29 August 2016, The Netherlands

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29 August 2016, The Netherlands

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Article 12 ICESCR

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:

a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;

b) The improvement of all aspects of environmental and industrial hygiene;

c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;

d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

  1. Right to (Mental) Health of Children and Youth

In the Netherlands, in 2015 the new ‘Youth Act’ came into force.173 All forms of youth care including youth mental health care, were decentralized to municipal level. In a recent rapport, the Dutch Ombudsman for Children ascertains that the new Youth Act system does not function properly. The main reason is the fact that the quality of expertise from the youth care professionals is insufficient.174 The report of the Monitor Transition Youth – a coalition of various national organizations in youth care – concludes that in the offer of care to young people, choices are based on the availability of medical supplies and not based on what is needed in a particular case.175 Furthermore, many general practitioners are not sufficiently informed about the teams that are contracted by municipalities, resulting in a lack of cooperation.176 Parents complain about the lack of information about the procedures in youth care.177 Moreover, since the Youth Act came into force the waiting time for psychosocial child care and child psychiatry has increased considerably due to insufficient purchase of care by municipalities, lack of control at the level of the neighbourhood teams and/or bureaucracy.178 The Department of Child and Youth Psychiatry of the Dutch Association of Psychiatry confirms that an increasing number of parents to arrange and pay themselves for mental health care for their children as a result of long waiting lists.179 Thus, apart from compromising the quality of care, the latter problems indicate that the Youth Act impedes the availability and accessibility of care.180

Recommendation 38:

The submitting parties recommend the Committee to urge the Dutch Government to increase its attention to the status of (mental) health of youth and children, and in particular to:

  • monitor the compliance with norms in information protection in care by municipalities;

  • ensure adequate provision of information about the organization of and contracts with youth care on municipality level to all persons and organizations involved, and to promote cooperation between general practitioners and neighbourhood teams;

  • provide municipalities with sufficient means to invest in education and further training of youth care professionals;

  • introduce a quality register for youth care professionals;

  • develop policies that prevent and reduce waiting lists in youth care facilities.
  1. The Abolishment of Subsidies for Interpreter Services in Health Care

Per January 1, 2012, the Dutch Ministry of Health, Welfare and Sport (VWS) abolished subsidies for interpreter-translators in health care.181 The government’s main argument that was used to justify these cuts is that patients (or their representatives) are responsible for their own command of the Dutch language.182 The measure has a particularly negative impact on the accessibility of health care for refugees and migrants. While there is an interpreter service available in the reception centres for asylum seekers, refugees are denied the right to interpreter services as soon as they move to regular housing in a municipality.

The Royal Dutch Medical Association (KNMG) has indicated that healthcare providers encounter all kinds of problems due to the Ministry’s decision to abolish subsidy for these services, including delays of care if an interpreter still has to be called in a later stage, inaccurate translations by informal interpreters, differing quality of healthcare services (depending on whether a competent interpreter is present or not), and that health care providers are more inclined to send patients to a specialist who speaks the language of the patient instead of the specialist best qualified for their health care problems.183 In addition, experts and medical practitioners agree that female asylum seekers experience maternity complications up to four times more often than Dutch women,184 and while these complications can partly explained by other factors (e.g frequent moving around and costs and the (non) availability of pregnancy tests (and contraception) in asylum centres), problems with accessing interpretation services certainly adds to the problem.

It is very difficult to guarantee that patients give informed consent if they do not fully understand the information being given and cannot ask questions freely. Healthcare providers will often not be able to obtain people’s full medical history and give instructions without the help of a professional interpreter. Apart from that, the requirement that patients should pay for the costs of interpretation themselves is likely to restrict access to health care for those who are least able to pay such fees – including ethnic minorities and (undocumented) migrants. As these groups already experience inequalities in health (care), this will add to their burden. Therefore these groups have diminished access to health care.185

Recommendation 39:

The submitting parties recommend the Committee to urge the Dutch government to provide for interpreter in medical care, since a lack of interpreters fundamentally prevents access to adequate health care for the most vulnerable.

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  • Right to (Mental) Health of Children and Youth
  • The Abolishment of Subsidies for Interpreter Services in Health Care

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