Navigating Ethics and Legal Frameworks in Dutch Healthcare

No matter how many years of experience you have in the field of mental health, (re-) starting your career in a new country is always challenging. PsyGlobal wants to guide you in this challenging process, to make sure your landing is as soft as possible. One important part of this challenging process, is understanding ethics and legal frameworks that we use in the Netherlands. Here’s an overview of the most important principles.

Legal Frameworks

1. Wet BIG 

The law on Healthcare Professions regulates healthcare professions to ensure client safety and quality care. It sets training and qualification standards and outlines disciplinary measures for misconduct (such as removal from the register in cases of severe violations). The law is only applicable for protected titles in healthcare: GZ-psycholoog (healthcare psychologist) and psychotherapist. Only professionals that meet the required education and training standards can call themselves GZ-psycholoog or psychotherapist. These professionals are listed in the BIG- register and are being held to very high standards. It is also only these profession that are eligible for insurance reimbursement.

2. AVG (General Data Protection Regulation)

This is a European law that protects patient information and ensures their privacy is respected.

3. Wkkgz

The Quality of Medical Care, Complaints, and Disputes Act requires healthcare professionals to have a complaints system available. Patients can turn to this complaints system if they are unhappy with the care they receive. Also, the law requires healthcare professionals to have an independent Disputes Committee in place.

4.WGBO 

The Medical Treatment Contract Act explains that the relationship between a client and therapist is a contract and protects the rights of the client.

Informed Consent: Clients must agree to their treatment plan. This is called shared decision-making.

Privacy: Everything discussed with a client must be kept confidential, with only a few exceptions. It also requires implementing specific administrative processes to ensure information security (secure systems for storing and sharing client information and adhering to privacy laws like GDPR).

Ending Treatment: Both the patient and the therapist can end the treatment. However, therapists need a significant reason to end the contract

Ethical Guidelines

Ethics go hand-in-hand with legal requirements. Healthcare professionals working in the Netherlands are encouraged to follow the ethical guidelines provided by the NIP (the Dutch institute for Psychologists). The complete ‘Code of Professional Ethics’ can be found here.

This Code of Professional Ethics describes the ethical principles and rules that psychologists observe when practising their profession.It serves as a guide or ethical compass for psychologists in their professional conduct and is structured around the concepts of: Responsibility, Integrity, Respect, Expertise

A few important outtakes:

Document Everything (Wie schrijft die blijft): Document everything you discuss with your client as well as your own considerations. For example, if a client threatens to kill someone, you have to assess what the chances are that he will actually do that. Write down your assessment of the situation, why you did or did not consider this a risk. If for some reason you have to defend yourself later, and you can show that you have carefully considered your decision, you can never be held responsible.

Confidentiality and Risk of Harm: If a patient threatens harm to themselves or others, the therapist may need to break confidentiality to prevent danger. However, they should carefully think about the situation and document their decision.

Taking Action to Prevent Harm: If there is a real risk to someone’s safety, the therapist must make a reasonable effort to warn the person or contact the authorities.

Stick to the Facts: When writing about a patient, therapists should only report facts. They should not make judgments about the patient, such as saying they are “too sick to work.

A final word of advice about ethics:

Don’t try to figure everything out yourself. It can help you to discuss the situation with a colleague or your supervisor. This might help you to come to a better decision.

About starting your Private Practice

In the Netherlands, only BIG-registered professionals can diagnose clients and treat clients independently. As a (basic) psychologist, you can only work under the supervision of a BIG-registered colleague. If not, the therapy you provide is not covered by insurance.

While your clients can choose to pay for therapy themselves, you are still obligated to have a complaints procedure and regulation in place, and to inform your clients about it. This includes providing access to a complaints officer and being affiliated with a disputes committee.

The NIP (Dutch Association of Psychologists) can provide you with these regulations, though it’s important to note that they are very costly.

Starting your own practice is ultimately your choice, as the title ‘psychologist’ is not legally protected. We would, however, advise against it and encourage you to find a position through official channels, working under the supervision of a regiebehandelaar. This way, both insurance reimbursements and all necessary regulations, are fully covered.

PsyGlobal has also written a series of articles on working in mental health care. These articles cover the subjects of Structure and Professional Relationship, the Intake Session and Diagnoses and Treatment Plans. Also, we have written extensive guidelines about working in the Netherlands; from peculiarities about the Dutch culture to roles and responsibilities within Mental Health Care. The guidelines can be found here. 

Please remember that PsyGlobal is here for you. There is no such thing as a stupid question, and we are available to answers yours anytime. You can also participate in intervision sessions to exchange experiences and ideas with us and fellow foreign mental health professionals, attend webinars or enroll for trainings. We will update you regularly through LinkedIn or our newsletter. Thank you for being part of PsyGlobal, and good luck!