The Dutch mental health provider GGZ* inGeest has developed a new concept for tapering for antidepressants: the ‘Afbouwpoli’ (directly translated: ‘tapering clinic’). The outpatient clinic, which specialises in controlled tapering of antidepressants, has a hybrid care approach and has integrated Minddistrict directly into its working methods. “You can delay the introduction of a digital platform, but eventually you just have to start,” says Kirsten Fransen, nursing specialist.
Kirsten Fransen
The specialists of GGZ inGeest know from experience that tapering antidepressants is not a straightforward process. The process of tapering is often very diverse, and the scientific knowledge is limited.
That's why in 2021, GGZ inGeest combined its own knowledge and experience on tapering in the ‘tapering clinic’, in order to better advise and support their patients. In addition, the clinic conducts scientific research to expand the knowledge available on phasing out antidepressants.
But the ambitions are bigger, says Kirsten Fransen. Innovation projects are under way to strengthen cooperation in the Amsterdam region around the theme of tapering. Additionally, the clinic is involved in a project to provide the blended care approach of the tapering clinic to primary care services throughout the Netherlands.
Multidisciplinary and hybrid approach
GGZ inGeest chose a hybrid form for the tapering clinic, including video call appointments and online modules, so that they can provide supra-regional care to patients from all over the Netherlands. Treatment at the outpatient clinic consists of four phases: the intake phase, the tapering phase, the evaluation phase and the monitoring phase. In all these phases, the approach is multidisciplinary, with psychiatrists, nurses, psychologists and pharmacists working together. Plans are personalised to the patient's specific situation, and preferably a close relative is also involved.
The outpatient clinic sees many people who have been using antidepressants for a long time and have often already made (multiple) attempts to stop using them. In combination with the multidisciplinary approach, the individual tapering plan and wide accessibility due to the hybrid approach, the clinic has created something completely new in Dutch healthcare.
The outpatient clinic sees many people who have been using antidepressants for a long time and have often already made (multiple) attempts to stop using them.
The hybrid approach of the clinic is not surprising, given the digital track record of GGZ inGeest, says Fransen. ‘We have been offering hybrid care for 10 years with our outpatient clinic Mindway – personalised online treatment for anxiety and depression, supported by Minddistrict.’ The initial team for the clinic consisted of two psychiatrists and a nurse specialist who were already working with Mindway. ‘So they already knew Minddistrict. That gave us a head start in knowing how we could use blended care in the tapering clinic.’
Set it up according to your organisation’s needs
The modules and questionnaires needed to guide people in tapering off antidepressants were developed by the clinic together with Minddistrict. ‘Nothing existed yet to guide the tapering process,’ Fransen explains. ‘That gave us the opportunity to set up modules exactly as we wanted, for instance with videos in which colleagues explain the process.’
‘The tapering clinic is a great example of how to adapt our product to the needs of an organisation, and then integrate it into processes,’ says Christopher van Duijn, customer success manager at Minddistrict. The modules and workflows have also very recently been updated and improved, says Van Duijn. Fransen: ‘We used feedback and experiences from professionals and patients for that.’
Patients in the director's chair
Why did the clinic choose hybrid processes? ‘For professionals, the breadth of the platform is very useful. There are many modules that I can turn on or off for specific problems, such as “i-Sleep” for people with insomnia. The secure messaging service is also very nice, to reach each other quickly and easily. That works so much better than missing each other’s calls 10 times.’
But above all, Fransen mentions the effect for patients. ‘They sit in the director's chair: they can use modules and fill in questionnaires when it suits them.’ Fransen also mentions the diary feature. ‘If necessary, people can briefly indicate every day how they think they are doing – red, orange or green. This allows them to see for themselves at a glance how they have been doing over the past few weeks. Something like that gives someone a lot of guidance.’
The patient satisfaction survey shows that the patients themselves appreciate this: people gave an average rating of 8.6 out of 10. And more than 60% of patients even rated it 9 or 10.
Questionnaires, measurement and personalisation
The clinic also uses questionnaires in the process. Here, it is especially convenient that patients can complete them in the mobile app, says Fransen. ‘In the beginning this wasn’t possible with the withdrawal questionnaires about complaints due to phasing out medication. You clearly notice the difference now: patients have much more freedom to fill in the lists.’
‘I notice that patients really appreciate that quick and easy accessibility from us. Without a digital platform like Minddistrict, that's not possible.’
The frequent questionnaires and other measuring points give a better picture of how a person is functioning during antidepressant withdrawal, such as a possible increase in symptoms of depression or anxiety. ‘I can see at any point, based on feedback, if someone is having a hard time, for example, and then get in touch,’ Fransen outlines. ‘That helps professionals and patients tremendously. You can exchange views a lot easier.’
Fransen: ‘I notice that patients really appreciate that quick and easy accessibility from us. Without a digital platform like Minddistrict, that's not possible.’
Further rollout
‘People sometimes think Mindway is mental health care “light”,’ states Fransen. ‘But it's just specialised mental health care that treats in a very efficient yet personalised way. The advantage of treatment modules like cognitive behavioural therapy is that they provide both professionals and patients with a structure. You are engaged in that module, and therefore much less inclined to treat all kinds of side paths.’
The hybrid working method of the tapering clinic is also being further rolled out. ‘In 2025, we started the innovation project to make the concept of the clinic accessible to primary care. Because, of course, many more people are phasing out medication than we can see at GGZ inGeest.’
Just get started
Even though the tapering clinic has been working with Minddistrict from the start, Fransen notes that adopting a digital platform is not easy for every professional. ‘I know from experience that you just have to start, but not with a big bang. Start small and allow a few months to exchange tips and tricks.’ But then it is also time to go full steam ahead. Fransen: ‘Just like with swimming: you'll never learn if you stay poolside.’
Want to know more?
Read this study on the working methods and initial results of the tapering clinic in the Dutch Tijdschrift voor Psychiatrie (Journal of Psychiatry).
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