Survey of the Network for Psychotherapeutic Care in Europe about the psychotherapeutic care of refugees in the EU
In 2015 estimated 19.6 million refugees worldwide have lost their homes to escape war and persecution —half of them being children. In Germany for example more than 1 million people have sought protection last year. Besides physical illness refugees suffer from acute mental health problems and trauma symptoms, above all post-traumatic stress disorder and depression.
The inadequate provision of care to refugees is an international topic of concern. Most countries offer some basic health care facilities, but mental disorders often are only treated in exceptional cases. Until now there is little evidence how the matter is being addressed in the different countries The Federal German Chamber of Psychotherapy (BPtK), in cooperation with the NPCE, therefore carries out mopping the situation of mental health care for refugees in the welcoming European countries. In case you are an expert in this field, please join the survey.
You will find the questionnaire here, for more more information on Health care for refugees in Germany please follow this link.
Please send your completed questionnaire to the following eMail-Address: firstname.lastname@example.org
Download: Survey about the psychotherapeutic care of refugees in the EU
NPCE contributes to EU Commission consultation on access to health services
The NPCE sent a general comment to the European Commission's public consultation on the preliminary opinion on ‘Access to health services in the European Union’. Despite the fact, that mental illnesses are treatable and the best treatments today are highly effective, there are serious gaps in the provision of services. The contribution underlines the following objectives:
- Promote health as quality factor of life and social value.
- Give priority in investment in prevention and early intervention and create specific programs dedicated to vulnerable populations.
- With the impoverishment, unemployment, isolation due to immigration, more human resources for the medical and psychosocial care for families and individuals is needed.
- Adapt health services to people and communities, effective decentralization of services, bringing services closer to communities.
- Networking with professionals, local and communities associations.
- The whole mental health professional staff needs a common ground of positive therapeutic attitudes and ethics. Building shared attitudes should be part of multi-professional efforts in developing quality standards in health care and multi-professional engagement in mental health care management.
- There is a need for first line treatment prior to medication that follows best practice and is driven by evidence.
- Mental health care should be taken as a priority, for that clinic psychology and psychotherapy services (for adequate prevention and intervention) should be included as first-line response in basic health services, with preventive value for the diagnosis and psychological treatment in this area.
PUBLIC CONSULTATION ON THE PRELIMINARY OPINION ON ‘ACCESS TO HEALTH SERVICES IN THE EUROPEAN UNION’
Conference report: European Health Forum Gastein 2015 - Securing Health in Europe
The 18th European Health Forum (EHFG) was held from 30 September to 2 October, 2015, in Gastein, Austria, and was titled “Securing healthcare and sustainability, strengthening healthcare systems.” Nikolaus Melcop took part on behalf of the Federal Chamber of Psychotherapists (BPtK) and the Network for Psychotherapeutic Care in Europe (NPCE).
In the course of the event, Mr Melcop had the opportunity to speak personally with Vytenis Andriukaitis, EU Commissioner for Health and Food Safety, and explain the need for improving psychotherapeutic care across Europe. In addition to addressing the overall supply shortage of such care that already exists, the European states must in particular establish psychotherapeutic services for the high numbers of mentally ill refugees arriving in Europe. Commissioner Andriukaitis affirmed this assessment and emphasized the important role of psychotherapeutic care in these circumstances. He assured Mr Melcop that these problems would be addressed by the EU Commission, and that efforts for improvement would be supported.
The entire conference was shadowed by the sharp increase in refugees arriving in Europe. Prof. Helmut Brand, President of the EHFG, stressed that the situation is particularly about European healthcare systems being additionally burdened by the ongoing influx of asylum-seekers. Prof. Brand summed up the discussion: “It’s a matter of primary medical care in the short term, caring for post-traumatic disorders – particularly among children – in the medium term, and adapting our healthcare systems to increasing migration in the long term.” Many presenters emphasised the European vision founded on solidarity and shared values. The principle of equal access was asserted as a primary objective. New technologies, in particular e-health practices, were identified as ways to facilitate this, and to work efficiently with resources.
