Navigating the Dutch Psychiatric Referral System: A Guide for U.S. Expats

In the Netherlands, the processes involved in accessing mental‐health care—including psychiatry—works quite differently than in the U.S. Most notably, you cannot simply call a psychiatrist’s office and schedule an appointment on your own. Instead, the huisarts (general practitioner or GP) serves as the gatekeeper. Below is a step‐by‐step overview that should help you, as a U.S. newcomer, understand how to navigate psychiatric referrals in Dutch practice.

1. Why You Need a GP (Huisarts) First

- U.S. approach: In the States, many people search online for a psychiatrist or therapist, call the office directly, and schedule a first visit.

- Dutch approach: In the Netherlands, everyone—expats included—must register with a local huisarts in their neighborhood. This GP handles all initial medical (and most mental‐health) concerns. You cannot go straight to a psychiatrist or mental‐health clinic without a referral.

Why it exists:

1. The huisarts is trained to do a broad initial assessment (medical history, meds, etc.).

2. By triaging through the huisarts, the system can direct you to the appropriate level of mental‐health care (e.g., a primary‐care psychologist, a specialist psychiatrist, or even a crisis team) and keep costs manageable.

3. Basic GP visits (and often basic mental‐health screening) are fully covered by your Dutch basic insurance (basisverzekering), subject to your annual deductible (eigen risico).

2. Registering with a Huisarts

1. Find a huisarts in your municipality. (You can search “huisarts + [your neighborhood] + English” to locate English‐speaking practices.)

2. Enroll by providing:

   - Your BSN (citizen service number)

   - Proof of address (rental contract or lease)

   - A copy of your health‐insurance card (zorgpas) once it arrives

3. The huisarts practice will usually give you an ID card or number for booking appointments.

Key point: Until you’re registered, you cannot proceed to mental‐health services (except in an emergency—see Section 6).

3. Discussing Mental‐Health Concerns with Your Huisarts

1. Book a regular appointment—typically 10 minutes. If you suspect you need more time, ask for a “double consult” (tien minuten is short; you can request twenty).

2. During your visit, describe your symptoms:

   - Sleep or appetite changes

   - Mood swings or persistent low mood

   - Anxiety attacks, concentration problems

   - Any thoughts of self‐harm or hopelessness (urgent concerns)

3. The huisarts may:

   - Do a quick physical exam (blood pressure, general health)

   - Screen you with brief questionnaires (e.g., PHQ‐9 for depression, GAD‐7 for anxiety)

   - Rule out medical causes (e.g., thyroid issues)

   - Offer immediate advice (basic coping strategies, a short prescription of a mild antidepressant/anxiolytic)

   - Determine the level of care you need:

     - Eerstelijnspsycholoog (first‐line psychologist or “POH‐GGZ”—a mental‐health professional embedded in primary care)

     - Specialized GGZ (secondary or tertiary psychiatric care for more complex or severe conditions)

4. First‐Line (Eerstelijns) Mental‐Health Care

If your huisarts judges that you have mild to moderate depression, anxiety, or another common mental‐health issue, you will likely be referred to a POH‐GGZ (Praktijkondersteuner Huisarts–Geestelijke Gezondheidszorg). This is a mental‐health worker attached to the GP practice.

- What they do:

  - Short‐term counseling (often 4–8 sessions)

  - Cognitive‐Behavioral Therapy (CBT) exercises, basic psychoeducation

  - Monitoring medication if prescribed by huisarts

  - Helping you develop coping techniques

- How to proceed:

  1. Your huisarts fax‐submits a referral (“verwijzing”) to the POH‐GGZ in the same practice.

  2. You receive a call within 1–2 weeks to schedule an intake with the POH‐GGZ.

  3. There is no extra insurance approval needed: this is covered by your basic policy (after eigen risico) as part of primary care.

- Typical wait time: 1–3 weeks for an intake; total program length varies by region, but many expats finish within 2–3 months.

5. Specialized Psychiatric Care (Tweede‐ and Derdelijns GGZ)

If your huisarts or the POH‐GGZ determines that you need more intensive support—because of severe depression, bipolar disorder, psychosis, or complex trauma—you will be referred to a specialist GGZ instelling. There are two levels:

1. Tweedelijns GGZ (secondary care):

   - Conducted by community mental‐health teams or outpatient clinics (e.g., local “GGZ” centers).

   - Staffed by psychiatrists, clinical psychologists, and specialized nurses.

   - Offers diagnostics (psychodiagnostic assessments), medication management, and longer‐term psychotherapy.

   - Wait times can vary: average is 4–8 weeks for an initial intake; urgent referrals may be seen within days.

