Eabout once an hour someone in Germany takes their own life. There were 9215 suicide deaths in 2021, that’s about 25 a day. For comparison: 2562 people died in road traffic in 2021. Nevertheless, the dangers on the freeway are talked about more often than those of mental illness. Ninety percent of all people who commit suicide are mentally ill. The number of suicides was reduced from almost 19,000 in the early 1980s to around 10,000 in the mid-nineties. Since then, however, it has stagnated. How could you lower it further?
The (too) simple answer is: with more money. The Federal Chamber of Psychotherapists is demanding at least 1,600 new cash register seats for psychotherapists. This is intended to reduce waiting times for patients. According to the Chamber, mentally ill patients wait an average of almost five months for treatment to begin. However, more checkout seats have hardly changed anything about it so far. According to the health insurance companies, there is an oversupply of psychotherapeutic practices in Freiburg with a coverage rate of 300 percent, but the waiting times are just as high as in other regions.
Overall, according to the health insurance companies, the number of psychotherapists increased by 54.6 percent from 2013 to 2021. Although this also includes part-time workers, the use of psychotherapy increased by 63 percent from 2013 to 2020. The costs developed accordingly: in 2021 around 3.8 billion euros were billed for guideline psychotherapy, in 2010 it was around two billion. After general practitioners, psychotherapists are the second largest group of doctors.
The fault is in the system
The demand for even more cash register seats is popular nonetheless. Josef Hecken, the chairman of the Federal Joint Committee responsible for demand planning in the healthcare sector, felt this when he responded to corresponding demands. He claimed that not everyone needs a therapist right away, adding that sometimes a bottle of beer does, too. That was in 2013. He later apologized for the “unfortunate, because misleading” statement. He just wanted to say that he didn’t immediately see every ailment as pathological with the corresponding need for therapy.
With his undoubtedly unfortunate statement, Hecken had touched on a point that hardly anyone in this debate dares to approach: mildly mentally ill people take therapy places away from severely mentally ill people. The slightly mentally ill can’t do anything about that, the fault lies on the other side of the coffee table – and in the system: there are hardly any incentives for psychotherapists to treat the severely mentally ill. You get as much money treating a lovesick student with mild depression as you do for an alcoholic with paranoid schizophrenia after a suicide attempt. No therapist would admit that, but many choose the student. This is observed by clinicians whose seriously ill patients cannot find any follow-up therapy.
In 2020, Hauke Wiegand, specialist in psychiatry and psychotherapy at the University Hospital Mainz, evaluated accounting data from almost 23,000 patients between the ages of 18 and 65 and came to a “shocking” result: 92 percent of the patients with severe depression did not receive therapy in line with the guidelines after a stay in the clinic. 21 percent returned to a clinic within a year. Also, compared to the average population, 3.4 times as many people died in the studied group. None of the deceased received adequate outpatient treatment. “From the hospital, we can often only watch how things don’t work out,” says Wiegand.
Pay therapists better – and hold them accountable
Josef Hecken points out that since October 1st doctors and therapists have been able to set up a network with clinics in order to help the severely mentally ill “quickly and as needed”. This is a good start for Wiegand, but such a network will probably only work where the structures are already good. What is missing are stronger incentives so that therapists can also network in structurally weak regions and treat more complex cases.
That brings the debate back to money. You could give therapists more money to treat severe cases. You could also oblige them to keep some of their places free for the seriously ill. It’s time not only to pay more and more therapists – but to hold them more accountable.
#mentally #ill #preference #lovesick #student
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