Models and ideas for improving the provision of healthcare were proposed, such as a future scenario in which each individual would manage his or her own health, thus assigning the responsibility of ownership, control and disclosure of personal health information to the individuals themselves. During the forum, the European Health Award ceremony was also held. This year’s winner was the MiMi Project (Healthcare with Migrants for Migrants).
For further information, please read the correponding EHFG Press Releases
At least half of refugees are suffering from mental illness
“Mental Disorders among Refugees”: The position of Germany’s Federal Chamber of Psychotherapists (BPtK)
At least half of refugees in Germany are mentally ill. Most are suffering from post-traumatic stress disorder (40 to 50 percent) or depression (50 percent). These two diseases frequently occur simultaneously. Refugees who suffer from post-traumatic stress disorder (PTSD) are often suicidal. Forty percent of them have either previously planned to take their own life or have attempted to do so. Mental disorders caused by traumatic experiences are also particularly common among child refugees in Germany. In fact, one in five child refugees is suffering from PTSD, a rate that is fifteen times higher than that for children born in Germany. These are the central points contained in "Mental Disorders among Refugees,” a position paper presented today by the Federal Chamber of Psychotherapists (BPtK).
Psychotherapy is the recommended method of treating PTSD. Solely treating this disorder with medication is not sufficient, and generally not medically responsible. Yet, only about four percent of mentally ill refugees receive psychotherapy. “Mental disorders are among the most common illnesses among refugees. As a rule, they urgently require treatment,” insists Dr Dietrich Munz, President of the BPtK. “The arriving refugees not only need accommodation and food, but also medical care. However, almost no mentally ill refugees are receiving appropriate care. The BPtK therefore urges that legislative changes be made, and that authorities be granted to psychotherapists and refugee centres, to enable guideline-appropriate treatment to be received by mentally ill refugees.”
Escape and trauma
Events that are life-threatening and catastrophic for those who experience them, and which cause deep despair, can lead to severe mental illness. PTSD most frequently occurs following traumatic events perpetrated by other people – by so-called “man-made disasters.” Approximately half of the victims of rape, war, forced migration and torture suffer from PTSD. Among the most common “man-made disasters” reported by refugees are being under attack with firearms and grenades, hunger and thirst (e.g. during imprisonment), death threats and mock executions, physical torture, electric shocks, sexual humiliation and rape, and witnessing executions and incidents of rape.
Those suffering from PTSD live through the traumatic event(s) repeatedly, usually in the form of nightmares or flashbacks. These recollections are experienced with such intensity that the sufferer feels as though the events are actually re-occurring. During their flight to Germany, Yezidi women who escaped captivity in the Islamic State experienced flashbacks and panic attacks that included palpitations, shortness of breath, dizziness and fear of death. The close confines of the airplane triggered memories of their captivity. PTSD sufferers therefore avoid situations that can evoke memories of their traumatic experiences. Other symptoms of PTSD are pronounced jumpiness, sleep- and concentration-related disorders, emotional numbness and indifference toward other people. “PTSD sufferers are severely mentally ill,” explains Dr Munz. “They urgently require psychotherapy. It is shameful that people with such severe and painful psychological wounds almost never receive appropriate assistance.”
In accordance with the current EU directive regarding the reception of vulnerable persons, Germany is obliged to take into account the specific circumstances of such individuals. Such vulnerable persons are defined as those with mental illnesses and those who have been subjected to torture, rape or other serious forms of psychological, physical or sexual violence. This directive was supposed to have been implemented by July of this year. In fact, the provision of care to mentally ill refugees in Germany remains shamefully poor. Indeed, the amendments made to the Asylum Seekers Benefits Law (Asylbewerberleistungsgesetz) in March 2015 brought no improvements for mentally ill refugees. The BPtK therefore urges that the treatment of mentally ill refugees be improved. This will in particular require social service agencies to have qualified assessors in place, refugee centres and private psychotherapy practices to be empowered to treat afflicted refugees, and funding for translation/interpreting services.
