Stigma and bureaucracy stop mentally ill Germans from receiving treatment

Stigma and bureaucracy stop mentally ill Germans from receiving treatment

Still from U.N. video illustrating depression. Credit: WHO on YouTube

Still from U.N. video illustrating depression. Credit: WHO on YouTube

In 2014, the world watched in horror as German co-pilot Andreas Lubitz set a plane on a deadly crash course in the Alps. No one in the plane survived. Two years later, 18-year-old Ali David S. shot and killed nine people before turning the gun on himself. Though years apart, these two events have much in common.

In both cases, once German media outlets confirmed that the events were not terrorist attacks, reports turned to mental illness as a possible cause for the deaths. News outlets pointed out that both suspects suffered from “psychological issues,” were “severely disturbed,” or just downright “crazy.” In the case of the plane crash, more than 40 percent of all articles made causal connections between the pilot’s depression and the murder of the passengers. In reality, studies have shown that depressed people are more likely to be victims of violence than perpetrators, but negative media portrayals linking depression to violent acts are still common.

“We are slowly returning to a medieval perspective on the so-called ‘insane,’” said Dennis Riehle, non-fiction author and co-founder of a mental health support group. Despite recent government efforts to inform the public on mental health, Riehle has noticed a “dangerous simplification” within German media that connects violence and depression.

“Media suggests causality: rampage, depression, violence,” said Paula Klein, a student from Frankfurt who has depression and PTSD. “Add some video games and you get a massacre.”

Stigmatization can have dangerous results. When people are scared to open up and seek help due to fear of social exclusion, these illnesses can become deadly. On average, someone in Germany commits suicide every 52 minutes, with more than 10,000 suicides every year.

But media coverage is not the only obstacle deterring people with mental illness from seeking help. Like many industrialized countries, German society is driven by performance and experience. The fast pace of life and blurred lines between leisure and work can cause stress, giving rise to anxiety or burnout syndrome.

“I was convinced that depressed people with burnout syndrome were basically lazy. This only changed when I got sick myself,” Klein admitted.

German society is focused on progress and places high value on willpower as part of the cultural heritage of the postwar era of economic success. Asking professionals for help contradicts these values. The U.S. has similar values, but pop culture references to therapists have normalized their role in society. Germany has never had “Doctor Phil” on primetime television, and it would be unlikely for characters in German television shows to openly visit a therapist.

“I do think that we have come a long way since the 1960s regarding mental illness,” said Ben Stromberg, who has been diagnosed with depression. “Yet, I was very skeptical of going to psychotherapy even after I institutionalized myself.”

This skepticism can be partly explained by the major obstacles that people with mental illnesses experience when trying to get professional help. Although therapy is covered by health insurance, long waitlists are common. It can take up to eight months to get an appointment, and therapists rarely keep records of the callers they turned down.

“It’s a system of good luck,” Klein said. “When a spot is open, it just goes to the next person. When you have kids or inflexible working hours, you don’t stand a chance.” Those who can afford it opt for the more costly private therapists that are not covered by health insurance. But even those who persevere through the painstaking process of finding a public therapist don’t always find success.

“I went through months of months of waiting time only to find out that this specific therapist was not for me,” Stromberg said. “The next one had an insanely tight schedule. Eventually, I went to the hospital but they turned me down — I was ‘too high functioning.’” At that point, he gave up on his search, which he called “impossible.”

Dealing with health insurance, bureaucratic requirements, taking time off work, and calling therapists can be difficult to handle for patients who are struggling to manage everyday tasks. But the system is vastly overloaded with patients and undersupplied with professionals who have to go through years of university and extensive training before being allowed to practice.

Riehle noted that stigma against mental illness must be addressed to open up discussions and to ensure quality health service. He would like to see a more transparent illustration of therapy treatment and low-cost services through helplines and insurance in the future while connecting patients and people who don’t have mental illnesses through a more positive discourse.

It is not only in the best interest of patients but also of employers and authorities to remove stigma and help people access mental health services. In Germany, the amount of sick leave taken because of depression is 70 percent higher than in 2000, and a WHO study suggests that by 2020, depression will be the second leading cause of world disability.

“The German health system offers many options and with common sense it is possible to deal with it,” Klein said. “But when you are severely depressed and haven’t slept for weeks, you no longer have that for the moment. You need help to manage and the way the system works right now, it’s failing to provide that help.”

For all those looking for an intuitive entry into the topic or have a friend or family member struggling with depression, have a look at this video:

The video was produced in collaboration with the World Health Organization to mark World Mental Health Day and was created by Australian writer and illustrator Matthew Johnstone.

For more information on mental health, please click here.

All names in the piece were changed to protect the identities of those concerned.

Cover cartoon credit: Sergio Algeri/GYV

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