The right to first access to psychotherapy is non-negotiable!
03.06.2025 17:49
„"The right to direct access to psychotherapy is non-negotiable for us psychotherapists and for our patients!" – This unequivocal appeal is being made by psychotherapeutic associations to the Federal Ministry of Health. Even in a primary care system, as currently planned, low-threshold, direct access to psychotherapeutic consultations must be maintained, ensuring timely access for people with mental illnesses.
The associations represent a total of over 50,000 medical psychotherapists, psychological psychotherapists, child and adolescent psychotherapists, as well as psychotherapists in training and continuing education. The Federal Association of Contract Psychotherapists (bvvp), the German Society for Psychoanalysis, Psychotherapy, Psychosomatics and Depth Psychology (DGPT), the German Society for Behavioral Therapy (DGVT), the German Association of Psychotherapists (DPtV), and the Association for Analytical and Depth-Psychologically Based Child and Adolescent Psychotherapy in Germany (VAKJP) also emphasize that the management of psychotherapy practices through the psychotherapeutic consultation hour is already functioning effectively. Representatives of these associations recently reiterated this position at the General Assembly of the National Association of Statutory Health Insurance Physicians (KBV). A position paper from the KBV addresses this concern and calls for an exception for psychotherapists within the planned primary care physician system. Now, the task is to convince the health policymakers of the new legislative session of the Bundestag through discussions.
New bureaucratic hurdles for patients:
Thousands of patients seek help from psychotherapists every day. The internal hurdle of turning to a psychotherapist with their problems is often very high, and it requires a great deal of trust. Introducing a primary care physician referral system would create another bureaucratic obstacle for patients. They would first have to obtain a referral and disclose their problems to their general practitioner beforehand. Low-threshold, referral-free access to psychotherapy is already guaranteed by law. Anything else would be a step backward and a deterioration of care.
Control by general practitioners' offices is questionable.
Psychotherapists are often the first and central point of contact for their patients regarding mental health problems. It is questionable whether the two million new patients per year who visit general practitioners would actually receive a timely referral. This is because over 5,000 contracted general practitioner positions are already vacant – particularly in rural areas.
Parallel treatment in psychotherapy is not possible
The coalition agreement aims to prevent duplicate examinations and parallel treatments by specialists through coordination by general practitioners, thereby ensuring maximum capacity for care. However, parallel treatment is not possible in psychotherapy. Therapies require approval from health insurance companies, meaning only one treatment can be received at a time. Furthermore, for long-term therapies, an external expert is consulted to assess the necessity of continuing treatment. The application and approval process by the health insurance companies, as well as the expert assessment, thus examines the appropriateness and cost-effectiveness desired by the legislature.
Patients are already being guided through the consultation process.
However, the system also serves a substantive function: it aims to ensure that the "right" disorders and patients are treated. Since 2017, psychotherapists have been using the psychotherapeutic consultation hour to determine whether therapy is necessary and how patients should proceed. This has created low-threshold and short-term access to psychotherapy. An evaluation by the Federal Joint Committee (G-BA) revealed that 40 percent of patients do not seek further psychotherapeutic services within one year following the consultation. The remaining patients sometimes receive a therapy slot quickly in the same practice, while others have to wait some time. The system of referrals in psychotherapeutic practices is therefore effective.