This very well researched article (1) unfortunately fails to address one essential issue: The ratio of medical psychotherapists (who can prescribe drugs) to psychological psychotherapists (who are not licensed to do so) registered with the Association of Statutory Health Insurance Physicians for North Saxony has shifted from 90:10 to 50:50 and then to 10:90.
As severe depression is almost always associated with intensive, expensive medication, patients first treated by psychologists are sent to their primary care physicians when they require medication. Primary care physicians fear legal claims as this is outside their area of expertise (my own experience as a primary care physician in Lower Saxony from 2001 to 2005) and refer patients to psychiatrists/medical psychotherapists, of whom there are no longer enough. The ordeals of patients with severe depression end in this cul-de-sac.
My own practice for psychosomatic medicine and psychotherapy, which has existed since 2013 (I was formerly a primary care physician with a special interest in psychotherapy), was threatened with a large claim for damages in 2015 in connection with taking on responsibilities for such medication. The medical review board has only now, in 2020 (after 5 years of uncertainty), declared the claim unfounded due to increased demand.
Footnotes
Conflict of interest statement
Dr. Baur has received reimbursement of conference fees and travel expenses from medice.
References
- 1.Wiegand HF, Saam J, Marschall U, et al. Challenges in the transition from in-patient to out-patient treatment in depression—an analysis of administrative health care data from a large German health insurer. Dtsch Arztebl Int. 2020;117:472–479. doi: 10.3238/arztebl.2020.0472. [DOI] [PMC free article] [PubMed] [Google Scholar]