the national alliance of client and familyorganisations in mental health) and theNetherlands Institute for Health Services Research (NIVEL). The Dutch Ministry of Healthprovided financial support in the initial year.

GPS and dementiaInformal carers of people with dementia areenthusiastic about a GPS system that enablesthem to trace the whereabouts of their lovedones via a secure website and to contact themby telephone. According to findings by theTrimbos Programme on Ageing, published inApril, 75 per cent of carers reported that theGPS system gives them a greater sense ofsafety, and 61 per cent that it allows the carerecipients more independence. The trackingtechnique still needs further refinement beforeit can be implemented on a broad scale. TheGPS system offers a variety of options. It sendscoordinates to the secure website, allowing thecarer to see where the person is located andthe route they followed to get there. The person with dementia can contact the carer by pressing a single button. The carer can alsophone the GPS system, activating a telephoneloudspeaker to make immediate contact without the care recipient having to answerthe phone.

Preventing relapse through Depressievrij.nl

Is online self-help an effective way to prevent relapse into depression? That is thecentral question in an evaluation study of www.depressievrij.nl conducted by the University of Groningen, the Trimbos Institute,the VU University Medical Centre and the Arkin Mental Health Service. Depressievrij(‘depression free’) is a web-based therapeuticintervention based on an empirically effectivegroup therapy model from the University ofGroningen. In cooperation with the Trimbos innovation programme Mental Vitality, thetherapy was adapted for online use. Users can perform it at home on their own time and at their own pace, receiving telephone oremail support from a therapist if needed. SMStext messages have proven to be one way to increase therapy adherence. Clients in the recovery phase of depression are sent two messages a month asking how they are doing.Their answers are plotted on a graph. This produces an overall view of their mood patterns and helps the therapist provide targeted feedback. Recurrence of depressivesymptoms can be detected more rapidly.

E-mental health

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Mild intellectual disabilities

People with mild intellectual disabilities (MID)have an elevated risk of mental disorders aswell as alcohol and drug problems. The TrimbosInstitute conducted a number of projects involving this group in 2010.

Mental health care to people with mild intellectual disabilities

A research report entitled Licht verstandelijkgehandicapten (LVG) in de GGZ (People withMild Intellectual Disabilities in Mental HealthCare), published by Trimbos in the autumn of2010, observed that a substantial number ofclients of mental health care services have mild learning disabilities. No reliable figuresare available, as generic mental health careagencies do not routinely screen or examinetheir clients for learning impairments. To improve services to this group, particularly in the generic sector, mental health careproviders need additional training to recogniseand work with people with mild learning disabilities. Research on the effectiveness of various therapeutic methods and carestrategies could further the development of evidence-based practices.

Alcohol and drug use by people with mild intellectual disabilities

Which adults with mild intellectual disabilitiesuse alcohol or drugs? How much do they useand what problems does it cause? These werequestions addressed by the Trimbos report entitled Middelengebruik bij volwassen met eenlichte verstandelijke beperking (Substance Useby Adults with Mild Learning Disabilities).Problem alcohol or drug use was estimated to occur in 10 to 30 per cent of the group inquestion. Most professionals specialising inmild learning disabilities were found to haveinsufficient knowledge of substance misuse;many professionals in other fields had too little knowledge of learning disabilities. Morecooperation between various sectors could ensure that adults with mild learning disabili-ties and substance use problems will receivethe services they need. Agencies for peoplewith mild intellectual disability can call on theOpen and Alert programme to enhance the expertise of their professionals as they develop

alcohol and drug policies. The programme hasbeen recognised by the Centre for Healthy Living (CGL), a knowledge centre of the National Institute for Public Health and the Environment (RIVM), as a ‘theoretically sound’lifestyle intervention suitable for the care ofpeople with mild intellectual disabilities.

