About 17.8 million adults, roughly one in three, are affected by mental illness every year in Germany, according to the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN). Of those, only 18.9% seek treatment each year. Nia* is one of them. “It’s not easy to ask for help. It’s not easy to admit to yourself that you have a problem,” he said of his struggle to find a therapist in the middle of a depressive episode.
Nia, who lives in Berlin, began seeking therapy to treat her recurrent depressive disorder in 2023. After months of phone calls, emails and two initial consultations with an unavailable therapist, Nia gave up. In 2024, he decided to try again. But the situation has worsened. Nia went for four initial consultations with therapists who ultimately did not have the capacity to take her as a patient.
“I basically broke down during the process because every time I would go to the initial consultation I would tell them my story and I would cry my heart out and it would continue with, ‘Yes, it’s true you need help but I can’t give it to you,'” Nia told DW. “I think I was traumatized by that experience.”
He was eventually admitted to a psychiatric clinic for inpatient treatment as his symptoms worsened and he began to have suicidal thoughts. He is out of the clinic now, and paying for online therapy with a psychotherapist in another EU country is cheaper than in Germany. “Eventually I decided to go abroad alone, from my own pocket,” said Nia. “It felt like life or death.”
As well as reaching psychotherapy abroad, research shows that more people are turning to artificial intelligence for therapy. Last year, a study by Berlin-based online therapy platform It’s Complicated found that more than 50% of clients had used AI tools like ChatGPT. About 70% of therapists surveyed said they were concerned about the accuracy and safety of advice given by AI tools.
Cut therapy costs despite high demand
Demand for psychotherapists is high in Germany, with waiting times for a first appointment exceeding a year in many regions. The situation could worsen if the cut plan for psychotherapists’ fees is implemented in April. At the beginning of March, the Extended Assessment Committee (E-BA), the self-governing body of the German health sector, decided that the cost of psychotherapy paid by public health insurance providers should be cut by 4.5%.
The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) states that the legally required fees for psychotherapists are increasing disproportionately compared to other specialized medical branches.
The Berlin Chamber of Psychotherapists has accused E-AB, under pressure from the GKV, of “cutting costs at the expense of the most vulnerable.” The Berlin Chamber is now calling on the Ministry of Health, led by Nina Warken of the conservative Christian Democrats (CDU), to oppose the planned cuts.
Outcry over the planned cuts has grown and the National Statutory Health Insurance Physicians Association is planning to take legal action. Demonstrations have been held in cities across the country, and a national day of protest is also planned for Saturday, March 28.
Impact on patients and the economy
Speaking to DW, Enno Maass, chairman of the German Association of Psychotherapists (DPtV), described the cuts as “a truly devastating sign” that the statutory health insurance will regret. “There are huge reserves throughout the health care system where savings can be made, but to cut mental health care and psychotherapy now, to disrupt good outpatient care, I really don’t understand that,” he said.
Maass is a practicing psychotherapist with a medical clinic in the small town of Wittmund in rural Lower Saxony close to the northwest coast of Germany. He says demand is very high, and people often wait a year or longer to start treatment.
“With the current practice of psychotherapy, we can only treat a portion of the people suffering from mental illness in Germany,” he told DW. “The overwhelming need and mental illness is, quite literally, an epidemic.”
In addition to the “enormous suffering” of patients stuck waiting for treatment, Maass stressed the potential negative impact on the economy. Mental illness is one of the most frequent causes of reduced work ability, reduced earning capacity and early retirement. “And on top of that, there are all the personal struggles: family conflicts, difficulties, losing a job because one might not function properly at work, and friendships,” he said.
Psychotherapists cutting the number of appointment slots for publicly insured patients to make way for more lucrative privately insured clients will be “inevitable,” Maass said. It would also result in more patients requiring more expensive acute care treatments, he added.
The public health system is under threat
The cost of a 50-minute session with a publicly insured patient is around €120, compared to €170 for those paying out of pocket, according to GVK. These rates may change depending on the type of therapy and the level of urgency.
Legally required fees for psychotherapists have increased by 52% since 2013, according to the GKV. It states that disproportionately when compared to other specialized medical branches rose an average of 33% over the same period.
GKV also said that legally required fees are reassessed every year to adjust for changes in the cost of items such as staff, rent and energy bills. Psychotherapists, at least according to the GKV, benefit disproportionately from this increase because their labor costs are lower than other specialized medical branches.
The decision was not based on cost savings for the public health insurance system, GVK emphasized. It is said that public health insurance providers have made more than €500 million in additional funding for psychotherapy treatment in recent years, which now amounts to €4.6 billion annually.
“Although the number of psychotherapists continues to increase and the volume of services grows, we do not see improved care or shorter waiting times,” GKV said in a statement.
In Germany, the so-called “needs assessment” determines how many psychotherapists accredited by the public health insurance can work in an area. Many areas are classified as “oversupplied” with psychotherapists despite the lack of appointments. Federal Chamber of Psychotherapists (BPtK) said this calculation is based on figures from the 1990s, and has warned that they do not reflect the true demand on the ground.
The BptK estimates that there is a shortage of 7,000 places of care in the public healthcare system in Germany. It has warned that the number of people seeking psychotherapy is likely to increase by 23% by 2030 – by which time a third of today’s practicing psychotherapists will have reached retirement age.
*Names have been changed to protect anonymity.
Edited by: Rina Goldenberg.
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