Mental Health

Crises are part of life– and can also be an opportunity for us to grow. People have different ways of dealing with difficult times. That is completely normal. Having a high level of resilience is helpful when facing difficulties. There are methods that can help you strengthen your resilience. You can also find detailed information in German on the pages of therapie.de. 

There are various ways in which you can boost your mental health. 

For example, it is important to get enough sleep, exercise and relaxation. Mindfulness and small positive moments in everyday life can help, such as a walk in the woods or a short break in nature. Relaxation, autogenic training, yoga and meditation can be useful. Socialising and joint activities regulate stress levels. Exercise helps against stress and depression. Having hobbies supports mental health. A sport that you enjoy or creative activities, e.g. painting, cooking, knitting, learning a musical instrument, travelling, and more, can also help immensely. Do things that make you feel good - it's not about performance, but about enjoying life. Take care of yourself, and take your feelings and emotions seriously. Good self-care is vital for your health. But also remember: mental illness can affect anyone; it's not your fault. If you notice that you are not feeling well, seek support from professional counsellors or therapists. 

Further information: People with refugee experience have often experienced particular stress. Here you can find information and some useful tips for support in English, Arabic and Farsi from ALMHAR. “REFUGIUM Flucht und Gesundheit” also offers information in German, Albanian, Arabic, Bulgarian, English, Farsi and Turkish.

Crises and difficult experiences in life can overwhelm and stress us. War and flight are experiences that often result in trauma. Everyday life can also present us with challenges. Problems in the family, stress or bullying at work, experiencing physical or psychological violence, health problems or financial worries can affect our mental health. 

It is important to take our own feelings and sensations seriously. The body often gives us many warning signals. And we can also tell something is not right from our behaviour and reactions. 

Symptoms by which we can recognise that we are not feeling well:

Often the first signs of mental stress are shown in sleep problems. You often have difficulty falling asleep or wake up more frequently at night. Headaches or back pain can also be the early signs. Other symptoms that are mainly felt in the body include frequent tiredness, stomach pain or a feeling of pressure in the chest. Mental symptoms such as excessive nervousness, feelings of anger, anxiety, inner emptiness and emotional apathy are also common. Problems with concentration, nightmares, constant brooding and circling thoughts can also occur. Our behaviour can also change: For example, we react aggressively more quickly, don't feel like socialising, don't let others finish what they are saying, speak very quickly or start to stammer. We may do less sport and become less active overall. Eating patterns can also change, e.g., in the form of loss of appetite or eating significantly more than usual. Other symptoms may include increased alcohol consumption or smoking in order to calm down.

All these signs are just a few examples. Make sure to observe and listen to yourself. Every feeling and every reaction matters and should be taken seriously. This is not a sign of weakness but of a healthy self-care skill.

If you are feeling unwell, remember that you are not alone. You can seek support. There are many counselling services for everyday worries and difficult times, e.g., psychosocial counselling. You can talk to professional counsellors about your worries, private problems, family crises, marital problems, separation, professional or financial difficulties and much more. The counsellors will listen and support you. Together you will find ways to improve your situation. Counselling is confidential, and the counsellors are very understanding of your concerns. 

If you feel bad, are often sad, are afraid or perhaps even losing your joy in life, you can get help in therapy. Professional therapists can help you come to terms with difficult times in your life. There are many mental illnesses, such as depression or trauma, for which therapy is strongly recommended. 

It is often not easy to get help and tell strangers about your personal worries. It takes a lot of courage and strength. But crises and worries are part of life and are completely normal. It is a sign of strength to seek help.

It's perfectly normal not to feel well after a traumatic experience or be stressed about ongoing painful incidents and require help. You can seek support both online and over the phone in many languages.