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Launch of Mentaalvitaal.nl and Psyfit.nl

A mind gym, not a body gym. On 8 October,Trimbos launched a portal called Mental Vitality (www.mentaalvitaal.nl) that brings together a realm of information on mentalhealth. It is for everyone who wants to learnmore about mental health and become morementally fit. It provides information, exercisesand tips for mental fitness, online courses andtherapies, and referrals to other services. In thefirst quarter of 2011, some 77,000 visitors foundtheir way to the portal. Mental Vitality is ajoint project of the Trimbos Institute and theNetherlands Mental Health Fund.

www.psyfit.nl is one of the Trimbos interven-tions associated with Mental Vitality. It was officially launched in November 2010. Psyfit.nlis a web-based course that helps to boost mental fitness through exercises, tests andtips. People that take the course learn whatmental fitness is and how they can feel happierand more relaxed in life. The principles of Psyfit.nl also form the basis for a book entitledMental Fitness: Verbeter je mentale conditie(Mental Fitness: Improve Your State of Mind),also published in November. NTR Television(formerly Teleac) produced a four-part series,broadcast in November, which was derivedfrom the book and the website. It showed how people with everyday problems and stresssituations put the Mental Fitness principles to work. The website, the book and the TV series were all based on research in positivepsychology, cognitive-behavioural therapy,mindfulness and lifestyle recommendations.

Centre for Safe and Healthy Nightlife In November, the Trimbos Institute and theDutch Centre for Crime Prevention and Safety(CCV) set up the Centre for Safe and HealthyNightlife (CVGU). It is a collaborative venturedesigned to support local authorities in tackling problems in nightlife, from both asafety and a health promotion perspective.Such an integrated approach is now widelylacking. The new strategy is aimed at reducingviolence and nuisance, health emergenciesamong young people in nightlife, as well as the

high costs associated with these.Personality Disorders Knowledge CentreThe Personality Disorders Knowledge Centre(Kenniscentrum PS) was established in earlyDecember to promote research on personalitydisorders and to improve mental health services to people with these conditions. It is a collaborative arrangement between the Trimbos Institute, the Viersprong Centre of Psychotherapy, the forensic psychiatric observation hospital Pieter Baan Centre, andthe Altrecht Institute for Mental Health Care.The purpose is to bring together expertise from a range of agencies and universities, toactively facilitate practitioners in accessingthat knowledge, to generate research and toencourage service innovation.

Mastery over Dementia wins international award

Mastery over Dementia (www.dementiedebaas.nl), a website developed for informal carers of people withdementia, has received an international awardas ‘the most promising psychosocial inter-vention’. In March, Anne Margriet Pot, head ofthe Trimbos Programme on Ageing, acceptedthe award, partly on behalf of the GeriantFoundation and the Alzheimer NederlandFoundation, at the 25th annual InternationalAlzheimer Conference in Thessaloniki inGreece. The award jury, which included representatives of Alzheimer’s Disease International and the Fondation MédéricAlzheimer, said it was impressed by the aims,design and initial outcomes of Mastery over Dementia. The prize was used to develop an international demonstration video: www.masteryoverdementia.com.

Mental Vitality

Drinking Less – best researched online intervention worldwide

A report issued in May in the EffectivenessBank Alert singled out Drinking Less(www.minderdrinken.nl) as the world’s best researched online self-help intervention forproblem drinking. The report made an inter-national comparison of studies hitherto conducted on Drinking Less with studies onother e-health interventions for problem drinking. Drinking Less has now been includedthe international Effectiveness Bank database.The Trimbos Institute is working with theWorld Health Organization (WHO) to promoteworldwide dissemination of the programme.

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Outstanding publications

In 2010, Trimbos staff members authored or co-authored nearly 300 publications, as compared to over 200 the previous year. These ranged from peer-reviewed articles indistinguished Dutch and international journalsto research reports and doctoral theses. They also conducted some 300 presentations, training courses and lectures at home andabroad. For the complete literature list, see www.trimbos.nl/jaarverslag. We highlight here some of the outstanding publications.

Exercising may reduce mental health risks

People who exercise regularly are 50 per centless likely to develop mental disorders thanthose who do not, according to the firstNetherlands Mental Health Survey and Incidence Study (NEMESIS 1) conducted by theTrimbos Institute and commissioned by theNetherlands Ministry of Health, Welfare andSport (VWS). The first copy of this latest NEMESIS report entitled Sporten en psychischegezondheid (Exercise and Mental Health) waspresented to Health Minister Klink on 19 January. People who exercise were found lesslikely than others to have mental disorderssuch as depression, phobias, other anxiety disorders or alcohol dependency. They werealso less likely to develop first-onset depres-sion, phobia, other anxiety disorders or drugdependence.

