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)