According to the German Society for Psychiatry and Psychotherapy, Psychiatry and Neurology (DGPPN), around 17.8 million adults, one in three, suffer from a mental illness every year. Of these, only 18.9% receive treatment each year.
Nia* is one of them. “It’s not as easy as asking for help. It’s not as easy as admitting to yourself that you have a problem.” She talks about her struggle to find a therapist during her depression.
Nia, who lives in Berlin, sought a therapist in 2023 to treat her recurrent depression. After months of phone calls, e-mails and two initial therapy sessions that went nowhere, Nia gave up. In 2024, she decided to try again. But the situation worsened. Nia went for four initial consultations with therapists who ultimately did not have the capacity to take her on as a patient.
“I basically broke down during the process because every time I went for an initial consultation I would tell them my story and I would cry my heart out and it would always end with: yes, of course, you need help but I can’t give it to you,” Nia told DW. “I think I was scarred by the experience.”
She was eventually admitted to a psychiatric clinic for inpatient care as her symptoms worsened and she began to have suicidal thoughts. She is now out of the clinic, and paying for online psychotherapy in another EU country where the prices are cheaper than in Germany.
“Finally I decided to go out in my pocket,” says Nia. “It felt like life or death.”
As well as reaching out to psychotherapy abroad, studies have shown that more people are turning to artificial intelligence for treatment. Last year, a study by a Berlin-based online therapy platform complicated it found that only 50% of customers used AI tools like ChatGPT. About 70% of therapists surveyed said they have concerns about the accuracy and safety of advice given by AI tools.
Reducing physician fees despite high demand
Psychiatrists are in high demand in Germany, with many waiting for the first appointment of more than a year. The situation could worsen significantly if the planned reduction in psychotherapy fees is implemented in April.
At the beginning of March, the Comprehensive Assessment Committee (E-BA), a body of the joint self-governance system in the German healthcare sector, decided that psychiatric fees paid by public health insurance providers should be reduced by 4.5%.
The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) states that legally set fees for psychiatry are disproportionately high compared to other specialist medical disciplines.
The Berlin psychiatric chamber E-BA has accused the GKV of “cutting costs at the expense of the most vulnerable,” under pressure from the GKV. The Berlin chamber is now asking the health ministry, led by Nina Warkin of the conservative Christian Democrats (CDU), to object to the planned cuts.
The outcry over the planned cuts has been loud and the National Association of Statutory Health Insurance Physicians intends to take legal action. Demonstrations have already taken place in cities across the country and a nationwide protest day is planned for Saturday, March 28.
Impact on patients and the economy
In an interview with Deutsche Welle, the president of the German Psychiatric Association (DPtV), Eno Maas, called the decline a “truly disastrous sign” that statutory health insurers will regret.
“There are enormous reserves in the health care system where savings can be made, but cutting mental health care and psychotherapy right now, interfering with our good outpatient care, I really don’t understand that,” he said.
Moss practices psychotherapy with a medical clinic in the small town of Wittmund in rural Lower Saxony near the northwest coast of Germany. He says demand is so high, people often wait a year or more to start treatment.
“With today’s psychotherapy methods, we can only treat a fraction of mental illnesses in Germany,” he told DW. “The need is great and mental illness is truly a pervasive disease.”
In addition to the “tremendous suffering” of patients who are left waiting for treatment, Moss emphasized the potential negative impact on the economy. Mental illness is one of the most common causes of reduced work ability, reduced income and early retirement.
“And on top of that, there are all the personal struggles: family conflicts, losing a job because someone may no longer be able to function properly at work, and losing friendships,” he said.
Psychotherapists reducing the number of appointments for publicly insured patients to make way for more profitable privately insured clients is “inevitable,” according to Moss. He added that this would lead to more patients requiring significantly more expensive emergency care.
The public health system is under threat
According to the GVK, the fee for a 50-minute session with a publicly insured patient was around €120, compared to €170 for those paying out of pocket. These prices depend on the type of treatment and the level of urgency.
According to the GKV, statutory fees for psychotherapy have increased by 52% since 2013. It argues that this is disproportionate when compared to other specialist medical departments where fees have risen by an average of 33% over the same period.
The GKV also says that the legally set fees are reassessed annually to adjust for changes in costs such as staffing, rent and energy bills. Psychiatrists, at least according to the GKV, benefited disproportionately from this increase because their personnel costs are significantly lower than in other specialized medical disciplines.
The decision was not based on cost savings for the public health insurance system, GVK insists. It said public health insurance providers had provided more than €500 million in additional funding for psychiatric care in recent years, now totaling €4.6 billion a year.
“Although the number of psychotherapy sessions is constantly increasing and the volume of services is expanding, we are not seeing any better care or shorter waiting times,” GKV said in a statement.
In Germany, the so-called “needs assessment” determines how many psychiatrists with public health insurance credentials can work in an area. Many areas are classified as “oversupplied” with psychotherapy despite a lack of recruitment. The Federal Chamber of Psychiatry (BPtK) says that these calculations are based on figures from the 1990s, and warns that they do not reflect real demand on the ground.
The BPtK estimates that there is a shortage of 7,000 treatment places in the German public health care system. It has warned that the number of people seeking psychotherapy will increase by 23% by 2030 – by which time a third of today’s psychiatrists will have reached retirement age.
*Name has been changed to protect anonymity.
Edited by: Rena Goldenberg.
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