Benefits under the Asylum Seekers Benefits Law
The decision by social services as to whether psychotherapeutic treatment is to be provided to a mentally ill asylum seeker during the first 15 months of his/her stay in Germany often takes several months. Most often, the decision as to whether psychotherapy is necessary or not is made by case workers or physicians whose training with respect to mental illness is either non-existent or inadequate. This often leads to erroneous assessments. Mental illnesses are thereby wrongly judged not to require urgent treatment, or are judged only to require a drug treatment, which is in fact inadequate. “The assessment and granting of psychotherapeutic treatment provided by the Asylum Seekers Benefits Law is grossly deficient,” explains Dr Munz. “In future, all applications for psychotherapy should only be reviewed by qualified assessors.” In the view of the BPtK, it is also unacceptable that refugees in Germany are being deprived of medical treatments that are considered in Germany to be necessary medical care. The restrictions on medical care to refugees stipulated in the Asylum Seekers Benefits Law should therefore be repealed.
Empowerment of refugee centres and private practices
After a stay of 15 months in Germany, refugees are entitled to statutory health insurance benefits. In principle, those refugees suffering from mental illnesses are then finally entitled to psychotherapy. Those currently receiving such psychotherapy are almost exclusively being treated in psychosocial centres for refugees and victims of torture. However, most of the psychotherapists who work in such centres are not entitled to bill the public health insurance authority. This means that after the 15-month period, refugees are also left receiving practically no psychotherapeutic treatment. The BPtK therefore calls for the entitlement of psychotherapists in refugee centres, as well as private psychotherapy practices, to bill the public health insurance authority for the treatment of refugees. This would be possible, based on the authorisation regulation applicable to physicians. “This would significantly improve the treatment of mentally ill refugees in a rapid and un-bureaucratic manner,” explains Dr Munz, President of the BPtK.
The psychotherapeutic treatment of refugees nearly always requires the assistance of interpreters. To date, the costs of interpreting services are seldom covered by social services, and never by the public health insurance authority. The BPtK therefore proposes that the Asylum Seekers Benefits Law be amended to entitle all refugees to interpreting services, when such services are necessary for their medical treatment.
Press Release "At least half of refugees are suffering from mental illness - Mental Disorders among Refugees: The position of Germany’s Federal Chamber of Psychotherapists (BPtK)"
(German Language Version, BPtK-Homepage)
EU Parliament breakfast discusses on “Standardisation of Heathcare Services and Patient Safety”
On 27th of May 2015 the Federal Chamber of Psychotherapists, together with the German Medical Association and the German Dental Association organized a breakfast debate in the EU-Parliament on Standardisation of Healthcare Services and Patient Safety. The breakfast debate was hosted by MEP Dr. Angelika Niebler (German, EPP) and MEP Dr. Andreas Schwab (German, EPP). About 25 representatives from the EU-Parliament, the EU-Commission, Regional German State Ministries, German health provider organizations, including hospitals, from The Standing Committee of European Doctors and the European Social Insurance Platform attended the discussion.
The speakers expressed their concerns on current activities of the European Committee for Standardisation (CEN) in the development of standards for healthcare services. They agreed:This activities are superfluous, inexpedient, intervene in national competences and raise serious concerns with regard to legitimacy and the preparation process. The standardisation of health professional services lacks market relevance and added value. At the conclusion of presentations, a lively discussion took place on the need, to develop standing principles for health care in a transparent process by independent medical and therapeutic experts. Standards from the CEN as a profit organization should refer on technical standards for products and should not be extended on public services and health care.
CEN is currently developing standards e.g. in the field of cosmetic surgery, treatment of cleft lips, homeopathy and osteopathy, dealing with requirements of documentation, qualification and for facilities. These activities are initiated by national members within the CEN. The EU Commission is empowered by regulation to initiate standardization processes, including public services and health care.
