According to the German Society of Psychiatry, Psychotherapy, Psychosomatic Medicine and Neurology (DGPPN), approximately 17.8 million adults in Germany, or approximately one in three, suffer from a mental illness each year. Of these, only 18.9% receive treatment each year.
Nia* is one of them. “It’s not that easy to ask for help. It’s not that easy to admit that you have a problem,” she says of her struggle to find a therapist during an episode of depression.
Nia, who lives in Berlin, started looking for a therapist in 2023 to treat her recurrent depression. After several months of phone calls and emails and her first two consultations with a therapist, Nia gave up because there were no openings. In 2024, she decided to try again. However, things were getting worse. Nia had four initial sessions of counseling with a therapist who ultimately did not have the capacity to accept her as a patient.
“Every time I go to the first consultation, I tell them my story and cry from the bottom of my heart, because it always ends with ‘Yes, you absolutely need help, but I can’t give it,'” Nia told DW. “I think I was traumatized by the experience.”
She was eventually admitted to a psychiatric clinic as her symptoms worsened and she became suicidal. She is currently away from the clinic and is paying for online treatment with a psychotherapist in another EU country, where fees are lower than in Germany.
“In the end, I decided to pay my own way and go abroad,” Nia says. “It felt like life or death.”
As well as reaching out to psychotherapy abroad, research shows more people are turning to artificial intelligence for treatment. Last year, a study by Berlin-based online therapy platform It’s Complicated We found that just over 50% of our clients use AI tools like ChatGPT. Around 70% of therapists surveyed said they were concerned about the accuracy and safety of advice given by AI tools.
Reduce therapist fees despite high demand
Psychotherapists are in high demand in Germany, with waiting times of over a year for an initial appointment in many regions. The situation could worsen significantly if plans to reduce psychotherapists’ pay come into effect in April.
In early March, the Enlarged Assessment Board (E-BA), the body of Germany’s joint autonomous system of health care, decided that psychotherapy fees paid by public health insurance providers should be reduced by 4.5%.
The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) says that the statutory remuneration of psychotherapists has increased disproportionately compared to other medical specialties.
Following pressure from the GKV, the Berlin Chamber of Psychotherapists accused the E-BA of “cutting costs at the expense of the most vulnerable.” The Berlin Chamber of Commerce and Industry is now calling on the Health Ministry, headed by Nina Walken of the conservative Christian Democrats (CDU), to oppose the planned cuts.
There has been so much outcry over the planned cuts that the National Association of Statutory Health Insurance Doctors plans to take legal action. Demonstrations have already taken place in cities across the country, and a national day of protest will also be held on Saturday, March 28th.
Patient and economic impact
Enno Maas, president of the German Association of Psychotherapists (DPtV), told DW that the cuts were a “really dire sign” that statutory health insurance companies would come to regret.
“There are huge reserves across the health system that could be saved, but to cut back on mental health care and psychotherapy right now and disrupt good outpatient care is really incomprehensible,” he said.
Maas is an active psychotherapist with a clinic in Wittmund, a small town in rural Lower Saxony near the northwest coast of Germany. Demand is so high, he said, that many people wait more than a year to start treatment.
“Today’s psychotherapies can only treat a small proportion of people suffering from mental illness in Germany,” he told DW. “The need is so great that mental illness is literally widespread.”
Mr Maas highlighted the potential negative impact on the economy, apart from the “immense suffering” for patients who continue to wait for treatment. Mental illness is one of the most common causes of reduced work capacity, reduced earning capacity, and early retirement.
“On top of that, there are all sorts of personal struggles, such as conflicts with family members, job loss due to the possibility of not being able to function properly at work, and loss of friendships,” he says.
Maas said it was “inevitable” that psychotherapists would reduce their appointment slots for publicly insured patients to make way for more lucrative private insurance clients. There will also be more patients requiring acute emergency care, which is significantly more expensive, he added.
Public healthcare system under threat
According to GVK, a 50-minute session cost around 120 euros for patients with public insurance, compared to 170 euros for self-pay patients. These percentages can vary depending on the type of treatment and level of urgency.
According to GKV, the statutory remuneration of psychotherapists has increased by 52% since 2013. It claims this is disproportionate when compared to other specialist medical sectors, where prices have increased by an average of 33% over the same period.
GKV also said statutory rates are reviewed annually to adjust for changes in costs such as staff costs, rent and utilities. At least according to GKV, psychotherapists have unfairly benefited from this increase because their labor costs are significantly lower than in other medical specialties.
GVK claims that this decision was not based on reducing costs for the public health insurance system. According to the report, public health insurance providers have provided more than €500 million in additional funding for psychotherapy in recent years, which now totals €4.6 billion annually.
“Although the number of psychotherapists is constantly increasing and the volume of services is expanding, there is no improvement in care or reduction in waiting times,” GKV said in a statement.
In Germany, a so-called “needs assessment” determines how many psychotherapists certified by public health insurance can work in a region. Many regions are classified as having an “oversupply” of psychotherapists, despite a lack of bookings. The Federal Chamber of Psychotherapists (BPtK) has warned that these calculations are based on figures from the 1990s and do not reflect the real demand in the field.
BPtK estimates that there is a shortage of 7,000 treatment facilities across Germany’s public healthcare system. The group warns that the number of people seeking psychotherapy is likely to increase by 23% by 2030, by which time a third of currently working psychotherapists will have reached retirement age.
*Names have been changed to protect anonymity.
Editor: Lina Goldenberg.
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