The Netherlands

Headnote

ABSTRACT

The Netherlands is a country where much is regulated, and several departments have made rules, regulations, memoranda and even laws related to people with intellectual disabilities. Large organisations that offer different forms of support dominate the system of care and support. The policy on care for people with intellectual disabilities has, generally speaking, developed away from segregation and towards integration and inclusion. Changes have led to improvement for people with mild and moderate disabilities, although the process is slow. At the same time, the situation for people with profound and multiple disabilities has deteriorated. For a real change in the support system, client-held budgets are believed to be of primary importance. However, this is still a slow development. This article describes the current organisation of care and support.

DEFINITION, LEGAL STATUS AND ELIGIBILITY

Terminology

In government papers, the term 'people with intellectual disabilities' is used. In practice, there are several terms used, like 'severe subnormality', 'mental handicap', 'feeble-minded people' and 'intellectual handicap'. For several categories of people, such as people with profound multiple disabilities, there are also several terms in common use, for example 'multiple complex handicapped'. Outdated terminology is frequently used, especially in medical circles. Only recently, the Health Department outlawed the use of the term 'idiots' (for people with profound intellectual disabilities).

Definition and eligibility

The definition of Luckasson et al (1992) is used in most official papers, and describes people with intellectual disabilities as people with:

* significant impairment of intellectual functioning

* significant impairment of at least two adaptive functions

* age of onset before 18 years.

In the Netherlands people with an intellectual disability have a legal right to services. They are entitled to receive care when they have been assessed as needing it. Until recently local governments decided whether or not a person would obtain some sort of care or funding. The local governments were not bound by central regulations. This meant that there were discrepancies between regions in Holland. Since January 2001 assessments for care have been provided by central government. This means that an assessment is formulated independently of the providers of care or the organisations that fund care. An assessment is given when a person belongs to the target group. This is determined on...