Some might see me as blessed, living in the Netherlands, where health care is taken care of, where sickness is allowed and where there is always something to fall back on. A country in which people’s needs are met, and where we get the care we need. A country in which everyone is insured for everything, making everything accessible for everyone, a country in which we don’t have to worry about loosing our job or having an untreated disease. The truth however, is that things aren’t as perfect as they seem, and getting the help you need when your problem in non physical is even harder than the problem you are already going through.
It has been about a year since I broke down, a year since I had to admit that I was not ok and that I needed help to change my life. A long year, that started with pain, with endless crying, with exhaustion and extreme anger. But in this year I’ve learned a lot, I have learned to work on improving myself, learned that I deserve to be better, that I deserve some joy and love in my life. I learned that life can be good for me, should be good for me even, that old wounds no longer have to cover my current life in darkness, and the time has come for me to really start living. Although this past year only brought me to this realization, and real change is yet to come, I started to feel better, and be better. I started to figure out what life could be like for me, and this felt great! Until yesterday, when laws and money brought me back to where I was exactly one year ago.
Yesterday, for the first time in months, I was overwhelmed with anger and tears. I couldn’t think straight, I was crying, yelling and throwing things around the house. I felt out of control, or actually, I felt so many emotions that I didn’t know what to do any more, they took over. Exactly what happened to me a year ago, and this scared me, because I believed I had passed this stage of my breakdown long ago. I did not imagine I would end up there again. Fortunately this year, one night of sleep is enough to take back control, instead of the months I needed last time, I did change, I did improve! And to be honest, realizing this made me even more angry right now.
So what happened yesterday? That is the long story I would like to share with you, because it’s more than just about yesterday, it is about a whole year of being pushed around in the Dutch health care system, it is about Dutch laws, that hurt the most vulnerable people, it is about the anger that has been building up while I was trying to find help with what I’m going through this year. It is about rules, laws and money, that push me and keep me back, it is about a system that generalizes everything and prevents really helping each person with what they need, off course to earn money, or to not lose any of it.
A year ago I broke down at a grocery store during my lunch break, while I couldn’t decide which soup to eat for lunch. I talked to my boss, crying, I talked to HR and I was sent home, to wait for the appointment with my GP I had made earlier that day, because something was really wrong with me.
I asked for help, but real help did not came until a month ago. My GP send me to one psychologist, a month of waiting, this one told me during the first call that she couldn’t help me, I was too complicated and I needed a better help. So I waited an other month, and thought, this is when it’s finally going to happen. But no. I got a psychologist that couldn’t help me the way I needed. I’m not saying she was useless, I did learn some things that made me get through my days, but whenever we came to a topic that was about my real problems, she would say “this will be part of your next therapy”. As a result I wasted 3 months with a psychologist that could not talk about my problems, but at least I left with a referral that would get me the therapy I needed, so I thought.
Now this is the time when money started to get in the picture. I wasted two months on waiting, and another three on a useless therapy, but I believed that month number five would be the one, the month that I would get my help. However, after the last talk with this psychologist, all my hope was gone, I needed to wait another two months. Why? Money! In the Netherlands, if a psychologist makes a diagnosis, and threats you for this diagnosis, they can be fined if there is another diagnosis within two months after this therapy. Basically because this would mean that they made a mistake, that they wasted money on a therapy for a wrong diagnosis. So, my psychologist knew she did not diagnose me properly, she knew she did not threat me for the right things, she know that another psychologist that would be able to help me, would make a different diagnosis and she would have to pay. And because she knew, she would only give me the referral I needed in month number seven.
Now I started to uncover another almost funny money thing, the fight between the GP and the psychologists. So what happens here in the Netherlands? The psychologist only accept referrals from a GP, while the GP will not write this referral without having one from a psychologist. My next psychologist was working in the same company as the previous one, but I had to go through the GP to be able to start a new therapy. My GP however, doesn’t agree to this, since this detour makes him responsible to potential money loss if it turns out I do not need the therapy or something. So the GP does not want to write the referral, while the psychologist does not accept the referral from theirselves, they both don’t want to be to blame if something goes wrong and they will get a fine for giving me the wrong treatment or something.
