More and more people live in precariousness and are excluded. Mostly people with serious psychological problems to get not the right help of agencies that need them. It is so bad that even the most needy can no longer get help.

Chelsea is one of them. They are trans, suffer from PTSD and borderline, and in urgent need of psychiatric care.

BPW Amsterdam spoke to them.

From the crisis service to the gutter

You would think that they would soon receive help in a prosperous country like the Netherlands. Not so. By the long waiting lists in the GGZ cannot immediately start a program for them. Until then, someone has to hold on, without any organization caring about them.

The request for help started about a year ago – immediately fierce. Chelsea arrives at the emergency department with the complexities of a borderline diagnosis, post-traumatic stress syndrome from rape, and a history of self-mutilation. This leads to a comprehensive care process: talking to a psychologist for an hour a week. In addition, Chelsea is also prescribed heavy, addictive medication.

Because of their mental problems, they are also unable to find a permanent home. That again means that she was rejected at a psychiatric institution, the only place where they can really get help.

The nadir of Kafkaesque care is reached at health institution Altrecht: after a promise that Chelsea can finally see a psychologist, on the morning of the appointment is suddenly told that because of the lack of a permanent place of residence, no help can be provided. Instead of placing Chelsea at an Altrecht location, they will be sent without further explanation dumped at the Salvation Army's homeless aid.

Ultimately, there is no place for Chelsea here either: the strict Christian nature of the Salvation Army offers no room for trans people, and this shelter must eventually leave them too..

From the crisis service to the gutter

Since then, Chelsea has been living in constant uncertain situations† There have been several houses and living situations, but these turned out to be short-lived or untenable because of the serious psychiatric problems. After they left their house in Amsterdam in November, they are finally, out of sheer despair, returned to Chelsea's native Hungary – given the political climate absolutely not a safe place for a trans person with complex problems.

Chelsea is of a needy person, by looking away and neglecting the entire Dutch healthcare system, turned into an addicted homeless person with whom it is difficult to maintain consistent contact. There is no working help offered, only protocols are looked at, referred to other authorities or rejected because of too complicated requests for help.

Thousands of Chelsea's in the Netherlands

Because our health care system is failing on all fronts in situations like Chelsea's, people are in serious trouble. At this point, almost 30,000 people wait longer for psychological help than the maximum acceptable waiting time of four weeks. This mainly concerns people with complex problems such as Chelsea, who need help the most. Due to budget cuts and perverse financial incentives within mental health care, healthcare providers mainly focus on patients with less serious problems. There is also a shortage of staff and beds.

In mental health care there is too little understanding for the inability of someone to deal with the bureaucratic process involved in obtaining the correct care and maintaining a stable living situation. Only one thing has to go wrong and the whole house of cards collapses. Healthcare organizations rely too much on protocols and can offer little or no help if someone has a problem that is not within their care range. The more complex your problems, the more agencies get involved and the harder it is to get help. Because you fall in between everything.

Chelsea is of a needy person, by looking away and neglecting the entire Dutch healthcare system, turned into an addicted homeless person with whom it is difficult to maintain consistent contact. No working help is offered, only protocols are looked at, referred to other agencies or rejected because of too complicated requests for help.Chelsea was sent from pillar to post and lost track. Even when they sought help in arranging bureaucratic matters, that care often depended on where they lived. As soon as they moved again, they could tell their whole story again somewhere else. The care is too fragmented to really help someone.

Mental problems make homeless

People who do not receive help are increasingly ending up on the streets. In 2016, forty percent of the homeless had applied for help from the GGZ in the three years before their homelessness. The psychological vulnerability of people cannot be separated from their insecure home situation, the two phenomena have a reinforcing interaction. The fact that people who have sought help several times still end up on the street, speaks volumes about the government's inability to fulfill its duty of care and provide people with appropriate guidance and shelter.

When they lived in Utrecht for two months (December and January), their mental health was so bad that they should have constant supervision from healthcare workers. I think they spent about a week at the Altrecht health care institution in the acute psychiatry department. The relationship with their housemates was so bad after all this that they had to leave. The moment they ended up on the street again at the end of January, they had a mental breakdown and they ended up at Altrecht again. They were told that they would have a meeting with a psychologist the next day. Instead, they were suddenly told in the morning that they had to leave because they had no fixed address. 

When they left, they assumed they were on their way to another location in Altrecht. They were misinformed. It turned out that they took Chelsea to a Salvation Army homeless shelter. On the spot, their weed was taken by the employees of the Salvation Army. Then they had another mental breakdown and left with the intention of committing suicide. Fortunately, they were then taken care of by friends. They were convinced that otherwise they would not have lived.

"Chelsea" isn't their real name. Hen's real name is known to the Bond Precaire Woonvorm.


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