The hosting Members of Parliament of the event, Dr. Angelika Niebler and Dr. Andreas Schwab, announced to engage for a position of the Parliament that health care services should be taken out of the Commission’s activities in the field of standardisation.
Programme Parliamentary Breakfast 27 May 2015
Dr Nikolaus Melcop (BPtK) on “Standardisation Of Therapeutic Services Using The Example Of Psychotherapy”, Text Of Speech
GVG EU Committee, Position of “Standardisation Of Healthcare Services”
2nd International Conference of the Polish Society for Psychotherapy Integration
From 6-8. June 2014 is taking place the 2nd International Conference of the Polish Society for Psychotherapy Integration-“Integration in Psychotherapy-Effectiveness and Limits” in Warszawa, Poland. It offers lectures and workshops with Prof. Leslie Greenberg, Prof. Stanley Messer, Prof. George Silberschatz, Dr Martha Stark, and Dr Kenneth Frank. The event will also be great opportunity to meet colleagues from all over Europe.
PSIP conference program EN 140315.pdf
Improved Access and Enhanced Collaboration
Conference: De-medicalising primary mental health care
On 30th & 31st May 2013 about 180 professionals across many disciplines – psychologists, psychotherapists, general practitioners, primary mental health care workers, researchers, policy makers and stakeholders - met at the University of Limerick/Ireland to discuss the political, social and scientific challenges to improving public access to talk therapies. The event was hosted by Member of Parliament Nessa Childers (Socialists & Democrats), and organized in partnership with the Network for Psychotherapeutic Care in Europe (NPCE).
Key speakers from Ireland, Europe and the US presented papers examining the political, social and scientific challenges of mental illness and addressing ways and means of providing improved primary mental health care that offers talk therapy rather than the medical approach that currently predominates. In her opening speech Nessa Childers emphasised that “apart from the obvious benefits for individuals, good mental health is increasingly important for economic growth and social development in Europe. All these are key EU policy goals”.
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Nessa Childer, MEP
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Dr Declan Aherne, University of Limerick
“Talk therapies are the most suitable form of treatment for the majority of mental health issues and could be made available at primary care level at no extra cost. In Ireland 90 percent of people with depression are currently receiving medication while the recommended treatment for depression in 70 per cent of cases is psychotherapy only. The total annual cost of psychological services at primary care level would be almost 20% less compared with the amount spent on antidepressant drugs in community drug schemes in 2012”. This was the key message from Dr Declan Aherne, clinical psychologist, head of counseling at the University of Limerick and one of the core members of NPCE.
Fiona Ward, director at the HSE Dublin North East, also acknowledged that there had been a 25 per cent increase in prescriptions for anti-depressants and other psychiatric drugs in the past five years for medical cardholders. “Providing counseling and therapy at primary care level can reduce stigma, offer early intervention, reduce the number of GP visits and prevent more complex difficulties,” said Ms Ward.
Examples of good practice from other European countries were presented. They showed that all European health care systems face the same challenges for the future and that there is the possibility and the need to improve services in every country. “Conditions for the work of psychotherapists in Germany are well developed, patients’ direct access to a psychotherapist is assured and psychotherapy is well integrated into the medical health care system”, reported Prof. Rainer Richter, President of the German Chamber of Psychotherapists and initiator of the NPCE. “Psychotherapists are highly qualified, but not enough use is made of psychotherapy's potential. The structures of the healthcare system lack coordination and cooperation in the care of mentally ill people.
Financial resources are not allocated efficiently. General practitioners and psychotherapists must work together more closely. The GPs have to be trained to recognize the need for psychological treatment. For patients with complex treatment needs in particular it is necessary to set up a horizontally and vertically integrated system of care”, he explained.
