Background Waiting times in child and adolescent mental health services limit timely access to care for youth and are widely recognized as a complex systems problem, yet their underlying drivers remain insufficiently understood. In the Netherlands, these services face significant challenges due to increasing waiting times.Objective To identify professionals’ perceptions of the root causes of waiting times in child and adolescent mental health services and to relate these to relevant policy developments.Method This qualitative study used root-cause analysis based on semi-structured interviews with professionals across the system. A targeted review of national and regional policy changes was conducted to contextualize the findings.Results We identified three main perceived causes: high demand, staff shortages, and poor throughput. High demand is perceived to be driven by factors such as a broad definition of youth care in Dutch law and increased mental health awareness among younger generations. Staff shortages are perceived to be associated with a poor sector image, a tight labor market, and insufficient training opportunities for care staff. Poor throughput is perceived to stem from inefficiencies in collaboration between care providers, the education sector, and municipalities, as well as procurement challenges. These causes were described as interrelated. Policy developments appeared to primarily target demand, with less emphasis on workforce capacity and service throughput.Conclusions Waiting times in child and adolescent mental health services are perceived to arise from interacting causes rather than a single factor, suggesting that coordinated approaches addressing demand, workforce, and service organization are required.
Linden et al. (2026) studied this question.