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Towards more appropriate care for patients on a waiting list for mental health care: a study on good practices to prevent and mitigate the risks of bridging care in general practices

Background and purpose

Despite many years of policy measures, mental health care waiting times remain long. We investigated the impact of mental health care waiting times on those waiting, their relatives, general practitioners (GPs) and general practice mental health professionals (GP-MHPs), and their experiences with support during the waiting period. We also compiled an overview of waiting time support initiatives. The aim was to contribute to better care for people with mental health problems, and lower workload in general practices.

Research design

This one-year cross-sectional study was conducted in 2024 in the Netherlands and consisted of: 

  1. desk research and literature scan
  2. questionnaires among 321 adults with experience with mental health care waiting times (in 2022 or later), 83 relatives, 127 GP-MHPs, 48 GPs and 9 other professionals
  3. (group) interviews with 7 experts from general practice care, mental health care, and patient organizations, 5 adults with experience with mental health care waiting times, 1 relative, 6 GP-MHPs and 2 GPs

The main limitation of the study was selection bias. Mainly higher-educated women (who were on a waiting list for specialized mental health care) participated.

Results

Mental health care waiting times had a significant, negative impact on those waiting, for example increasing mental health problems and a “wait modus”’, and on relatives, for example negative emotions. GP-MHPs and GPs also experienced a major impact, including increased workload and less accessible consultation hours. Almost half of those waiting used some form of support during the waiting period. They often received consultations within general practice, with mixed feelings. They appreciated the accessible emotional support, but also experienced a lack of expertise. There was a wide range of waiting-time support initiatives available outside general practices. Their aim was often to stabilize the situation of patients or to (already) work on recovery. Patients and professionals saw potential in these initiatives. Nevertheless, GP-MHPs and GPs did refer little patients to these initiatives, partly due to a lack of familiarity, but also to insufficient trust in their quality. Patients and professionals also worried about the suitability of waiting-time support in the case of complex problems. Furthermore, some types of waiting-time support had barriers in terms of accessibility, for example costs, the requirement of digital skills, or because people at risk for a mental health crisis were not allowed to participate.

Conclusions and implications

First of all, the findings endorse the urgency of adequately addressing mental health care waiting times. Within policy measures, people with complex problems should be given priority, because they face the longest waiting times, are presumably most at risk during the waiting period, and waiting-time support seems less accessible or appropriate for them. Moreover, a (long) waiting period for this group puts a lot of pressure on relatives and general practices. Apart from this, waiting-time support initiatives seem to have potential, because they: 

  1. can be valuable support for those waiting
  2. are in line with the current transition to look for solutions to mental health problems outside of the health care system
  3. contribute to the demedicalisation of mental health problems
  4. contribute to less pressure on general practices. GPs and GP-MHPs can help - especially less self-reliant - patients to navigate through the broad range of services. 

In order to do this, they need to be aware all the available services, and should get (provided with) more confidence in them. People with mental health problems may also need to adjust their expectations of what can be helpful, and be open to consider different possibilities. This asks for everyone to collaborate and navigate the road to recovery together, as well as for sustained efforts to reduce waiting times.