Prof Rainer Richter, President BPtK
The conference also heard about free access to short-term psychotherapy for all citizens at primary care level in Holland. “We work close to the living environment of the patient in close connection with the doctor and social worker and we see patients in the practice and at home,” explained Prof Jan Derksen from the department of clinical psychology at the University of Nijmegen. “We ask the GPs not to start prescribing medication before we see the patients and we have new plans for GPs and psychotherapists to treat patients in shared consultation,” he said. The need for mental health services to reach out to people in areas with high levels of social deprivation and the need for first line treatment prior to medication was the focus of a talk by Dr Jim White, clinical psychologist who leads the primary care mental health team in southeast Glasgow.“We are dealing with people who are demoralized, demotivated and not psychologically minded so we shouldn’t have waiting lists and hurdles for them to cross to get to therapy,” said Dr White. He stressed the importance of leaving the clinic and meeting people where they are.
Patrizia Reilly, cabinet member in the office of the European Commissioner for Research and Innovation pointed out the chances within the EU's new funding programme for research and innovation Horizon 2020 that is currently being discussed. “Health and wellbeing for all will be one of the cornerstones of Horizon 2020, which will begin in 2014. Such an encompassing programme fits the cross-disciplinary nature of mental health research that you are discussing today” she underlined.
In effect, participants agreed on the need to move away from the medical model that is currently in place and towards a psychosocial model that follows best practice and is driven by evidence. They underlined the idea of creating a system that integrates mental health into different services. It was put forward that pathways are not always sufficient clear. In order to make collaboration accountable, it also becomes important to understand how the different orientations within psychotherapy work and to develop in the direction of a unified theory.
Participants emphasized the need to pilot a project by the European Commission on improving access to psychotherapy across a number of European states and underlined the will to achieve enhanced collaboration across professional groupings in the future.
Conference Presentation Nessa Childers, MEP
Conference Presentation Dr Declan Aherne, University of Limerick
Conference Presentation Prof Rainer Richter, President BPtK
A third European Conference on Psychotherapy will take place under the headline
De-medicalising primary mental health care: Can we afford to, can we afford not to?
Revolutionising access to psychological care in Europe
Hosted by Nessa Childers MEP
In association with the Network for Psychotherapeutic Care in Europe (NPCE)
University of Limerick 30 & 31 May 2013
Examining the political, social and scientific challenges to improved public access, through primary care, to psychotherapy across the EU - key speakers from Ireland, Europe and the US will present papers addressing different aspects of primary mental health care. This conference is aimed at increasing our knowledge and understanding of the issues facing primary mental health care and of identifying ways and means of facing these challenges.
Being held on the occasion of Ireland’s Presidency of the Council of the European Union, a main objective is to generate a proposal to the European Commission to pilot a project on improving access to psychotherapy across a number of European states. A further aim is to achieve collaboration across professional groupings in this endeavour.
Who should attend
This conference is for professionals across all disciplines – clinical psychologists, psychotherapists, counsellors, general practitioners, primary mental health care workers etc. – as well as researchers, policy makers and all stakeholders who have an interest in and are working in primary mental health care or would wish to do so.
Participants will gain a clear insight into the contribution of talk therapies to primary mental health care as well as an understanding of how non-medical primary mental health services can be delivered efficiently and effectively.
You can view the entire conference programme here
Please view speakers' biographies here
EXPERT PANEL SPEAKERS
Names of our expert panellists can be viewed here
The conference is being held over two days, and registration is essential. Delegates can register for either day, or register to attend both days. Registration is €25 per day. This includes lunch and refreshments during the conference.
Delegates may also wish to attend the Gala Dinner, cost €45, being held in the University on Thursday evening, 30th May, pre booking is also essential for this event.
To book your place please register here online registration form
For more information on the conference
Phone: Bronwen Maher 087-7841937 (toll free)
The Portuguese Society of Clinical Psychology has organized a III International Forum on Clinical Psychology.The conference took place in Lisbon on April 11th, 12th, 13th. under the headline
Challenges of Contemporaneity in Europe Psychotherapeutic Perspectives on Mental Health-Care and Well-being
Download Conference Report here