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Explained: How to receive help for a mental health issue in Germany

Suffering from a mental health issue as a foreigner living in Germany can be tough. In this article we break down the steps you can take to get help.

Explained: How to receive help for a mental health issue in Germany
Source: dpa-tmn

What should I consider first?

In an emergency 

A mental health issue can become a Notfall (emergency) in many cases. Here are some choices you have if the situation is urgent:

1. If the situation is life-threatening, you should call the emergency services on 112. 

2. If the situation is not putting you or anyone around you in immediate danger, but is still urgent, then you can call the Patient service on 116117 any time of the day or night. They can help you to find an appointment.

3. Every Bundesland has numerous psychiatric emergency departments and you can find a list of them here.

If it’s a long-term problem

If your problem is more chronic than critical, then you may need to find a mental health professional who you can visit on a regular basis. You do not necessarily need an Überwiesung (referral) from your Hausarzt for this, but it can be helpful in speeding up the process. 

READ ALSO: I arrived in Berlin expecting a giddy European adventure. Instead I got depression.

Psychiater, Psychotherapeut, or Psychologist?

As with their English equivalents, the terminology for German mental health professionals can be a bit confusing. Here is a breakdown of the main groups of mental health professionals and what they do. 

Source: dpa-tmn

Psychiater (Psychiatrist)

A psychiatrist is a qualified medical doctor who is specialized in psychiatry, having completed further training in psychiatry and psychotherapy as well as a specialist exam.

A psychiatrist will usually take a detailed medical history at the first appointment, taking the biography and medical history and after that, may do some psychological or neurological tests to rule out other diagnoses.

READ ALSO: Five ways to calm anxiety in a German workplace

Psychiatrists mainly take care of the physical diagnosis and treatment of people with mental health problems, determining physical and medical causes for mental illnesses and can prescribe medication to treat them. Psychiatrists rarely offer psychotherapy.

Psychotherapeut – Psychotherapist

A psychotherapist is someone who has studied psychology, with a focus on clinical psychology and completed several years of training as a therapist. After this, they can apply for a license to practice medicine in order to treat patients with psychological problems. 

READ ALSO: What are the main reasons internationals in Germany turn to therapy?

Psychotherapists deal with all mental disorders which can be treated with therapy, dialogues and mental exercises. These can include depression, anxiety disorders, eating disorders or sleep disorders and addiction disorders.

Psychologe – Psychologist

A psychologist is someone who has studied psychology, but who may not treat patients without completing additional training. 

Psychologists can work in many fields without training as a therapist and are often employed as experts in business, marketing, advertising, various advice centers, and healthcare. 

Getting an Appointment

If you want to go directly to a mental health professional, you can start by searching online. 

The Federal Chamber of Psychotherapist’s website is a very helpful starting point, which enables you to search for psychotherapists in every Bundesland and also to filter them by the languages in which they offer psychotherapy. 

Another great resource is the “Kassenärztliche Vereinigung” – with websites for every Bundesland, you can search here as well for a Psychotherapist or Psychiatrist. 

READ ALSO: 'Being honest helps': How expats have overcome loneliness

If you do have a good Hausarzt however, paying them a visit can be a very useful starting point. They can give you a referral and perhaps also recommend a local mental health professional and, if they determine you problem to be acute, they can give you a special Dringlichkeitscode (urgency code) on your referral sheet which can be entered into the Kassenärztliche Vereinigung website and guarantees you an appointment within four weeks.

As with arranging a doctor’s appointment, E-mail can be a very effective way of seeking an appointment with a psychiatrist or psychotherapist, as you can contact many practices in a short space of time and can avoid a sometimes tricky conversation in German. 

How long will you have to wait?

Depending on where you live in Germany, you may have to come to terms with long waiting times. A 2018 study by Germany’s Federal Chamber of Psychotherapists (BPtK) showed that the average waiting time for a therapy place is 20 weeks and that in big cities, there are an average of 36 psychotherapists per 100,000 inhabitants, but only between 12 and 18 outside.

However, waiting times for an initial appointment are, on average, much lower – around 6 weeks and if, in this initial appointment it is decided that you need acute treatment, the waiting time for a treatment place drops to three weeks.

Source: dpa-tmn

What can I expect if I get an appointment with a Psychotherapist?

Erstgespräch

All psychotherapy sessions start with an Erstgespräch (initial consultation) where a therapist will try to get an overview of the issue and make a preliminary diagnosis and recommendation for further treatment. 

Exactly how this conversation will look, depends on the therapist – some therapists have a short initial conversation of around 20 minutes, others longer, some focus on regulating formal details and getting to know the patient, while others may already be getting a detailed picture of the patient.

Probatorische Sitzungen

If psychotherapy is deemed to be necessary, the next step is to have between two and six Probotorische Sitzungen (trial sessions) with a therapist. During these sessions, the patient can receive some initial treatment, clarify any open questions and can decide whether the or not the “chemistry” with the therapist is right, or whether they would prefer to see someone else for longer term therapy.

Treatment

If it is determined that long-term therapy is needed, the therapist will make an application to the patient’s Krankenkasse to cover the cost of one of three longer term treatments: behavioural therapy, psychoanalytic therapy and deep psychological therapy.

Once this has been agreed by the Krankenkasse, a minimum of 12 appointments can begin. When and how often the appointments are to take place are usually to be determined between the therapist and patient. A word of caution – if you miss an appointment without giving 48 hours notice, most practices will charge you forty euros for the missed session. 

Therapy in English?

Although there are many therapists who are able to offer treatment in English, there is no guaranteed right to therapy in a language other than German. One of our readers took her health insurance company to court, after they told her that she had no entitlement to therapy in English. The lower court rejected her claim and advised her that an appeal court was likely to reach the same decision. 

However, this does not mean that you will not be able to find a therapist who can offer therapy in your language – it may just mean that you have a longer wait. 

READ ALSO: How foreigners in Berlin are turning to a black market in mental health treatment

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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