Hey there, I’m from Germany and have mental health issues such as depression and was wondering how prevalent this topic is in America.
Here in Germany this topic has become extremely normal and pretty much everyone seems to openly talk about it even with strangers sometimes. We have a lot of therapists but it’s often hard to get an appointment since medical care in Germany is free and they have overwhelming numbers of people and the therapists don’t have enough availability to accommodate everyone. The therapists I had so far were pretty good since they really seemed to care about me and often did overtime and such to talk.
I wonder if it’s similar in America that a lot of people go to therapy and openly talk about mental health. What is the situation in America like? Do you have many therapists (especially in rural areas) and how easy is it to get in/finance? Or would you say this topic is generally more frowned upon in America in comparison?
I’ve seen it vary widely from place to place (America is pretty big, after all).
I would say the prime candidate to be open to talking about mental health in America is a young (~15-25), wealthy, city-living person. As you move away from those traits, the less likely the person is to being candid about their mental health (i.e. older, poorer, and rural-living people are less likely to talk about it).
There’s definitely some taboos about speaking about it among blue-collar workers. It seems like there was a push a decade or so ago to start doing psyche evals for people who worked in heavy machinery. I knew one guy who (as a wave of psyche evals ame through) was dropped from his machinist job (that he’d done for 20+ years without injuring hisself or others) after telling the doc he had 1-3 beers almost every night. Cause for firing was that “he is a hazard to himself and the people he worked with”. I know everyone else in that shop clamped their mouths shut about any depression, anxiety, and sleep issues after that.
Word is they’ve gotten a lot better about how they conduct them, but the point is that among blue collar workers, it feels like talking about mental health issues has (historically) been a fast track to losing the ability to put bread on the table.
I do white collar work now, and on this side of the wall, its definitely a lot less taboo. There’s still a stigma about it, but that could just be my own anecdotal experience.
All that is to say, there’s a history of mental health being used to harm people, so its not yet an open subject, but that taboo is lifting, if not exactly quickly.
I do. I’m 40 years old and live in an isolated although not quite rural area of a mostly conservative state. I used to keep my struggles and issues to myself out of shame. At some point it occurred to me that talking about my struggles with depression and anxiety might help someone else not feel ashamed or embarrassed about their mental health leading them to seek help. “Be the change you want to see in the world”, right?
Like any chronic health condition, insurance can be a pain in the ass trying to find a good provider. Reading some of the other responses I’m feeling lucky in that the most difficult issue I’ve had is just finding a therapist I click with. My insurance has a feature on their website where I can find therapists in my area that are in their network.
Americans answer to mental healthcare is jails. There’s almost no access to mental healthcare. You qualify for free healthcare in certain states if you are poor. Insursnce plans won’t generally cover entire doctors visits. It costs me $65 to talk to my pdoc for 5 minutes just to get a perscription refilled and thats discounted from the $150 rate they would charge without insursnce. Some insurance will cover therapy, but not long term. It can be difficult to even find a psychiatrist who will take insurance, let alone your insurance. Insurance is a regional thing and plan sppecifuc so it’s not the same for anybody. Therapy is seen as something that people briefly do after a major trauma event, or done by whiny little rich girls.
Damn really?
The first part is true, it’s super expensive. But anecdotally therapy is very socially acceptable and mental health is openly talked about, in younger generations at least.
Holy hell, is this real? Do they actually say “ASAP” in the letter? That feels threatening
Oh this is just the beggining too. Sometimes you pay a bill like this and then weeks to months later you get another one and it turns out it was only part of the bill.
After my twins were born I spent 1.5 years cleaning up and dealing with medical bills. I even just got another one a few weeks ago.
Also the reason it says ASAP is definitely because they are trying to apply pressure. In the US, you cannot charge fees or interest on medical bills. All they can do is send you to collections. They want to give off the vibe that if you dont prioritize their bill on the list something bad will happen to you.
It feels threatening because it is threatening, and it’s just the beginning. If they send it to debt collection you could end up with wages being garnished, credit being tanked (this was just recently banned 2 weeks before Trump took office but I expect it to be rolled back within a year), and other forms of harassment for hire.