Recommendations

    • Continue to address the reduction of mental health care waiting times, and the improvement of accessibility of mental health care, especially for the groups of patients with complex problems and/or the fewest resources. Be aware that certain waiting-time support initiatives have barriers in terms of accessibility, for example for patients who are at risk for a mental health crisis. Some general practices do no longer offer waiting-time support to patients, as a matter of principle. Consider a system where referrals can be given (extra) urgency or priority. This is also something the Dutch General Practitioners Association (LHV) advocates.
    • Ensure that the attention, money and capacity devoted to waiting-time support is in proportion to the mental health care waiting time problem behind it. Since it is not completely clear (yet) what the added value is of waiting-time support initiatives, there is a risk of (too much) investment in waiting-time support that has not proven its impact yet. This may lead to inefficiencies in a health care system that is already facing scarcity. At the same time, waiting-time support seems to have potential, because they are in line with the current transition to look for solutions to mental health problems outside of the health care system.
    • Create preconditions for collaboration between general practices, mental health care, and social and informal care, and encourage a joint responsibility for patients during the waiting period. Consider developing a multidisciplinary guideline for professionals addressing waiting-time support.
    • Provide solutions for a centrally organized overview of available services, for example per region. It turns out to be very difficult for patients, relatives, general practice mental health professionals (GP-MHPs) and general practitioners (GPs) to get an up-to-date overview of all services providing support for mental health problems, and to “navigate” through the complex care system. Work towards an up-to-date (online) overview with providers and waiting list information, so that professionals can also refer to less known care providers with a shorter waiting time, and to other forms of support. An overview of all support options for mental health problems should also be easily accessible to patients. Develop policies that simplify navigating through the care system for patients (and professionals).
    • The results of this study call for further vision development on what ‘waiting-time support’ entails (including naming) and what everyone's role and responsibility in it is, also in relation to the current major transitions in the Dutch health care system.
    • Be aware that a “rejection” by a mental health care service, uncertainty about the duration of the waiting time, and having to wait for mental health cate treatment, in addition to an increase in mental health problems, can have a major psychological impact on patients, including the reaction of losing hope, going into ‘wait modus’, or losing trust in health care providers. Acknowledge and show understanding for this; at the same time, manage expectations. Explain to patients, for example, that all kinds of solutions and support can be helpful with (a large proportion of) mental health problems, not just mental health care treatment.
    • Be aware that the communication towards patients prior to or during the waiting period is important, It can activate and motivate patients, or on the contrary demotivate them (with the risk of a ‘waiting mode’ in patients). Towards patients, avoid using the term ‘waiting-time support’. For instance, use these alternatives: ‘exploring a wide range of solutions that can help with mental health problems’, ‘getting started’, ‘working on recovery’ or ‘preparing for mental health care treatment’. Inform patients that some mental health care institutions have support options available during the waiting period. Encourage patients (and relatives) to explore various options that may contribute to their recovery, while waiting for mental health care treatment. At least provide less self-reliant patients with some guidance.
    • Consider using a broad, person-centered intake method in general practices for patients with mental health or social problems. This could be a first step to refer patients more often to alternative forms of support, for example in social or informal care, also during a mental health waiting period. Examples of often-used models are the Spiderweb model, the 4Domains(4D) model, and the KOP model (Bos et al., 2025).
    • Do not always, by default, offer waiting-time support within general practice, but discuss and set a specific goal together with patients (and relatives).
    • Use Appendix C from the final report of this study (Magnée et al., 2025) for inspiration to explore to what forms of support the GP or GP-MHP can refer patients more often during a waiting period. A recently published guideline on lifestyle during the mental health waiting period (Coalition Lifestyle in Care, 2025) also offers advice and tips. Forms of support in settings outside the health care system, such as social or informal care, often lack scientific studies on their effectiveness, but sometimes practical or experiential knowledge can give trust in their quality.
    • Invest in collaboration with mental health care, social care, and informal care. A national guideline (Akwa GGZ, 2016) provides information on collaboration agreements between general practices and mental health care. However, the guideline is outdated; the revision will start in 2025. Since 2024, the GP-MHP receives four hours extra a week, to invest in collaboration. Better collaboration can lead to familiarity with all available services.
    • Be attentive to the relatives of patients with mental health problems, especially in the case of a long waiting time. They might be at risk for stress and burnout. If needed, offer relatives emotional support, and psycho-education on how to deal with (the individual with) the mental health problems. Provide relatives with options for self-support. The websites naasteninkracht.nl and naastentraining.nl provide information, tools and courses.
    • If the waiting time exceeds 14 weeks, ask your health insurer for mediation. The health insurer should help you to find another caregiver who can provide treatment faster.
    • Don't put all your hopes (only) on mental health care treatment. A broad range of support services is available in other settings. Other patients and relatives find these valuable and helpful (also during the waiting period).
    • Navigating through the mental health care system can be complex. You can make use of support from patient organizations, an independent client supporter, or a healthcare provider.
    • As a relative, if needed, seek support during the mental health waiting period for yourself, for example through the websites naasteninkracht.nl and naastentraining.nl, or at your general practice.
    • Communicate about (the benefits of) your initiative to general practices, mental health care institutions and patient associations. For example, publish in professional journals (preferably in collaboration with the relevant professional group), offer presentations or trainings to health care professionals, or participate in collaboration networks. 
    • Communicate regularly with waiting patients, relatives, and general practices about the expected duration of the waiting time.
    • Provide a quick intake after referral and form a plan of action together with patients and relatives; ideally also provide a plan regarding the waiting period.
    • Use Appendix C from the final report of this study (Magnée et al., 2025) to explore to what forms of support mental health professionals can refer patients to or provide them with during the waiting period.
    • Collaborate with general practices and other domains, also regarding waiting-time support. Be available for consultation by the GP or GP-MHP, especially during any waiting period. Locally, formal agreements can be made on consultative psychiatry.

Quick links

  • General practitioner care
  • Primary care
  • Mental health
  • Right care in the right place
  • Organisation of care
  • Appropriate care
  • Waiting times in municipal mental health services

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