[dgellow]

To add some nuances, as someone living in Germany, it’s correct you might have to wait months for a medical appointment, but not for emergencies. Psychiatrists, psychotherapists are generally overbooked and you likely have to wait 3-6 months (sometimes more), which isn’t great if you are in a bad place. However if we are talking about breaking something, you can get everything happening quickly and efficiently.

Personal anecdotes:

I had to wait 6+ months to get an actual diagnostic when I had a pretty bad depressive episode. Everybody around me shares that same experience. The eventual diagnostic (adhd with high anxiety) didn’t cost me anything. And I pay 15€ every 3 months or so for my meds.

When I got a lumbar disc herniation that required urgent medical intervention I got brought to a hospital immediately, got MRI scans, multiple days in hospital with an assigned physiotherapist, bunch of prescribed medication. Everything was done extremely way quickly. The whole thing, including the ambulance, drugs they injected to be able to move me, scans, hospital bed, crutches, and medication cost me around 40€. And something like 30€ for the month of physiotherapy that followed.

I have a high incomes and am self-employed so pay a bit more than 900€ a month for the public health insurance, which is the maximum here (the fact we have a cap instead of a pure percentage of income doesn’t make any sense to me, I should be paying way more). Insurances manage everything automatically.

Agreed that German doctors are really hit or miss, though that has been the case everywhere I lived

[47282847]

What German health care providers don’t tell you is that you have the legal right to get faster psychological assistance, and they have to cover the costs of a private therapist if you can show that there is no availability in your area. They try to make the process as ugly as possible, and I understand that typically you will not have the capacity to deal with that in times of need, but with some more awareness around this topic maybe you can find a friend or a social worker to assist you with that. See eg https://www.kassenwatch.de/ In all major cities, there are dozens of nonprofits that quickly will help you for free; it’s more that those in need most times don’t feel comfortable asking for that kind of help.

Personally, my life improved considerably when I decided I’ve had enough of it, and that spending around 100€/h on my mental health, plus attending group therapy which you can find for as low as 20€ for a full weekend (for example IoPT), was the best quality decision of my life. I understand not all of society is in a position to spend that kind of money, but think and be honest on your own spending and valuation. I know people that easily spend that amount on drugs or booze or hobby activities that don’t really address their mental health issues. If I hear you complaining about not finding a therapist but I see you driving a 50k€ car, or spending 2k€ on “vacation”, that’s on you.

Yes, public health insurance could be better than it is, but it’s not without alternative. The private therapists I work with have zero waiting time, and anyone can get an appointment within a week or two with them. You can spend a long time complaining and waiting, or you can invest in yourself.

It can feel life threatening to go to a therapist. And I get how people are not ready to admit to others that they’re fucking scared, and ashamed. But they should at least admit to themselves that that is the real reason, not the waiting times. The people I know that actually finally found the courage to take the step suddenly discovered that for some reason they actually didn’t have to wait very long. The federal 116117 assistance line used to be pretty bad but it has improved considerably in the past decade. Same for the local mental health crisis lines (“Krisendienst”).

[esbranson]

> legal

> don’t tell you

As a Wikipedian who has edited primarily on US legal systems but also Germany's ... I seriously doubt more than a handful of non-attorneys have any clue about the actual workings of the German legal systems.

The biggest issue is of course the lack of codified laws and regulations. (Note that collections like the Gesetze im Internet are more like US Statute Compilations. If you don't know what the Statute Compilations are and have never heard anyone mention them, case in point.) The Swiss SR is odd man out of course, even though it's unofficial it's still usable. US states and states like Germany do however follow similar court reporting practices, e.g. court case decisions are only selectively published, so we have similarly little insight into how laws are actually implemented in practice. (The US federal government is better, but its impact on everyday people is incomparable.)

[dgellow]

Thanks, that's great info to share. I remember trying 116117 and reaching out to a bunch of places and not having any luck with it in my region, but it was just after Covid, anything assistance related was overwhelmed at that time

[fundad]

In the US, most specialists are booked out 6 months. It seems impossible to find a mental health care provider that accepts insurance and is taking new patients. You can get prescribed mental health drugs from your primary care physician.

That's just my experience and I have health insurance provided by one the world's richest employers, I pay 4,318.86/yr in premiums for our family with a multi-thousand-dollar deductible.

Maybe if I was a very rich person in a poorer area that still happens to have a hospital, I'd have an easier time scheduling healthcare but I'd have to make that choice over moving abroad.