It’s a terrible system, and the worst is, this affects the most vulnerable people amongst us. I was able to make five angry phone calls to get the referral I needed, however, even these small phone calls that seem like nothing, caused me days of energy, it fucked up my mindset, it set back my recovery, and before every phone call I was about to give up, to just go back to the terrible life I used to have, the broken version of myself, the pain that I had been living with for decades. I was strong enough to fight for myself, but if this would have happened just a month earlier I would not have had the strength to do so, and this makes me wonder how many people in the Netherlands did not get the help they need because of this stupid money fight? How many people will never be able to fight for themselves because the system needs them to fight before they can start learning how to? It makes me angry!
But to get back to my story, month number seven has started, I won my fight and I feel like someone will finally help me. For about two months, I spend my afternoons filling in questionnaires, about how I feel, how I react, how I think, how I was, how I am.. Many endless online lists with difficult questions would keep me busy for hours end every session with my psychologist she would sit behind her computer screen and tell the many problems that showed up in my answers. I believed this was needed for her to make a diagnosis, I believed these lists would make her able to help me, I believed that these first months would create the solid base we needed to help me. But then came the end of these lists, and when I expected a diagnosis and a treatment plan, my psychologist however, had completely different news. “Your problems are complex, and I only have eight sessions with you, which means there are just three left after this. I can not help you and will have to send you to another psychologist.”
I broke. Again two months of nothing, again no help. I left without a diagnosis and a lists of psychologists that might be able to help me. And the worst thing, I’m sure that the previous psychologist knew I was a complicated case, knew I was going to need more than the eight sessions she signed me up for. Even during my first therapy I was told I needed intense and long therapy, I was told I was a complex case that needed time, however, if she would have send me to someone that could have truly helped me, her company would not have gotten the money. Which they need desperately.
Month number nine. November. The month in which I was confronted with yet another money rule in the Netherlands. Mental health care is covered by the insurance companies, but only when you are starting it early in the year. Mental health care gets a budget from the insurance companies, based on the amount of clients this insurance company expects the psychologists to have. However, every year, this budget is insufficient, they never calculate enough money, never! So what happens in the Netherlands is that every psychologist is unable accept new clients after October or November, simply because the health insurances don’t pay them anymore, while paying an intense therapy like this yourself is impossible. I did some math to give you an idea about why I’m bound to my health insurance, a consult is about 110 euro’s per 45 minutes, I’ll have to go to therapy weekly for two years which makes a total of 11.440 euro’s! Monthly I would have to pay 440 euro’s, if I add the costs of my health insure to this number, it’s the same as what I’m paying for rent each month, while my salary is not much more than double my rent!
October, November and December are months in which it is almost impossible to start a therapy in the Netherlands, we all have to wait till new money comes, however, this doesn’t mean that people don’t sign up for therapy during these months, meaning that the waiting lists that already exist just start building up. When I called the different psychologists in November, they told me I would have to wait till March, April or May before I could start, an average of five months, after already waiting for nine! The system is fucked up!
To make things even worse, November was also the month in which my company got impatient, blaming me for not getting proper treatment, for not getting the help I needed to get back to work. Imagine not being in your right state of mind, being send back and forth between psychologists and the GP, having to fight to even get on a waiting list, and someone then telling you it’s taking too long and you have to hurry up. It made me furious! I was doing my best but the system seemed to fail me, and instead of help or compassion, I got the blame, because, again, money, because me being sick costs them money, or will cost them money, but more on that later.
How did I solve this? I could not pay for private treatment nor could I wait again for months, I felt trapped. Luckily I found one psychologist which was not on the list and half an hour cycling from where I live but that is as much against our health care system as I am. They don’t agree to health insurance companies that give them a budget that is too low, they fight for enough money, they fight against the system as much as they can and try to do everything they can to truly treat there patients and break free from all the rules and fines that usually define mental health care in the Netherlands. They don’t sign contracts with a health insurances that they know will not give them enough money, and although this means that no big health insurance company will sign a contract with them, they choose patient care over quantity of patients. They believe, as one of the very few, what I believe in, and because they believe this, I could start my therapy in after just one month, January, because it took me month to find this rare company.
I felt positive psychologist would help me, I changed my health insurance, I repaired my city bike, I made another five angry phone calls, I fought another fight between my GP and psychologist, and I was ready to finally start. And even from the first consult I knew that this would get me the help I need. Relieve.
