The feeling that something is off…

Changes in mental health are still often dismissed as "everyone has bad moods!" Too often, the first signs of mental illness are downplayed, which makes later treatment unnecessarily more difficult. What remains the most important first step is that those affected are taken seriously when they reach out.  However, an early, open and as specific as possible discussion of the situation can be an enormous hurdle for most of those affected. Before confiding in someone, it can be useful to ask yourself some basic questions:

  • Is there an isolated stressful situation that I need help to cope with? (Exams, change of job, separation, bereavement).
  • How much do the symptoms vary in quantity, quality and intensity?
  • How situation- or context-dependent are the symptoms?
  • Who can or should I not confide in? (Exclusion principle)

Not ruling out a mental illness per se (please do not confuse this with "self-diagnosis"!) is an important and courageous step towards getting help and improving one's life situation. Who to confide in and when always depends on the personal situation. However, professional medical help should always be an option. Those who do not want to talk to friends, family or other trusted persons from the university environment will find a sympathetic ear at counselling centres and the crisis service.

  • CampusOhr, a consultation service offered by psychology students who listen and offer conversation. Simply send an email: campusohr@gmail.com
  • Psychosocial counselling centre of the Studiwerk
  • Telephone counselling by trained volunteers sponsored by the church, phone: 0800/1110111 or 0800/1110222,Available free of charge around the clock
  • Rescue ring, online counselling, Help for people in psychological crises
  • Crisis hotline Trier: 0651/718-4545,Monday to Friday 5 to 9 p.m. (!) and all day on weekends. Psychosocial hotline for people from the city of Trier

Beginning treatment

The general practitioner/family doctor is usually the first point of contact for general health problems. Even if a mental illness is suspected, the GP's office is a good first choice. The reason for this is because it should first be checked whether the symptoms can be traced back to physical causes, e.g.:

  • Intolerances, allergies, etc.
  • Nutrient/vitamin deficiencies
  • Metabolic disorders
  • Hormonal imbalances, e.g. due to hormonal contraception
  • Previously unknown physical illness

If necessary, the family doctor can follow-up on a suitable treatment themselves or issue referrals to the appropriate specialist(s). In addition, a suspected diagnosis can be verified, initial information about the mental illness can be provided and information about possible treatment options can be offered.

What happens next?

Was a physical cause for the symptoms ruled out and/or is there a solid suspicion of a mental illness? The specialist’s diagnosis may differ from the initial assessment by the family doctor. At this point, most importantly, do not panic! The actual diagnosis of a mental illness can be shocking, stressful and unsettling. Nevertheless, it is often helpful to deal with the new situation directly and proactively. Those who are not satisfied with the diagnosis should communicate this clearly and, if necessary, get a second opinion. The next step is to decide on treatment.

Intermediate step: Insurance

What services does my health insurance cover? What else do I have to consider? For clarity, simply call the health insurance provider directly - and do not be discouraged by being put on hold.

Psychiatrist, psychologist, psychotherapist - what is the difference?

Psychiatrists have studied medicine, are a medical doctor and subsequently completed several years of specialist training (psychiatrist). They do not carry out talk therapy, but prescribe medication and occupational therapy, write sick notes and can refer patients to rehabilitation.

Psychologists have studied psychology. Clinical psychology is only a small part of their studies; important focal points are methodology and statistics.

Psychotherapists studied psychology or medicine and subsequently completed several years of training. They carry out talk therapy, paid for by health insurance if there is a health insurance coverage. They can write sick notes, prescribe occupational therapy, apply for rehab or issue a referral for psychiatry if necessary. In a psychotherapeutic practice, the patient and the psychotherapist work in a goal-oriented manner, and the goals and focal points are discussed with each other before and during treatment. Different types of therapy are detailed below:

