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