Psychotherapy: In the country you wait up to a year

Mentally ill people need patience. There is a lack of therapists, especially in rural areas, and there is a waiting time of up to a year. The same applies to mental illnesses: the earlier you treat them, the better the chances of recovery.

Stefanie Boeke has been suffering from multiple sclerosis (MS) for 20 years. As symptoms worsen, so does the psychological burden. For weeks she calls practices in search of a therapy place, leaves messages on answering machines, writes e-mails.

“It was often the case that I got the answer: You no longer need to contact us, the waiting list is so long that it’s not worth putting your name on it,” says Boeke. “It’s just managing the shortage.”

Waiting times up to a year

Luckily she finally got a place in therapy at the Munich University Clinic. Anyone who doesn’t live in the catchment area of ​​a larger city or who has fallen ill several times, like Boeke with her MS, often waits longer than the average three months – up to a year, according to surveys by the German Association of Psychotherapists.

She felt helpless and alone, says Boeke: “I’ve tried all my life to help other people and then sometimes I feel a bit – well, I’ll say it – fooled, now that I’m need help myself.”

Finding a therapist is an additional burden

Experts assume that mental illnesses are no different than physical complaints: the earlier they are treated, the better the chances of recovery and the milder the course, says Peter Henningsen, director of the clinic for psychosomatics at the Munich Klinikum Rechts der Isar .

Even if there are no clear studies on this: “If you take this plausible assumption as a basis that clinical pictures also tend to worsen in long waiting times, it is clear that some patients will then require inpatient treatment, which would not have been the case if they had been in hospital sooner adequate outpatient therapy would have come.”

The number of therapists is determined

The Federal Joint Committee in Berlin determines how many psychotherapists there are in a region. Representatives of doctors, health insurance companies and hospital operators sit together here. According to this, a psychotherapist should be available for around 3,000 people in urban areas, and this will be financed by health insurance companies.

For rural areas, however, it was determined that one psychotherapist is sufficient for around 6,000 people. It is assumed that rural residents also travel to the cities for medical care. As a result, waiting times are longest in rural areas.

“Power Political Questions”

Why is this regulation not adapted to better serve the regions? According to Henningsen, this is a result of the struggle between medical associations and health insurance companies. “There are constant distribution battles between the different branches of medicine and the health insurance companies,” says Henningsen.

Everyone demands more money for their area. The funds, in turn, wanted to save in order to keep the contributions stable. “These are ultimately health-political, if you will, power-political questions, where the money goes,” says the clinic director.

The number of psychotherapists has increased

How do the coffers see it? Is the supply of psychotherapists sufficient? The written answer of the AOK: “In order to further reduce waiting times, we are committed to the further need-based approval of psychotherapists.”

The fund also points to successes, using the example of Bavaria: the number of licensed psychotherapists there has increased by around 250 since 2016. “There are currently 4,062 seats in the Free State,” according to the AOK. Converted, that is an increase of 6.5 percent in the past six years. According to a survey by the German Association of Psychotherapists, the demand for therapy places has risen much more sharply: by 40 percent nationwide since the beginning of 2020.

Crisis Service Bavaria

There has been a crisis service in Bavaria since 2021. Anyone in mental distress can call a national toll-free number. Professional psychotherapists are available here day and night, all week long. The well-known climber Alexander Huber is committed to making this facility better known: “Ultimately, the Bavarian Crisis Service is nothing more than the rescue service for mental illnesses. This actually ensures today that everyone in Bavaria has the opportunity to get someone on the phone to achieve. I think that’s incredibly important.”

If it turns out during the conversation that more help is needed, mobile teams are available throughout Bavaria and can be on site quickly. This does not eliminate the lack of therapy places. But at least everyone gets immediate professional psychological first aid.

More options for inpatient treatment

Back to the Munich Klinikum Rechts der Isar: Doctors, physiotherapists and psychotherapists are currently discussing the further treatment of Stefanie Boeke. The cooperation between the various disciplines is very successful, says senior physician Nadine Lehnen: “What is special is that we can coordinate very closely in this multimodal therapy and the different therapists can also bring different input to such a team meeting for the individual patients. And that’s a very nice thing.”

Patient Boeke hopes that this intensive and effective treatment will soon reach more patients – also outside of the clinics, with resident therapists. In any case, she has found new courage to live and found something suitable in a book from the hospital library, as she thinks. “The book is called: ‘Get up even if you can’t! Disability is rebellion!’ That’s my new motto in life now!” she says and laughs. After the hospital stay, however, she will have to continue to see a registered therapist.