Now it’s almost time to talk about what happened yesterday, time to talk about yet another money thing that will be able to ruin my recovery, one more rule that will be able to make me loose everything because I’m trying to find myself. The first nine months of being sick I did not work, but from November I slowly started again. The beginning was difficult but after a while I found the love I used to have for my work again. In the past four months I went from being completely exhausted after two hours of work, to fully enjoying the 24 I will be working this week. I found my passion for architecture again, and increasing the time I spend at work actually helped me to feel better the past months. I feel more confident, I gain energy from drawing and designing the buildings I’m working on, I enjoy talking to my colleagues, I learn to listen to my body, I learn to express my needs, to show my emotions. I’m improving, a lot, because I do the job I love.
In the Netherlands, there is a rule saying that when you’re sick, the first two years your employer will pay you, as long as you both work on getting better. Fine. But apparently there is more than just this two year rule, apparently there is a one year rule that they forgot to tell me about. I have been sick for a year, and this means, on paper, that I have become a risk for long term sickness. As an employee you have two years to get better, however, after a year everyone will get stressed, again because of money.
Here is how the system works: Once an employee is sick for two years, he or she has to apply for unemployment benefits with a company, called UWV, payed by the government, a government that prefers not to spend too much money on these benefits. This UWV will try to reduce their costs by making the employer pay part of the benefits, and to be able to do this, they made a long list of rules to follow during a long sickness, a list. The main idea of these rules is to do everything possible to make a sick employee work again, as fast as possible. The first year no one really cares, there is a monthly talk with a doctor from the company that will decide if you have to work and how many hours are suitable, but in general everything is fine, you’re sick and there still is time plenty of time before benefits have to be discussed. There is time to heal.
But then the end of the first year arrives, and the employer is just one year away from potential money loss. Rules need to be followed, and they get scared of the risk. At this one year point, you’re simply abruptly out of time, something they never tell you about before. There is a rule that says that for the employer to not have to pay part of the benefits after two years, they should have tried to:
1. Help you to get back to your old job.
2. Give you an adjusted job within your own company.
3. Help you with finding another job, starting within the first 52 weeks of sickness
I understand these rules, they basically say, do whatever you can to make your employee work again. Help in every way possible. I understand where the rule comes from, if a truck driver get’s sick because of an accident in which he got paralyzed, it is not enough to wait two years for this man to get back into his truck again. It makes sense that for these cases, cases in which it is clear that the employee will not be able to return to his or her old job, the employer should help to find a new and more suitable job, whether or not in another company. But here comes the thing that makes me angry, I am probably more capable of doing my own job than I will be to do any other one. My work as an architect helps me recovering, it gives me energy and makes me feel good, besides, there is no link between my sickness and my job, they don’t relate. I’m perfectly capable of doing step number 1 with just a bit more time, however, today, step number three needs to be started.
Yesterday I had a talk with an “Occupational Health Assessor”, a talk part of the rules to follow when you’re an employer afraid of money loss. This woman, which I have never seen before and will never see again in my life, is hired by my employer to cross one item of the UWV checklist. Her task is to determine if I am capable of doing my job, and even from her professional opinion, I am. As she said: “Your job helps you to recover, it is good for you, none of your problems prevent you from doing your job, and you will in the future be fully capable of doing what you used to do one year ago.” But then she asked me one question, can you work full time in two months? And me doubting about this answer was enough for her to force me to start looking for another job! And to make things even worse, she even told me that if I wan to learn from my therapy, if I want to take the time I need to heal myself, it will be too great of a risk for my employer to not start with the next step on the UWV checklist. And a risk for everyone because if UWV decides my employer did wrong, they can sue their doctor that he did wrong, and he can sue this woman, that she did wrong.
Fucking money! Everyone is protecting his or herself, everyone is afraid to get the blame, and so they choose to force some stupid rule on to me instead of choosing what is best for me. I’m trapped and whenever I try to talk to one of these parties involved, they will blame it on the other. They all say, it’s a bad thing for you, this shouldn’t happen, you should get some extra time to keep growing back into your job, but they all say this, so what should I do? Who can give me some extra time? Who should I fight? Who dares to listen to my story instead of being frightened by the rules? Who will truly support me in this fight without turning on me when money might enter the picture? Who sees the importance of my work and my therapy for my improvement? Who is brave enough to acknowledge that I am right where I should be, brave enough to have trust?
I’m trapped. But I will keep fighting!