Around 17.8 million adults — roughly one in three people — experience mental illness each year in Germany, according to the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN). Yet only 18.9% of those affected seek treatment annually.
Nia* from Berlin is among them. She began looking for a therapist for recurrent depressive disorder in 2023. After months of phone calls, emails and two initial consultations with therapists who had no available capacity, she stopped searching. When she tried again in 2024 the situation had worsened: four more initial consultations ended the same way. “I basically broke down during the process because every time I would go for an initial consultation I would tell them my story and I would cry my heart out and it would always finish with, ‘Yes, absolutely, you need help but I cannot give it you,’” she told DW. “I think I was traumatized by the experience.”
As her symptoms deepened and suicidal thoughts emerged, Nia was admitted for inpatient psychiatric care. She is now out of the clinic and pays for online therapy with a psychotherapist in another EU country because cross-border rates were cheaper than those available to her in Germany. “I eventually decided to go abroad on my own, out of my own pocket,” she said. “It felt like life or death.”
Alongside seeking therapy abroad, more people are turning to artificial intelligence for mental health support. A study by the Berlin-based online therapy platform It’s Complicated found that just over 50% of clients had used AI tools such as ChatGPT; around 70% of therapists surveyed expressed concerns about the accuracy and safety of advice from those tools.
Cutting therapist fees despite high demand
Demand for psychotherapy in Germany is high, with first-appointment waiting times often exceeding a year. The outlook could get worse if planned cuts to psychotherapists’ fees take effect. In early March the Extended Assessment Committee (E-BA), part of the self-governing healthcare system, decided publicly reimbursed psychotherapy fees should be reduced by 4.5%.
The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband or GKV) argues that legally mandated psychotherapist fees have risen disproportionately compared with other medical specialities. The Berlin Chamber of Psychotherapists accused the E-BA, under GKV pressure, of “cost-cutting at the expense of the most vulnerable” and has called on Health Minister Nina Warken (CDU) to object. The planned cuts prompted large demonstrations across Germany, and a nationwide day of protest was scheduled for March 28. The National Association of Statutory Health Insurance Physicians has signaled intent to take legal action.
Impact on patients and the economy
Enno Maass, chair of the German Association of Psychotherapists (DPtV) and a practising psychotherapist in Wittmund, Lower Saxony, described the cuts as a “truly disastrous sign” that insurers will regret. Maass said practices can only treat a fraction of those who need care and warned of the personal and economic consequences of untreated mental illness: reduced ability to work, lower earnings, early retirement, family conflict, job loss and social isolation.
He said many psychotherapists would inevitably reduce the number of slots reserved for publicly insured patients in favor of more lucrative privately paying clients. That shift, he warned, would increase demand for costly acute inpatient care.
Public healthcare system under threat
According to the GKV, a 50-minute psychotherapy session reimbursed for publicly insured patients was about €120, compared with roughly €170 for private-pay patients; rates vary by therapy type and urgency. The GKV says legally mandated psychotherapist fees have risen 52% since 2013, while fees in other specialties rose on average 33% in the same period. The insurers argue annual reassessments meant to reflect changing costs (staff, rent, energy) led to disproportionate increases for psychotherapists, who typically have lower personnel costs than other specialists.
The GKV also points out it has made more than €500 million in additional funding available for psychotherapeutic care in recent years, bringing total annual funding to €4.6 billion. Despite growing numbers of psychotherapists and service volume, the GKV says care quality and waiting times have not improved.
A key planning tool, the so-called “needs assessment,” sets how many publicly accredited psychotherapists can work in each region. Many regions are officially classed as “oversupplied” even where appointment access is poor. The Federal Chamber of Psychotherapists (BPtK) says these calculations rely on outdated 1990s figures and do not reflect real demand. The BPtK estimates a shortage of around 7,000 therapy treatment places within the public system and warns demand for psychotherapy could rise by 23% by 2030 — by which time about one-third of current psychotherapists may retire.
The debate over fee cuts has highlighted tensions between cost control and access to care. Psychotherapists, patient advocates and professional bodies argue cuts will worsen access and increase long-term costs, while insurers call for restraint amid rising mandated fees.
*Name changed to protect anonymity.
Edited by: Rina Goldenberg.