this post was submitted on 08 Feb 2025
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52
How prevalent is the topic of mental health in America compared to Germany? (self.nostupidquestions)
submitted 4 days ago* (last edited 4 days ago) by wondering_mind to c/nostupidquestions
22 comments fedilink hide all child comments
 

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?

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[–] [email protected] 18 points 4 days ago

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.

[–] [email protected] 12 points 4 days ago (1 children)

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.

[–] wondering_mind 5 points 4 days ago (4 children)

Damn really?

[–] [email protected] 14 points 4 days ago

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.

[–] [email protected] 8 points 4 days ago (1 children)

[–] wondering_mind 4 points 4 days ago (3 children)

Holy hell, is this real? Do they actually say "ASAP" in the letter? That feels threatening

[–] edgemaster72 8 points 4 days ago (1 children)

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.

[–] devfuuu 2 points 4 days ago

This basically seems to work as we usually see the mafias or gangs enforcing their rule. Makes sense.

[–] [email protected] 7 points 4 days ago

Gotta keep me anxious so I have to keep coming back.

[–] [email protected] 1 points 3 days ago* (last edited 3 days ago)

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.

[–] lordnikon 4 points 4 days ago

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.

[–] Rhynoplaz 3 points 4 days ago

That's pretty accurate.

[–] Stamets 7 points 4 days ago

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.

[–] [email protected] 6 points 4 days ago* (last edited 4 days ago) (1 children)

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.)

[–] wondering_mind 2 points 4 days ago* (last edited 4 days ago) (2 children)

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.

[–] [email protected] 2 points 4 days ago* (last edited 4 days ago) (1 children)

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.

[–] [email protected] 2 points 3 days ago

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.

[–] [email protected] 1 points 4 days ago

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.

[–] WhySoSalty 2 points 4 days ago

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.