Bas van Riet Paap, CEOMental health care in the Netherlands faces long waiting lists, increasing demand and pressure on practitioners, challenges that are closely linked to how care is organized. In 2012, BuurtzorgT was established by psychiatrist Nico Moleman and Jos de Blok, founder of Buurtzorg, the country’s largest elderly home-care provider as an alternative to this system, bringing specialized psychiatric care directly to patients’ homes.
“By choosing to treat people at home, we can see the whole system around the client to provide better care,” says Bas van Riet Paap, CEO.
Distinguishing BuurtzorgT’s home-based care model are small, self-steering teams of professionals who operate within local communities. Placed firmly at the helm and given the autonomy to organize and deliver care, these teams adopt a systemic approach to treatment that enhances care quality while making it cost-effective.
How Care Is Delivered in Practice
How does the patient journey begin and progress within the home-based care model?
Care at BuurtzorgT follows a clear patient journey. Once a patient enters the system, a local team conducts an in-home assessment, evaluating not only clinical symptoms but also the broader context surrounding the patient, including family dynamics, living conditions, daily routines and social environment.
Based on this, treatment is co-developed with the patient, ensuring that care plans reflect real-life conditions rather than isolated clinical settings. Care is then delivered through a mix of structured home visits and continuous engagement, allowing professionals to adapt interventions in real time.
Follow-up is ongoing and embedded within the patient’s daily life, enabling sustained recovery and reducing the likelihood of relapse or re-admission.
The Operating Principles Behind the Model
Why are self-steering teams and guiding principles central to this care structure?
Professional autonomy is reinforced through a clearly defined philosophy expressed in ten symbols that BuurtzorgT describes as its soul. These symbols are Trust, Simplicity, Craftsmanship, Self-steering, Recovery-focused care, Wholeness, Proximity, Systemic thinking, Organic growth and From ourselves. Each symbol carries equal weight and complements the others. Together, they shape decision-making, collaboration and patient engagement.
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By choosing to treat people at home, we can see the whole system around the client to provide better care.
Self-steering forms the structural foundation of BuurtzorgT. Operating without traditional team leaders or hierarchical layers, the company is organized into 76 small, neighborhood-based teams. Each team consists of seven to eight professionals, including psychiatrists, social-psychiatric nurses, therapists and other mental health specialists. Deeply rooted in their communities, these teams operate within close proximity to their clients, often ensuring they can reach them by bicycle. This local presence enables rapid, direct care in patients’ homes while strengthening continuity and connection within the community.
The teams hold full responsibility for both clinical and financial decisions. Regional coaches provide guidance to sustain their self-managing practices, while a lean central office ensures alignment across the organization.
Home-based care is supported by purpose-built electronic patient systems that facilitate information sharing, access to collective knowledge and e-health modules that complement in-person visits when appropriate. Each year, BuurtzorgT Day brings teams together to exchange insights and strengthen their shared learning culture.
Home-Based Care That Puts Patients First
In what way did adoption by insurers influence the expansion of this model?
Establishing this alternative model was not immediate, as early efforts were met with skepticism from insurers. A turning point came in late 2018, when BuurtzorgT secured its first contract with one of the largest healthcare insurers in the Netherlands. As of 2021, almost all Dutch healthcare insurers had adopted the BuurtzorgT model, confirming its effectiveness and alignment with the national system. Since then, it has grown to 520 employees, reflecting its rapid expansion and growing impact.
As the company expanded and needed external capital, it adopted steward-ownership, a governance model designed to protect the care model. Seven elected stewards oversee the organization to ensure that all decisions remain aligned with the mission and core symbols, safeguarding independence while enabling necessary funding.
BuurtzorgT offers a compelling alternative to institution-centered care, demonstrating how home-based, system-aware treatment can deliver more effective and sustainable mental healthcare.
Advancing Psychiatric Care through Home-Based Treatment Models
Mental health systems across developed healthcare markets continue to struggle with structural pressures that hospital-centered models were never designed to absorb. Long waiting lists, clinician burnout and fragmented treatment pathways frequently delay care for patients who require sustained psychiatric support. Institutional settings often treat episodes of illness rather than the broader social and personal contexts that shape recovery. Healthcare executives evaluating home-based psychiatric treatment programs increasingly view them as a strategic response to these pressures, not merely as an alternative service format but as a redesign of how psychiatric care is delivered.
Effective home-based psychiatric treatment depends on proximity to patients’ lived environments. Treatment that takes place in the home allows clinicians to understand the social systems that influence mental health: family dynamics, neighborhood context and daily routines. Institutional care tends to isolate symptoms from those surrounding influences, while home treatment allows clinicians to observe the full context in which recovery must occur. Programs capable of operating deeply within communities often demonstrate stronger continuity of care because treatment occurs where patients already live their daily lives.
Workforce structure also shapes the effectiveness of home-based psychiatric treatment. Traditional psychiatric organizations frequently rely on hierarchical management layers that distance clinical professionals from decision-making authority. Many clinicians experience limited autonomy in treatment planning and scheduling, which can contribute to disengagement or administrative friction. Community-based psychiatric programs that place clinical professionals closer to decision authority tend to reduce bureaucratic delays while improving accountability within care teams. Small multidisciplinary teams that manage their own caseloads can respond quickly to patient needs, coordinate appointments efficiently and adjust treatment strategies without waiting for managerial approval.
Digital infrastructure plays a complementary role but must remain secondary to therapeutic relationships. Psychiatric care depends heavily on trust between clinician and patient, which means technology should support communication rather than replace it. Electronic patient systems and telepsychiatry modules help clinicians track patient progress and provide flexible contact points when in-person visits are not required. Care models that combine digital tools with regular in-home engagement often maintain continuity while preserving the relational foundation of psychiatric treatment.
BuurtzorgT demonstrates how these principles can operate in practice. Founded in 2012 as a specialized provider of psychiatric treatment delivered in patients’ homes, it was created to address systemic strain in the Dutch mental health sector, including long waiting lists and rising demand for care. Its approach centers on neighborhood-based teams composed of small groups of clinicians who manage their own work without traditional managerial layers. Communication from a central office provides shared frameworks while regional coaches help teams sustain their self-managing structure. The model currently includes dozens of local teams and several hundred employees, illustrating how decentralized psychiatric care can scale within a national healthcare system.
BuurtzorgT represents a compelling option for healthcare executives evaluating advanced home-based psychiatric treatment programs. Its structure places clinical professionals at the center of care delivery through self-managed teams that operate locally and maintain direct responsibility for patient outcomes. Treatment occurs primarily in patients’ homes, allowing clinicians to address the social systems influencing mental health rather than focusing solely on institutional interventions. Digital patient systems and e-health modules complement in-person treatment while preserving strong clinician–patient relationships. Governance through steward ownership ensures that strategic decisions remain aligned with the organization’s mission and values. This combination of decentralized clinical autonomy, neighborhood-based care and disciplined governance positions BuurtzorgT as a leading example of modern home-based psychiatric treatment.
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