NEMESIS 2: New statistics on mental health

Results from the second NEMESIS populationstudy have delivered new figures on the prevalence of mental illnesses in the Netherlands. One finding was that attentiondeficit hyperactivity disorder (ADHD) occurs in 2.9 per cent of the Dutch population inchildhood or early adolescence, persisting intoadulthood in 72 per cent of those in question.This second Netherlands Mental Health Surveyand Incidence Study (NEMESIS 2) is a represen-tative study of 6646 adults aged 18 to 64 in the Dutch general population. It was con-ducted by the Trimbos Institute with fundingfrom the Health Ministry (VWS). The new study

was presented to the Lower House of Parliament on 23 March. The first follow-up assessment began in November.

HBSC study: Dutch youth are doing well

Dutch adolescents feel good, rate their socialsituation as positive, and feel they are leadinga good life. Yet they still engage in many riskbehaviours, such as smoking, drinking and unhealthy eating. Those are some results from the nationwide Health Behaviour inSchool-Aged Children (HBSC) survey conductedamongst 11- to 16-year-olds. The accompanyingreport by Utrecht University, the Trimbos Institute and the Netherlands Institute for Social Research (SCP) was presented to theDutch Health Minister Schippers in December.In comparison with the 2001 and 2005 surveys,Dutch adolescents now reported slightly morehealthy eating habits, perceived their paternalrelationship as more positive and were subjectto less bullying at school; the younger age categories were drinking and smoking less.Once adolescents started drinking, they werequick to develop heavy drinking patterns.

TRIP board game for youth with mild intellectual disabilities

TRIP is a board game with pawns, dice andquestion cards. It has been produced by theTrimbos Institute and Brijder Addiction Care for use in alcohol and drug education to youngpeople with mild learning disabilities. Thequestions are divided into four categories:Knowledge (What do you know?), Skills (Whatwould you do?), Opinion (What do you think?)and Propositions (True or False). The game forthree to seven players can be played duringdrug and alcohol education sessions at school or in supported-living groups, led bya facilitator such as a health promotion workerfrom an addiction service.

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Suicide

Survivors’ study on 113-OnlineSurviving friends and relatives of a person who has committed suicide run a greater riskof becoming socially isolated, are more likelyto have health symptoms, and experience moredifficulties with bereavement than when lovedones die from other causes. To improve support to the survivors, the Trimbos Instituteis studying what benefits they may derive fromcontacting people in similar situations via theweb-based forum at www.113online.nl. Thewebsite is designed both for people who areconsidering suicide themselves and for theirloved ones or survivors. Survivors may turn tothe site for information about suicide and itsimpact on surviving friends and relatives andthey may take part in a web forum specificallyfocused on survivors’ peer support. The Trimbos study includes survivors aged 18 orolder who have lost a child, partner, parent orother close companion to suicide, either recently or in the past. The study began on 1 March 2010 and results are expected in 2011.

Regional strategies on suicide prevention

Wide regional differences exist in the Netherlands when it comes to suicide prevention. Research studies by the Trimbos Institute and the National Institute for PublicHealth and the Environment (RIVM) show thatthe greatest chance of success lies in jointstrategies involving the regional communityhealth service and mental health agencies,under close coordination of a local health authority. The study entitled Regionale aanpakvan suïcidepreventie: Een kader voor opzet envoorbeelden (Regional Strategies for SuicidePrevention: A Design Framework and Some Examples) focused on suicide prevention inAmsterdam, the region of West Friesland andthe province of Friesland. Some communityhealth service interventions that have provedviable are health surveys to identify at-riskgroups, public education campaigns, the training of teachers in the early detection ofmental health problems, skills training foryoung people, and support to vulnerable people such as surviving friends and relatives.

Improving care and aftercare to peoplewith suicidal behaviour

The Kwaliteitsdocument Ketenzorg bij suïcidaliteit (Quality Document on Continuityof Care in Suicidality) was published in July.Continuity of care is crucial for people with suicidal tendencies. Local and regional arrangements to ensure continuity are ofteninadequate. The quality document offers toolsand guidelines for improvement. Four types of health care providers at the local level encounter people who attempt or consider suicide: general practitioners, hospital casualtydepartments, acute and consultation psy-chiatric services, and generic communityhealth services. There is often a lack of clear-cut arrangements between such parties as towho is responsible for helping people with suicidal behaviour and when. Particular problems arise when clients must be trans-ferred from one health care provider or agencyto another. The quality document was createdby the Trimbos Institute and GGZ Nederland(the professional association of the mentalhealth and addiction sector), in cooperationwith the Dutch College of General Practitioners(NHG) and with financial support from theNetherlands Ministry of Health.