2. Derdelijns GGZ (tertiary care):

   - Reserved for the most complex cases (e.g., inpatient hospital stays, secure psychiatric wards, specialized eating‐disorder programs).

   - Requires a formal “AVG—Assessment for Geestelijke Gezondheidszorg” (extensive report from GP/POH and any prior specialists).

   - Wait times are longer (2–3 months in some regions), unless urgent (in which case you may go through a crisis team).

Referral process:

- Your huisarts submits a formal “verwijzing” to a chosen GGZ provider (you can often select among a few local centers).

- That provider reviews your file, then contacts you to schedule an intake diagnostic.

- If approved, subsequent appointments (therapy, medication‐check, day treatment) are scheduled—often behind a “zorgtoewijzing” (regional allocation), which determines what care level you receive and how quickly.

6. Emergencies & Urgent Care

- If you feel an immediate risk to yourself or others (suicidal thoughts, psychotic symptoms), you do NOT need a referral; you can go directly to:

  - 112 (Dutch emergency number) for life‐threatening crises

  - GGZ Crisisdienst (regional psychiatric crisis service) by phone (e.g., in Amsterdam, call 0800‐1540 for psychiatric emergencies)

- The crisis team can send mobile mental‐health workers to your home, or direct you to the nearest Emergency Department that has a psychiatric intake (“Spoedeisende Psychiatrie”).

7. Cost & Insurance Considerations

- Basisverzekering (basic insurance): Covers GP visits, POH‐GGZ sessions, and most secondary psychiatric care—after you pay your annual eigen risico of €385.

- Eigen risico example: If your POH‐GGZ charges €100/session and you have four sessions, you pay the first €385 total for any combination of GP, medication, lab tests, or therapy. After that deductible is met, sessions are covered at 100%.

- Supplementary insurance (aanvullende verzekering):

  - Sometimes offers extra mental‐health benefits (e.g., more sessions per year, broader therapy options, alternative therapies).

  - If you know you’ll need psychiatric care—for instance, ongoing psychotherapy—you might purchase a basic “tandarts+” or “alternatieve” aanvullend plan that includes more POH‐GGZ or psychologist coverage.

8. How This Differs from the U.S. Model

Self‐referral | US: Can call/Google a psychiatrist or therapist | NL: Must go through huisarts for any mental‐health referral

GP (Huisarts) Role | US: Often optional | NL: Mandatory gatekeeper for all non‐crisis mental‐health care

First‐Line Care | US: Direct access to some community counselors and clinics | NL: POH‐GGZ embedded in GP practice (no extra referral)

Insurance Process | US: Varied plans, sometimes pre‐authorization required  | NL: Basic insurance covers GP, POH‐GGZ, GGZ (after eigen risico)

Outpatient Psychiatrists | US: Many private practices, direct scheduling | NL: Employed by GGZ instellingen; only via formal GP referral

Emergency Access   | US: ED/911 or private crisis hotlines (e.g., 988) | NL: 112 or regional GGZ crisis number—no referral needed

9. Practical Tips for U.S. Expats in the Netherlands

1. Find an English‐Friendly Huisarts: Use expat forums or the NL huisarts locator (huisarts.nl); many practices list language capabilities.

2. Prepare for Short Appointments: Book a double visit (20 minutes) if you know mental health is your primary concern—otherwise, basic physical issues may steal the limited time.

3. Ask About POH‐GGZ Services: After describing your symptoms, explicitly ask, “Is it possible to see the practice mental‐health counselor (POH‐GGZ) here?” It’s part of your basic insurance package.

4. Research GGZ Providers Early: If you suspect you may need specialized care, start looking up local GGZ instellingen (Geestelijke Gezondheidszorg centers) in your region (e.g., Arkin in Amsterdam, GGZ Rivierduinen in South Holland) so you have options when you receive a referral.

5. Consider an Aanvullende Polis: If you prefer more therapy sessions or want direct psychologist access, a supplementary insurance plan can reduce your out‐of‐pocket costs once your eigen risico is met.

6. Keep Records & Translations: Bring any U.S. psychiatric history (diagnoses, medication lists) with you. Having an English summary helps your huisarts and speeds up the referral process.

7. Crisis Planning: Save the national psychiatric crisis number (0800‐1540) or your regional alternative in your phone.

RJ Pesigan is the founder and owner of Cornerstone Health, created to address the multifaceted healthcare needs of expats in the Netherlands. Trained in Internal Medicine and Sport & Exercise Medicine, RJ has worked in both resource-limited and advanced clinical environments—from busy hospital wards treating critically ill patients to performance-focused sports clinics guiding athletes to peak health. Through Cornerstone Health, RJ leverages clinical expertise and real-world expat insight to help families and professionals navigate the Dutch healthcare system with confidence, clarity, and peace of mind.