Dutch municipalities to receive 1.3 billion extra euros for youth care

Dutch municipalities will receive 1.3 billion additional euros next year to improve youth services under an agreement reached with the national government. The support will augment the 300 million euros already promised for 2022 to address budget shortfalls. As a condition of the additional funding, the municipalities agreed to decrease spending on youth services by 200 million euros in the coming year by implementing additional cost-saving measures. Still, until 2028, municipalities will continue to spend more than the 3.5 billion euros allocated to youth services by the national government. The accord resolves a longstanding disagreement between the national government and the municipalities over the reimbursement of funds spent on the provision of youth services.

A mediation committee headed by Richard van Zwol was appointed to resolve the dispute after discussions between the national government and the municipalities over the funding had reached an impasse. The municipalities sought repayment of the extra 1.7 billion euros they had spent since 2015, when local entities took over responsibility for youth services from the national government.

Costs for youth services have been steadily rising since 2005. Expenditures increased by 250 percent between 2005 and 2015, ultimately reaching 3.75 billion euros. Under the assumption that municipalities would be able to provide services more cost-effectively, local authorities assumed responsibility for the delivery of youth services in 2015, and the budget was reduced by 425 million euros. However, the allocated funding quickly proved insufficient. Average spending on youth services reached 12,000 euros per child in 2019, with a great deal of variation between municipalities. Some communities spent upwards of 24,000 euros per individual, others approximately 8000 euros.

The committee found that the youth care budget should be increased by 1.9 billion euros in 2022 and 1.6 billion euros in 2023 and 2024. According to the committee’s plan, that total would be gradually reduced to 800 million by 2028. Although the municipalities will receive less than the 1.9 billion euros suggested by the committee, Jan van Zanen, head of the Vereniging van Gemeenten (VNG), thinks the agreement is faithful to the mediators’ guidance.

Before the promise of reimbursement, many municipalities faced the specter of being forced to close other public facilities such as libraries and swimming pools, just so they could pay for youth services. The additional funding has provided a bit of breathing room. “Municipalities now have clarity for 2022. That provides relief,” says Van Zanen.

Treatment providers, however, while encouraged by the additional funds, argue the delivery of high-quality care will require a complete reorganization. “There is certainly a lot of money needed to keep the youth care services afloat, but most of all, it has to be different,” suggest Elnathan Prinsen and Arne Popma of the Dutch Psychiatric Association (NVvP). They argue that urgent and specialist youth mental health services should be organized and funded regionally instead of by municipalities.

So far, the municipalities’ plans to save money by the decentralization of 2015, which aimed to focus on prevention of mental health issues, failed spectacularly, resulting in high demand for intensive interventions and uncontrolled costs. Waiting times increased and the quality of care declined as a result of the reorganization and austerity measures implemented by municipalities. Many children in need of urgent, specialist or intensive mental and social care faced extended waiting periods, often up to a year, for their treatment. In addition, many patients experienced treatment disruptions due to budget issues, a high turnover of staff leading to chaotic provision, and a lack of appropriately trained caregivers. Measures designed to reduce costs effectively drove some facilities into bankruptcy, reducing the number of available treatment providers.

Both the municipalities and the cabinet agree on the importance of lowering costs and shortening waiting periods — goals that will require structural changes. A decision regarding the future funding and structure of youth services has not yet been made. “A new cabinet will have to decide about the structural finances and necessary adjustments to the youth care policy,” suggests Paul Blokhuis, outgoing Minister of Public Health, Welfare and Sport.

Written by Lorre Luther