Understanding mental health care in Germany

by Dr. Eileen Wollburg
Stripes Europe

Arriving in a foreign country, one faces many challenges, and navigating an unfamiliar healthcare system may seem like an under¬taking best left avoided. Yet military life presents stresses beyond adjusting to a different culture, and understanding what choices are available can lead to a difference in quality of life and mental well-being. Germany offers a range of options to visitors, and U.S. military personnel and their families also have the option to use TRICARE coverage for psychological services.

Mental health is defined by the World Health Organization (WHO) as “a state of well-being in which an individual can realize his or her own potential, cope with the normal stresses of life, work productively and make a contribution to the community.” This defini¬tion includes that psychological problems not only affect the people suffering, but also their families, friends, caregivers and society. About one-third of adults suffer from at least one mental disorder over the course of their lives. Yet despite mental illness being frequent and the leading cause of disability in many Western countries, those suffering are not only faced with the direct consequences of their illness, but also with stigma and discrimination. Therefore, the WHO strives to improve promotion, preven¬tion, care and treatment.

Germany leads Europe in its commit¬ment to treating mental illness by providing financial support for patients, access to healthcare services, help finding or staying in work, outreach programs and awareness campaigns. Inpatient and outpatient services are included in German mental health care, and general practitioners (GPs) play a key role in dealing with mental health problems on a daily basis. They identify patients, diagnose and treat problems, and refer people to specialists. Aside from primary care, patients can seek help directly with psychiatrists (for psycho-pharmacological treatment), licensed clinical psychologists (for psychotherapy), or specialists for psychosomatic medicine (MDs who conduct psychotherapy). In most cases, psychiatrists do not offer psychotherapy due to time constraints. Off-base licensed psychologists can be found through the psychology state board´s website (for example, here is the website for Hessen), which allows you to narrow the search to your specific needs (e. g., language, specialty, group vs. individual therapy). Near major cities, some therapists also offer their services in English. Physicians can be found through the medical counterpart: the states´ medical association (for Hessen: portal.laekh.de/arztsuche).

If inpatient psychological treatment is required, two options exist: psychosomatic clinics — which treat depression, anxiety, obsessive-compulsive disorder (OCD), and eating disorders, for example — and psychiatric hospitals. Both of these can exist as stand-alone clinics or as wards of general hospitals. Even though there is wide overlap, psychiatric treatment is usually necessary for more severe mental problems such as acute suicidal ideations, addiction or psychotic symptoms. Psychiatric hospitals offer support for a few days (emergencies) up to several months, while the average length of stay at a psychosomatic clinic ranges between four to six weeks. In addition, psychiatric hospitals often provide an integrated outpatient clinic. Furthermore, Germany offers partial inpatient treatment (Tagesklinik) to ease the transition from clinic to home. In these settings, patients spend the entire day at the clinic, but go about their everyday lives afterward and sleep at home.

Various doctors or clinics are part of the International SOS/TRICARE Overseas Program (TOP) Network. If you seek help from a TRICARE Participating Provider, you will not be required to make an up-front payment. Your local TRICARE Service Center can provide you with a list of physicians/clinics in the overseas network. Overall, coverage depends on the beneficiary and plan. For off-base care, you usually need to receive pre-authorization. TRICARE Overseas Program (TOP) Prime family members and TOP Standard members, however, receive eight sessions of psychotherapy per fiscal year without authorization, except for analysis and therapy provided by a substance use disorder rehabilitation center. Aside from benefit coverage through the military, one always has the option to pay out of pocket for any service.

The most important step is to seek help, and hopefully this is made easier by knowing that host-nation choices are accessible.

Read our Stripes Health and Medical Guide online.

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