This basically seems to work as we usually see the mafias or gangs enforcing their rule. Makes sense.
Gotta keep me anxious so I have to keep coming back.
Yeah Dann accurate I used to have some of the best insurance you could get and even that didn’t matter she just stopped talking insurance as BCBS kept screwing her . If not for the VA as a backup I would be fucked (we will see how long that lasts) but I have to just pay her out of the pocket for now. Honestly anything health related needs to be divorced from our jobs in the US.
That’s pretty accurate.
I can’t really speak for America outside of what I hear friends say but they seem fairly similar. I’m Canadian and it’s almost the same here as it is in Germany, with the exception of therapy. Psychiatrists are often covered by healthcare but have obscene wait times. Psychologists rarely are. There are some free intake ones and what have you but otherwise you’re paying.
America also seems similar to us in that regard too. Sometimes certain docs might be covered by your insurance but if so their wait times are insane. The ones who aren’t cost an arm and a leg. People like 35 and younger seem more open to talking about mental health issues than any of the older generations.
I’m from Germany, too. But judging by what comes across the ocean via the internet… A lot of Americans seem to talk about their anxiety, depression and how it affects them…
And from what I’ve heard from other people and the news, we (Germans) don’t have enough therapists or doctors. It takes quite some time to get an appointment, even if you badly need one. So I’d say we don’t have a lot of them.
(Edit: It’ll take some time until proper answers trickle in… It’s still in the middle of the night in the USA.)
But judging by what comes across the ocean via the internet… A lot of Americans seem to talk about their anxiety, depression and how it affects them…
I got a similar impression because I listen to the rapper Juice Wrld and he basically constantly talks about the deepest mental health issues in his music.
And from what I’ve heard from other people and the news, we (Germans) don’t have enough therapists or doctors. It takes quite some time to get an appointment, even if you badly need one. So I’d say we don’t have a lot of them.
Would you say it’s more about not having enough therapists in Germany or having too many people who seek them. Cause when it comes to the amount of therapists there always have been some in the areas I lived even in small towns. The problem for me was always to get an appointment cause they already had lots of patients and requests for new patients and were overwhelmed by that.
I think it’s a general issue with our healthcare system. And the lack of doctors and hospitals is more pronounced in rural areas. But basically the same thing applies in the city. And not just for mental therapy. You often also get to wait for a MRT, if there’s something wrong with your foot… I’m not an expert on this. But I guess we could do way better. And I hear that a lot, that someone had to wait for therapy for relatively normal physical issues. And similar things apply to related professions. One home for the elderly next door, just closed a year ago. Not because we don’t have elderly people anymore, on the contrary, there is quite some demand. But they just didn’t have enough employees to do the work. And at some point they had to close. I think it’s going to become a big issue unless we deal with that and find a suatainable solution.
Thr American Medical Association lobbied Congress to limit how many residency positions they open up. This artificial constraint reduces the supply of doctors so that they can keep their wallets fat.
not having enough therapists or having too many people who seek them
Neither actually. The health insurances are allowed to decide amongst themselves how many therapists are covered. And this number hasn’t been adjusted (much) since 1999 even though demand has skyrocketed since then.
Approximately 50% of therapists in Germany cannot accept public health insurance. Yet there is enough demand from the 10% of Germans with private health insurance ( + those who pay for therapy thenselves) to keep those therapists afloat.
In other words:
12.5% of Germans have been diagnosed with depression => 9.5 million people officially diagnosed which is certainly an underreported figure.
There are ~24,000 therapists in Germany.
As a result, there are 396 people with depression per therapist - meaning if every therapist worked 40 hours per week with 1 hour per client you’d have to wait 10 weeks between sessions.
Now add all other mental illnesses which would require therapy and you’d get an even larger number.
Sure, not everyone diagnosed with depression requires therapy. But this doesn’t excuse the obvious lack of paid therapists - which is openly acknowledged by the public health insurances but they are not legally required to change anything.
