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How to find mental health resources in Germany for children

As mental illnesses and behavioural disorders among children and teenagers continue to rise, it can be difficult for international parents in Germany to know where to find resources.

Published: 19 April 2024 16:17 CEST
A child looks out the window. How can you get mental health help for children in Germany?
A child looks out the window. How can you get mental health help for children in Germany? Photo: picture alliance/dpa | Sebastian Gollnow

Whether it’s school stress, adjusting to a move abroad, low self esteem, a personal crisis, hormonal changes or family issues, there are plenty of things that may make it hard for young people to cope with everyday life. 

A survey screening child anxiety disorders, found children in Germany ages 11 to 17 with symptoms of anxiety more than doubled over the course of the pandemic from under 15 percent before the pandemic to nearly a third of children surveyed exhibiting symptoms in January 2021. 

And social media has only added to the problem. According to a recent DAK study, media addiction among children and young people in Germany has nearly tripled from numbers before the pandemic. 

Girls and boys with heavy social media use reported more depressive symptoms, anxiety and a higher level of stress than children with less media usage. The parents of the affected children and young people also reported more dissatisfaction with communication within the families.

While Germany has a large capacity to care for mental healthcare patients, it can still be tough to find resources for children, especially if there’s a language barrier. Here’s a guide to finding mental healthcare for children and youth in Germany:

Is mental health care covered by insurance in Germany?

Yes, Germany’s state health care system covers mental healthcare. Statutory health insurance currently covers nearly 90 percent of the population. This insurance gives residents access to consultation with a psychiatrist, therapy, in- and outpatient care, emergency mental health services and medication. 

READ ALSO: How to receive help for a mental health issue in Germany 

Where should you start?

Parents should start by reaching out to their children’s paediatrician or family doctor. After explaining how your child is doing, they will likely refer you to a child psychiatrist to further evaluate treatment options. Treatment can include prescribing mediation, talking therapy, or a combination of both. You can also directly set up a consultation with a mental health professional for your child.

Insurance type, public or private, can also impact the type and availability of services. Public insurance covers fewer practitioners, meaning you may have to cover the cost of therapy for your child upfront and wait to be reimbursed.  

Whether you have public or private insurance can impact the type and availability of services. Public insurance covers outpatient psychotherapy, but patients must meet specific requirements for coverage. Doctors can also write a letter that parents can submit to their health insurance to access up to six therapy sessions, with the possibility of extension. 

Families using public insurance may also have longer wait times. Nearly half of all patients must wait three to nine months before receiving care, according to Germany’s Federal Chamber of Psychotherapy. 

A school girl at a Leipzig school. Photo: picture alliance/dpa | Hendrik Schmidt

This problem is worsened because public insurance does not cover all mental health professionals. Practitioners must have a ‘Kassensitz’ licence to bill public health insurance. These licences are regulated by the government and are limited. The cost of this licence, along with the waiting time for it, is often a deterrent to some practitioners. 

Another option could be to talk to your child’s school. Some schools employ social workers and psychologists who can screen and provide resources to children. These professionals can screen young people who exhibit symptoms of mental and emotional distress or hyperactivity in the classroom. They can also refer you to additional resources for more specialised treatment. 

What mental health resources are available?

As of 2022 there were more than 55,000 child and adolescent psychologists working across the country, according to data from the German society for psychiatry and psychotherapy, psychosomatics and neurology (DGPPN). The majority of these health professionals work in outpatient facilities, and the remaining 15 percent work in inpatient or day-care facilities. 

Germany has 274 mental health hospitals, 401 psychiatric units across general hospitals and 63 mental health outpatient facilities, according to the UN’s 2020 Mental Health Atlas. The country also started granting more specialist titles, including in child and adolescent psychiatry, in 2022.

Germany has also launched a helpline called “Nummer gegen Kummer” (number against grief) to support children facing mental health issues, whether it’s to do with getting bad grades or dealing with unrequited love.

READ ALSO: ‘Being honest helps’: How expats have overcome loneliness

The free help line – which is accessed by calling 116 111 – is active Monday to Saturday from 2pm to 8pm daily. Children can anonymously speak with volunteer consultants who range from the elderly to students ages 16 to 21. It is important to note that this resource is intended for children comfortable speaking German at an elementary level.

Other resources to consider include:

  • Online directory Therapy Route features English-speaking psychologists and social workers across Germany
  • It’s Complicated connects users to in-person or virtual therapeutic care based on your language and insurance type
  • Online directory Therapie.de lists around 600 English-speaking therapists currently working in Berlin, 150 in Frankfurt, around 230 in Hamburg, and 240 in Munich

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OPINION AND ANALYSIS

OPINION: Why it’s becoming harder to get a doctor’s appointment in Germany

Germany's health service is known as one of the best in the world but securing a timely appointment with a doctor is getting harder. A creaking system and the culture around excessive doctor visits are part of the problem, argues Brian Melican.

Published: 17 May 2024 11:54 CEST
OPINION: Why it's becoming harder to get a doctor's appointment in Germany

Germans have always been known for being health-conscious – some would even say hypochondriacs. That has its down-sides (see Covid…), but also some notable advantages. One is the ability to go to any doctor’s practice and request treatment, skipping general practitioners, referrals, and all of the attendant bother.

As a result, in any well-to-do area of a major German city, you’ll have a bewildering array of medical practitioners within walking distance, from general physicians (Allgemeinmedizin) and orthopaedic practices (Orthopädie) to ones that will have you Googling (HNO stands for Hals-Nase-Ohren – ears, nose, and throat – by the way. You’re welcome.)

The strength of this patient-choice system is that it allows people to manage their own care. So if one doctor can’t see you, you go and find another. And if you’ve moved towns or fall ill away from home, you can still access care. In theory, this spreads demand and keeps people with non-urgent complaints out of casualty wards. Yet in practice, the system is now creaking audibly. 

