(Social) system

He tells me that he used to have a contingent of therapy places. It has been reduced steadily and now he can only allocate one every four months. He hates to make that choice, keeping in mind how many people come to see him. Apart from that he can’t help me anyway if I want to keep working with my current therapist.

This is how my consultation at an advice center for people who can’t perform fully in their jobs due to an illness went. As I’ve been working less since October in order to have more energy for therapy and my social life, paying for therapy has obviously not become easier. I have tried many things during the last few weeks in order to make this issue a little easier to cope with:

  • Statutory health insurance in my country contributes a small part of the costs. What remains is about as much as the rent for my flat.
  • It would be possible to wait for a fully financed therapy place which would mean that I’d have to wait for quite some time until I would get one of them. The most important disadvantage here is that I was sent to people who weren’t even willing to “work with a borderline” when I last tried. One is not popular among therapists with therapy places that are paid for by statutory health insurance when the diagnosis is a personality disorder (this is just my impression).
  • In order to get any refund from the statutory health insurance you have to waive doctor-patient confidentiality which makes the comfort zone “therapy” even more cozy. They want to know quite a lot from your therapist.
  • Also with organisations that offer affordable therapy for people with low incomes there is often a lack of experts for certain diagnoses or they only work with methods I’ve tried and not been able to benefit from. Therapy especially for BPD is mostly inpatient in my country so the fact that I’m in the middle of my career in spite of everything and that I don’t have an acute crisis is not helpful here *sarcasm off*.
  • I also tried to get into additional insurance so that a part of my costs would be covered. Understandably, insurances want to make money so all treatments for current diagnoses would have been excluded. The insurance person let me know that it would have been wise to get the insurance when I was still healthy. When I pointed out that I’m not sure if my problems started in primary school or even before and therefore I would have had to think about this insurance thing really early they didn’t respond anymore.
  • 7% of psychiatrists in my city have a contract with statutory health insurance. The poor, overloaded bastards.
    In the same city with about 2 million inhabitants there are 20 psychiatric day clinic places for childen and adolescents. In one of the richest countries in the EU.

Now this post sounds awfully like whining which is why I want to emphasize that I am in a happy situation as I have low fixed costs and a little nest egg which means I can fund my therapy despite everything. Nevertheless the financial burden isn’t small and my understanding for the lack of insurance-paid therapy places isn’t huge. I am angry with a system that abandons the weakest – all those who can’t work, who don’t attract enough attention for a hospitalization and who could never afford outpatient therapy or wait for an affordable therapy place. They are the people we sadly read about in the newspapers because they were so desperate that they jumped from a skyscraper – simply because there is no extensive, quick, and for many VITAL care. I don’t except myself when I say that you only notice these things when you’re dealing with it yourself. Until then you assume that everything’s fine.
I’m also angry because meds are so terribly easy to get your hands on in my country – I only have to see my general practitioner in order to get painkillers or sleeping pills without any problems. A 15-minute conversation with a psychiatrist who had never seen me before caused him to prescribe 3 (!) meds that can possibly be addictive without thinking twice. I had to ask both doctors about psychotherapy. Both couldn’t give me a satisfying answer, let alone help me. In the middle of depression the few vague colourful leaflets overwhelmed me just as much as the huge amount of phone calls that inevitably followed in order to get information. Statutory health insurance is willing to pay for all kinds of meds, regardless if there even are meds for the current diagnosis – always hoping that this cheap device keeps you inside the system and that you will continue to work like a robot and that’s that. A helpful therapy that works on the cause of problems (and obviously can be supported by meds) takes much too long for our achievement-orientated society. And although I am grateful to live in a social system that helps with a lot of things, I just don’t understand when people claim that there is no stigma surrounding mental illness – if that was the case, there would be more therapy programs, shorter times of waiting, less bureaucracy and arbitrariness…and maybe, just maybe, a lower suicide rate.

Note: Obviously these are just my experiences – neither do I claim that it’s like this for everyone nor am I an expert. And I am grateful because I’m very lucky to have the support I have and completely aware that there are many countries with a much worse health care. Just to be sure…

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