Are you nuts? I don’t know which farytale fantasy part of Germany you live in but Germany is basically in the stone age of psychology and mental health care, it’s almost non existent. Therapist, psychologists and psychiatrists are almost never covered by insurance and cost an arm and a leg to pay out of pocket. If (and that’s a big “If”) you’re lucky enough to get a referal from you doctor you’ll struggle to find a clinic that’s isn’t a 2 hour drive away and will still have to endure a waiting period of up to 6 months for a single appointment. And that’s if you manage to convince your doctor to actually take your mental health complains seriously in the first place.
You essentially have to have a full blown mental breakdown with police involvement to stop your doctor from laughing iit off when you mention that you don’t feel mentally well.
On top of that, if you begin a mental health care journey you’re insurance payment magically increases because depression is usually associated with an unhealthier lifestyle and higher risks of self harm (don’t forget, insurance companies are still buisnesses).
And on top of that, don’t ever and I mean EVER mention you mental health problems at work kr you’ll be first on the line when the company decides to push people out.
Come to think of it, in about 20 years I haven’t heard a single individual talk about their mental state - stranger or friend. It’s not like people hide it well, you can tell when somebody is depressed or stressed out. But people never talk about it, no matter how bad it is.
In the US on the other hand, the short time I spend there, 7 of the 10 people I actually knew by name told me they’re in therapy and taking meds for their mental problems. They literaly couldn’t shut up about it. Hell, even the University had a mental health counselor that was actually used by a lot of students.
The most common pills you find in a German household are Ibuprofen and Lacteeze (because we sure love our cheese) but never Prozac or Lexapro.
So no, the topic isn’t “extremly normal” and people don’t “openly talk” about it. There are no overwhelming number of people in therapy because therapist barely exist in Germany. And the amount it cost you will likely be the root cause for your depression anyway.
Sure, maybe if you’re from a wealthy family with excellent private insurance and access to private doctors and therapists in a gated community without any care for your future job security then maybe it’s a different experience. But for the average Jane/Joe, Germany is a depressive hellscape.
What is all that unnecessary attack for? Have you even ever been to Germany? My therapy got paid with normal insurance. Just gave the therapist the card to scan and that was it. I had 2 appointments every week for years. That was at least my experience as a now 21 year old German (I had therapy from when I was 16 until I was 20).
So you would say America is better in this regard?
Because it gives people a completely wrong impression. If you got your therapy covered by insurance and have availability that’s very good, but it’s a very rare fringe case.
I’d say maybe in general the German population is less affected by mental health issues (statistics also show that), but if you are in actual need of help the accessibility of counceling and care in Germany is abysmal.
The general consensus is that medical care in Germany is subpar, especially if you don’t have private insurance. There aren’t enough qualified doctors especially in rural areas. If there are, they are often overworked themselves. For most walk-in clinics doctors don’t even take their eyes of the computer screen, yet alone give you a proper diagnosis.
I’m not expecting Dr. House level of detective work, but for the most part, doctors have their mind already made up about your condition and balantly ignore any secondary symptoms until they become severe enough to be a problem of their own.
Since mental health can’t be reliably “tested” for, like you would with an MRI or X-Ray, usually, unless you bring a lot of money to the table it is just not even worth looking into by general practitioners to get a referal.
That is simply not true. It is a pretty annoying process and often takes time to get a therapy, but nobody I know, including myself had to pay for this. And I know that because most people here are pretty open about therapy nowadays. There are more than enough problems with the German health care system, but OPs description fits my experiences muuuch more than what you describe.
Same, same. I don’t think you can compare the two, unless you’ve experienced it yourself. I mean it’s gotten worse here. But still, it seems to be entirely different levels. I can still get appointments. People don’t just die from diabetes like they used to in the USA. We can just call an ambulance and someone will treat your broken arm. It’ll work just fine without private insurance. And you don’t even need a lawyer to challenge the hospital bill. You can bear a child without being in debt for the rest of your life… There are issues. And we’re not as good as some neighboring contries. But I don’t think the situation compares to what I read from across the ocean. But yeah, I’m missing actual experience from other countries.