In recent months, I’ve tried to get appointments for several routine procedures with doctors’ offices I have been visiting for years – and the earliest I could get anything was, to my surprise, now several months off. Both dentists and dermatologists are currently, it would seem, planning their schedules for September and October. And when a rather unpleasant case of shoulder pain struck earlier this year (fittingly, just ahead of my 39th birthday…), the earliest appointment I could get at any of the three(!) local orthopaedic practices was at least a month off.

This isn’t just me getting unlucky here. In a recent representative survey, only 25 percent of respondents reported having no trouble getting a doctor’s appointment. The rest are having to wait anything between two weeks and two months – and I’m clearly now one of the 15 percent who report even longer delays. 

I’m not alone in thinking – knowing – that it didn’t used to be this way. So what has gone wrong? 

READ ALSO: Seven things to know about visiting a doctor in Germany

Structural changes in medical practice: fewer doctors working fewer hours

First off, there are changes afoot among Germany’s niedergelassene Ärzte – literally ‘settled doctors’ with surgeries, called so in order to distinguish them from hospital medics. For one, these doctors are getting old and retiring – just like the population they serve (or rather: have served). And as younger cohorts are less numerous, physicians looking to pass on their practices are having difficulty finding takers – especially in disadvantaged urban areas or out in the sticks.

A patient undergoes a consultation with his doctor.

A patient undergoes a consultation with his doctor. Photo: picture alliance/dpa/AbbVie Deutschland GmbH & Co. KG | AbbVie Deutschland GmbH & Co. KG

Even where there is no shortage of potential successors, ever fewer of them actually want to set up in business for themselves. For most young medics’ taste, there’s too much paperwork, too much commercial risk, and far too much work involved in running their own surgery. Instead, they prefer to merge with others or sell on to management companies who will, in turn, employ them (often part-time, with no annoying evenings or weekends on call). 

The results of all of this are as follows. Within the space of just one year, between 2022 and 2023, the number of surgeries fell by 1,987 – a drop of over two percent. Meanwhile, in 2023, for the first time ever, more than one third of Germany’s 150,000 non-hospital doctors were employees, not self-employed. That’s twice the number in 2013. Moreover, over the same period, the number of medics opting to go part-time has gone up by 235 percent to 60,000. This means that, if your local surgeries haven’t closed, the likelihood is that the doctors there are now working fewer hours – and so there are fewer appointments left to go round.

READ ALSO: Do doctors in Germany have too little time for their patients?

This would be bad news for any society, but it hits particularly hard in Germany. As a rapidly-ageing society with a relatively unhealthy population (high rates of smoking and obesity), our demand for medical services – often for complex chronic illnesses – is rising just as provision is declining.

Cultural differences in consulting doctors

Another problem is that Germans are accustomed to a historically high number of available doctors – and as serial worriers (and passionate sick-note seekers) make excessive use of them. Your average German racks up almost 10 consultations a year – not including visits to the dentists! The OECD average is closer to six. And the stoic Swedes, strong silent types that they are, go the doctor’s just 2.3 times a year.

Even if I wanted (or needed) to, I simply couldn’t to get to the quack’s almost once a month: I don’t have the time and they don’t have the appointments. But in conversation, I notice that others clearly do manage to find both. Increasingly, I’m wondering how many of them, unlike me, have private health insurance. 

This brings us to the third major issue facing non-hospital care in Germany. When the figures in the representative survey I quoted above are broken down, it transpires that almost 60 percent of people who are insured in the state system (gesetzlich versichert) are now waiting longer than two weeks for an appointment; among those who are privately insured (privat versichert), that figure is only 37 percent.

Doctors ‘keen on private patients’ 

Doctors are keen on private patients because their insurers pay more for the same procedures and will also cover all sorts of supplementary stuff – from the clinically-proven through to the just plain wacky. As such, practices reserve as many appointments as possible for private patients and try to keep the rest of us at bay.

Given that around four in five people in Germany are in the state system, however, this leaves the majority of patients competing for the minority of slots. If you want to see how the other fifth live, try “accidentally” clicking privat on surgeries’ online booking tools: you will now see a range of appointments available within days while the rest of us are being fobbed off for weeks or even months.

Not only is this, as my grandmother used to say, enough to make you want to join the Communist Party – it’s wildly inefficient. By restricting the hoi-polloi to slots often months off, doctors are creating their own appointment-management problems: sometimes, the complaint in question will have disappeared by the time the consultation rolls around; more often, it will have actually been dealt with – not infrequently by the same physician – if the patient presents as an acute case earlier.

As such, slots weeks away are booked, only to be cancelled later by conscientious patients (and left blocked by others), while those same patients crowd into waiting rooms begging to be seen urgently at an open surgery. (That’s how I got my shoulder looked at.)

A German health insurance card.

A German health insurance card. Photo: picture alliance/dpa | Jens Kalaene

The cynic in me says that, in the long run, this might not be such a bad thing. If the increasing scarcity of doctor’s appointments gets Germans thinking about whether they really, really need to be seen for yet another case of the common cold (“No, Christian, it isn’t pneumonia this time, either!”) or various nebulous self-diagnosed ills (Kreislaufbeschwerden (circulatory problems) is the day-off-work-one I love to hate), maybe it’s not a bad thing.

Swedes don’t die unnecessarily because they avoid the doctor’s: in fact, they live a good year longer than us on average. The German in me, though, says: “My shoulder hurts. Maybe I’ve got early-onset arthritis. I should probably go and get it checked out…” And even though I don’t go too often, I’ve got used to being able to see a specialist when I need one. It’s a shame that this is becoming markedly more difficult.

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