Germans struggle to find mental health care

Susanne Günther knows that the Christmas holiday can be a time of crisis. The social education specialist, who works at a crisis help center in Berlin, is often busier in the days right before and after December 25.

"There are more family issues," she told DW. "People think about what they're doing for Christmas: 'Do I want to see my brother, my mother, my sister, my children?' Maybe there are conflicts. Or they're lonely, and they're thinking about where they're going to spend Christmas and a frustration builds up."

The people working at Günther's crisis center in the Lichtenberg district of the German capital are all professionals trained in various areas of counseling. "Most of us are psychologists and social workers," she said, and people have the option of either phoning a hotline or appearing at the centers in person. In emergencies, Berlin's crisis centers also make house calls.

After providing initial support, Günther's center can help people find long-term therapists, which can be difficult since the average waiting time to find psychotherapists in Germany is rapidly lengthening. "The supply is smaller than the demand," she said. Some therapists are paid through state health insurance companies, which gives people on lower incomes a chance to get help, but the number of such insurance-supported posts is limited.

Read more: Victims' rights groups urge German health insurers to cover therapy

Low-threshold access

In fact, the high demand for psychotherapists has been on the government's agenda, which is why conservative Health Minister Jens Spahn has come up with his own solution: to make those seeking help attend a pre-check from a specialist who decides whether they really need to see a therapist.

This idea has faced almost universal derision from the profession. Many psychotherapists believe it will only install an extra bureaucratic hurdle that will make it harder for people who need urgent help. Earlier this year, three psychotherapy associations joined forces to start a petition, which took no time to gather the 50,000 signatures necessary to force a parliamentary committee to hold a public hearing.

It was pointed out to the Bundestag members that, according to a study by the Federal Chamber of Psychotherapists, the average waiting time for treatment was five months, and longer in rural regions. Not only that, the professional psychotherapists were outraged that Spahn's assessor would have the power to "appoint" a therapist for each patient, thus depriving those patients of their right to choose their own.

All these arguments were supported by a mental health care patient writing anonymously in Stern magazine of the difficult path to getting treatment in Germany: "I might have completely given up on the whole thing if I had had to 'prove' again that I was ill," she wrote.

Free will

There are already plenty of bureaucratic obstacles to getting psychological care in Germany. The emphasis on patients' free will, for instance, often means that therapists are hamstrung when reaching out to people who are suffering, even if those patients struggle to reach out themselves.

Of course, many other factors play a role in how people find psychological care, as Thomas Götz, psychotherapist and Berlin's state commissioner for psychiatry, pointed out: "How well-known are the offers? How sensitized is one to them? Do I know where I can call in a crisis situation?"

Like many aspects of German domestic policy, mental health care is administered at the state level, which means that there are different degrees of care and availability across the country.

In Berlin, advertising for crisis centers is relatively visible, especially in public transport, and helplines are manned 24 hours a day by specialized professionals — either care workers, social workers, or therapists. But the awareness and the availability in geographically larger states, with more rural areas, is much lower.

"When it comes to the demand for psychotherapy, it's certainly the case that there has been an increased sensitization," Götz told DW. "People are more likely to go to a doctor, and doctors are more likely to look more closely at certain patients."

But the "big problem in the system," according to Götz, "is that the people with the most serious psychological problems only rarely get psychotherapy. The people with less pronounced problems get quicker access to resources."

Crisis centers in Berlin can be reached at the Berliner Krisendienst website. The services are available free of charge 365 days a year, and are in some cases multilingual. 

Other mental health advice centers in Germany can be found by searching on the website of the Deutsche Depressionshilfe.