Behavioural therapy (VT) assumes that problematic behaviour is primarily the result of learning processes and can be changed by using behavioural and learning principles. It sees itself as a transparent procedure, therapy goals are determined together with patients and treatment strategies are only used after consultation with the patient. The duration of a behavioural therapy treatment is usually 30 - 50 hours and takes place once a week. Patient and therapist sit opposite each other. Psychodynamic or depth psychology-based psychotherapy (TP) focuses on inner conflicts and developmental disorders that occur in the patient's current life situation with the unconscious taken into account. In therapeutic practice, the patient and psychotherapist work in a goal-oriented manner, and the goals and focal points are discussed with each other before and during treatment. The duration of a depth psychology-based treatment is usually 50 - 100 hours and takes place once or twice a week. Patients and therapists sit opposite each other. The focus of analytical psychotherapy (AP) is on inner conflicts, the collective unconscious. The detailed processing of the underlying causes of such conflicts and disorders, which stem from the wider past, especially from early childhood, play a central role. The duration of an analytical treatment is usually 80 - 200 hours and takes place once to three times a week. In addition to therapy in a sitting position, some therapists also offer treatment in a lying position.

How do I find a therapist?

Psychotherapists contact information is available in various places:  The Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) in each federal state provides an overview of practices online, e.g. for Rhineland-Palatinate at: www.kv-rlp.de (Start -> Patients -> Psychotherapy -> Practices for Psychotherapy).

In the Yellow Pages you will also find the address and telephone numbers of psychotherapists in your area, but there is no further information about the billing authorisation and the speciality. You can also request lists of therapists from some health insurance providers. This can be worthwhile, because in some regions the insurance companies may also offer to cover the costs of therapists not registered with a health insurance provider.

How do I make reach out?

Depending on where you live, insurance status and the therapy method chosen, the availability of therapy places can vary greatly. Waiting times of several months to a year are common at present. In order to find a place in therapy as quickly as possible, it makes sense to contact several therapists and ask for an appointment for a first session. What sounds easy in theory is often the most difficult part of the search for a good treatment. Many therapeutic practices do not have a receptionist, instead offering a time slot a few days a week when you can call and make an appointment by phone. Often you can only reach the answering machine and if you leave a message there, there is no guarantee of a call back. Since many practices have waiting lists, it is quite common and advisable to get on several waiting lists right away significantly increasing your chances of getting treatment quickly. Once you have reached a practice, they will first make an appointment with you for a "trial consultation".

Approval for therapy

In the course of the trial session (first session), the psychotherapist will make a diagnosis and apply to the health insurance company for a certain amount of therapy hours. Depending on the requirements of the funding agency, it may be necessary for the psychotherapist to prepare a report for an assessor. The report is forwarded to the assessor by means of a sealed envelope via the health insurance provider, so that the insurance provider staff do not find out anything about your medical history. Only when the assessor approves the necessity of the therapy can the treatment continue. Often there is a break during the processing time, which can last several weeks. The so-called consultative report is always required. You give this form to your treating doctor, and they state there that the current symptoms are not the result of a physical illness. Note: If you have already been in therapy and not prescribed more hours, you can try to change the treatment method, i.e. request a TP (Psychology based psychotherapy) treatment after the VT (Behavioural therapy) treatment in order to remain in treatment.

Additional treatment options

In addition to outpatient treatment by psychiatrists and psychotherapists, there are other inpatient options.

Day clinic: This semi-inpatient offer includes individual and group therapy, occupational therapy, often sports and leisure activities, as well as medical care by psychiatrists and nurses. The patient stays there from morning to afternoon and sleeps at home. They stay there for about three weeks, during which time they are also on sick leave. You can register there yourself or let the treating doctor initiate the treatment. A referral is required before treatment can begin.  There is usually a waiting period for a free place.

Acute treatment/psychiatric clinic: The desire for a voluntary stay in a clinic - apart from compulsory admissions - can arise more quickly than expected. Especially in acute stress situations (and to save one's own life!), a stay in a psychiatric hospital appears to be the best (or last) option. The range of services offered by psychiatric clinics also varies greatly, so it makes sense to find out about the clinic in general, the treatment methods and the staffing. You should also ask yourself what sort of help you want; to what extent you are in need of a sheltered/secure environment and to what extent you need a prescribed as well as sometimes restrictive daily structure. As a rule, waiting times are also very long here. It is always better to go to the clinic once too often than too little and demand admission. Such a "self-referral" is also successful if it is urgent enough. Worries that you will not be able to get out of the clinic after a self-referral are unfounded. Once you have admitted yourself, you can leave the clinic again after 48 hours at the latest, even against the will of the doctors.

By the way: All inpatient and outpatient treatment options can be combined!