A referral for mental health care: how does it work and what do you need?

Why is a referral needed at all?

For reimbursement from the basic insurance a valid referral is required in most cases. That is not the insurer being difficult, but a gatekeeper function: someone with medical knowledge first has to consider whether specialist mental health care (sggz) is indeed the suitable form of help.

Part of that is that there must be a (suspected) psychological disorder that falls within the insured basic package. The National Health Care Institute (Zorginstituut Nederland) determines what does and does not fall under it. Some complaints, such as work or relationship problems without an underlying disorder, are deliberately not reimbursed from the basic insurance.

It comes down to this: the referral is your access pass to reimbursed care, and at the same time a first check whether you are knocking on the right door. Ask yourself: have I already discussed my complaints with my GP? This route almost always starts there.

Who may refer you?

The most common referrer is your GP, often together with the mental-health practice nurse (POH-GGZ). But a medical specialist (for example a psychiatrist, paediatrician or internist) or sometimes the company doctor can also refer. For youth mental health care the municipality or a youth doctor may additionally play a role.

What they have in common: it is someone with the authority to assess whether, and to what type of care, you should be referred. A friend, teacher or employer can advise you ever so well to seek help, but they cannot give a formal referral.

Do you doubt who the right referrer is in your situation? Then just call your GP practice. They know exactly how the route runs and can help you further.

What must the referral letter contain?

A referral letter is more than a note saying 'please treat'. To be valid for reimbursed mental health care it contains a number of fixed elements: your name, address and place of residence and date of birth, the date of referral, and the details and signature (or AGB code) of the referrer.

In terms of content it should state: that there is a suspicion of a psychological disorder (a so-called DSM classification or the suspicion thereof), and to which echelon the referral is being made, basic mental health care or specialist mental health care. Professional associations such as the LVVP and the GP standard (HASP-ggz) describe exactly which requirements such a letter must meet.

An important detail that many people do not know: the referral letter must be dated before your first conversation, and the first consultation must usually take place within 9 months of the date on the letter. A referral that is two years old is therefore no longer usable.

Basic mental health care or specialist mental health care?

Not all mental health care is the same. Roughly: lighter, single complaints are treated in generalist basic mental health care (bggz), and more complex, heavier or long-term problems in specialist mental health care (sggz). Your referrer assesses which of the two suits you, and notes that in the referral letter.

That distinction determines not only where you end up, but also how your treatment is reimbursed and organised. AndersGGZ is specialist mental health care, aimed at people whose complaints are more complicated, often interwoven with language, background and life course.

It can happen that during the intake it turns out that another echelon fits better. That is not a rejection, but care: we want you to end up in the place where you are actually helped.

Two ways to apply to AndersGGZ

There are two routes. The first: your referrer applies on your behalf directly via ZorgDomein, the digital system with which GPs and specialists refer to care providers. The referral letter then comes to us automatically and securely.

The second: you apply yourself via our application form on the website. Uploading a valid referral letter is then a requirement, so that we can assess your application properly straight away. So you first arrange the referral with your GP, and then apply to us.

Whichever route you choose, the result is the same: a complete application we can get started with right away. Do you already have your referral letter within reach? Then you are closer to the start than you think.

And then? What happens after your application

After a complete application you receive a confirmation straight away. We contact you personally as soon as we can schedule you for an intake; that depends on the current waiting time. In that first conversation we look together at whether specialist mental health care is suitable and calmly map out your complaints, your context and your wishes.

Should something be missing from the referral letter, that is rarely a disaster. Often we can still request the missing information, and in many cases treatment may start in the meantime. So do not let a small paperwork problem hold you back from taking the step.

The paperwork around a referral sometimes feels like a threshold, but in the end it is only one thing: the key that opens the door to suitable help. And behind that door a team is ready that thinks along with you in your language.

What if your GP does not want to refer right away?

It happens: you ask for a referral and your GP suggests trying something else first, for example a few conversations with the practice nurse (POH-GGZ). That sometimes feels like a rejection, but usually it is not. The GP is obliged to assess which care is suitable, and lighter complaints can often be helped nearby and faster.

If you disagree, you may say so. Explain why you think specialist help is needed, and what you have already tried. Ask concretely: 'What, in your view, is needed before a referral would be appropriate?' That way you make a plan together instead of standing opposite each other.

If you keep feeling that you are not being heard, you always have the right to a second opinion with another GP. You do not have to settle for a 'no' if you notice that you are really stuck.

Referral, deductible and costs

Mental health care from the basic insurance is reimbursed, but does fall under the compulsory deductible (eigen risico). That means you first pay the statutory deductible yourself (which applies per year to almost all care from the basic package), before the insurer reimburses the rest. There is no separate 'personal contribution' for the treatment itself in regular mental health care.

The deductible applies per calendar year. If your treatment runs across the turn of the year, it may be that you draw on your deductible in two years. That is not an extra penalty, but simply how the system works; it is good not to be surprised by it.

Do you want to know exactly for your policy? Your health insurer can tell you exactly what is reimbursed and how the deductible works out in your situation. Feel free to ask, so that you are not faced with surprises later.

What happens to your data?

A referral letter and an application contain sensitive information. Understandable that you wonder who is allowed to see all that. The short answer: only the people directly involved in your care. Care providers have a duty of confidentiality, and your data are processed in accordance with privacy legislation (GDPR).

Concretely that means, among other things: your data are not simply shared with others, you have the right to inspect your own file, and information to your GP, for example, is only fed back if you give permission for it. At AndersGGZ we moreover send sensitive data via a secure, encrypted connection.

You may always ask about this. 'Who sees my data, and how long are they kept?' is a perfectly reasonable question, and you should get a clear answer to it.

Frequently asked questions about the referral

My referral letter is a year old, is that still alright? Probably not: the first conversation usually has to take place within 9 months of the date on the letter. In that case ask your GP for a current referral; that is usually easily arranged.

Can I apply without a referral? For reimbursed specialist mental health care you need a valid referral. Without a referral a treatment can sometimes start, but reimbursement from the basic insurance is then usually not self-evident. So preferably arrange the referral beforehand.

Does this also apply to children and young people? For youth mental health care the financing runs via the municipality, and besides the GP a youth doctor or the municipality, for example, may also refer. The core remains the same: a referral is needed from someone authorised to give one.

Do you have a question that is not here? Feel free to ask it when you apply; better one question too many than a misunderstanding that delays your treatment.

How to prepare the conversation with your GP

The referral almost always starts with one conversation at the GP, and that conversation goes more smoothly if you prepare for it briefly. Ten minutes pass quickly; it helps if you already have the essence clear.

Write down beforehand what you find most important to tell: since when your complaints have been going on, how they affect your daily life (work, sleep, relationships), and what you have already tried. Also name concretely what you hope for: 'I think I need specialist help and would like a referral.' The clearer you are, the more specifically the GP can think along.

Do you find it daunting or hard to put your complaints into words? Then bring someone you trust. A loved one can add what you forget in the moment, and it helps that you are not sitting there alone. Which three things would you want to have mentioned for sure as you leave that consulting room?