Experts: Mandatory counseling ensures quick access to mental health care

09.01.2015 20:09

Berlin – Appointment management and more group therapies demanded – IGES supports reform of mental health care with new working group

To combat long waiting times for therapy for people with mental illness, the concept of mandatory preliminary consultations is gaining increasing support. In an IGES study, representatives of health insurance funds, as well as doctors and psychotherapists, advocate for a mandatory initial consultation to better manage access to outpatient mental health care. They also call for improved appointment scheduling, more alternative care options, and the promotion of group therapy.

The study advises expanding the range of treatment options offered. Initial counselors should be allowed to recommend not only psychotherapeutic and psychiatric therapies, but also supplementary support services such as community assistance, family and debt counseling, self-help groups, or special health insurance programs (integrated care, online services).

Data gaps regarding illnesses and treatment needs

„"The more therapy and counseling options are included, the more specifically insured individuals and patients seeking help can be directed to the right point of contact," the study states. This allows for a more targeted allocation of existing treatment capacities. The background to this is that Germany currently lacks solid data on the actual need for outpatient psychotherapeutic and psychiatric care. Furthermore, it remains unclear whether the right patients are actually receiving psychotherapeutic care.

Do not restrict free choice of doctor

The treatment recommendation given at the end of the consultation should not be mandatory, according to the study participants. Experts also emphasized the importance of counselors quickly finding a therapy slot for their patients to prevent the illness from escalating. This requires a central appointment management system – organized locally or regionally – to which therapists would be required to register their available appointments. Previous attempts to implement such a system have all failed.

In the study, researchers from the newly established "Mental Illnesses" working group at the IGES Institute interviewed experts from health insurance companies and professional associations. The aim is to support a reform of outpatient treatment for mental illnesses in light of existing supply shortages. At the end of 2013, the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) had already presented a corresponding reform concept. The Federal Joint Committee (G-BA) is also currently revising the psychotherapy guidelines. Both institutions are addressing, among other things, new regulatory mechanisms.

Removing obstacles to group therapy

Experts emphasize that effective treatment methods such as group therapy are still underutilized in Germany. The reasons cited include a lack of training and reimbursement, organizational obstacles, and patient reservations. Appropriate incentives should be introduced to promote group therapy more effectively, thereby alleviating the shortages in care, which are particularly acute in psychotherapy.

Demand planning can benefit

„"An access concept should not serve rationing, but rather ensure the needs-based utilization of existing capacities," the IGES authors summarize the statements of the study participants. Such a concept could also be designed differently regionally and for specific patient groups.

Testing innovative forms of care in models

Insights gained from a coordinated approach to mental health care could also help optimize future needs planning. However, this would not solve all regional problems. Therefore, innovative therapy concepts such as telemedicine, teleconsultations, or online therapy services should also be included, after being tested in pilot regions.