• At ipso-care, you can seek advice from experienced counsellors online, anonymously and free of charge. The employees speak German, English, French, Turkish, Russian, Ukrainian, Somali, Italian, Farsi, Dari, Arabic, Tigrinya, Pashto and Burmese. The consultation is free.
• If you need urgent help, contact the telephone counselling service (Telefon-Seelsorge) on 0800 111 0 111. Alternatively, you can reach the "Muslim Counselling Telephone" (Muslimische Seelsorgetelefon) in Arabic, Turkish and Urdu on the telephone number 030 44 35 09 821. The Russian-speaking telephone counselling is available at +49 30 44 03 08 454. The employees of all three hotlines are reachable day and night, and their service is free. You can also contact a clinic with a psychiatric department. To search for a psychiatric emergency room nearby, visit psychenet.de.
• You can also find a mental health tips app at almhar.org. The app offers support for the most common mental health issues and gives you initial tips on dealing with the situation. The app is available in English, Arabic and Farsi.
• Refugee-trauma.help provides information on dealing with trauma in Arabic, German, English, Farsi, Spanish, Tigrinya and Ukrainian. You will learn what trauma is and how the body reacts to it. The website also provides tips and specific exercises which help you deal with trauma.
• So-called "self-help groups" are also helpful for many people. In a self-help group, you meet other people who have had similar experiences. Trained therapists lead these groups. On nakos.de, you can search (in German) for a self-help group in your area. There are also groups in other languages.

Psychotherapy is the treatment of the soul. Therapists can support you, for instance, if you are anxious or sad. Or if you have a lot of stress and worries. There are various types of illnesses and therapy methods. In therapy, you talk about your feelings and about difficult times in your life. Everyone is treated with respect and taken seriously in therapy. 

Good to know: Psychological psychotherapists do not prescribe medication, such as antidepressants. Psychiatrists are responsible for that. Here you can find more information about the expertise and roles of psychotherapists, psychologists, psychoanalysts, psychiatrists and alternative practitioners.

Some of the most common mental illnesses:

Therapy can help with a variety of mental illnesses, such as depression, anxiety disorders, burnout, addiction or trauma. You can find an overview of various clinical profiles of various mental illnesses in German on the pages of therapie.de.

Important: The selection below includes examples of illnesses that can often be associated with stress and traumatic experiences. There are many other mental illnesses– and an accurate diagnosis can only be conducted by professional therapists.

Depression

Depression is an illness that is significantly widespread. It is completely normal for everyone to feel sad sometimes. However, if you are sad very often, you may suffer from depression. Depression can be treated with therapy. To find out if you are depressed, ask yourself: Am I often sad? Have I lost interest in certain things? Do I no longer enjoy certain activities? Am I often tired? Are the daily tasks too much for me? 

Perhaps you can no longer concentrate or feel bad and worthless. You may even think that your life no longer has any meaning. These are important signs of depression, and you should seek help immediately. 

Further information on symptoms of depression and possible treatments can be found on the website of ÄZQ (The Medical Centre for Quality in Medicine) in German, Arabic, English, French, Spanish, Russian and Turkish.

Anxiety disorder

Being afraid is quite normal in many situations. Anxiety warns us of dangerous situations and can protect us. However, sometimes anxiety can also be a mental illness. An anxiety disorder is when you are anxious even though there is no reason for anxiety. Or if you are suddenly afraid of everyday things and the anxiety leads to problems in everyday life. Anxiety disorders can also have physical symptoms such as severe palpitations, trembling, nausea, shortness of breath and sweating.

Further information on anxiety disorders and their treatment can be found on the website of the Medical Centre for Quality and Prevention (ÄZQ). This information is available in German, Arabic, English, French, Spanish, Russian and Turkish.

Stress and burnout

Stress and the symptoms of stress are also natural. In difficult situations, our body tries to improve its performance to enable us to cope well with challenges. But too much stress can make us ill. It makes us feel restless and overworked constantly and can lead to burnout.

Addiction

Addiction is an uncontrollable craving for something, be it substances or behaviours. An addiction makes a person mentally or physically dependent: the addictive substance or behaviour makes us feel good and triggers positive stimuli in the brain. Without this positive stimulus, we feel a craving that we cannot control. However, addictive substances are harmful and make us ill. Common addictions include alcohol addiction, nicotine or medication addiction and addiction to illegal substances such as cocaine, heroin or cannabis.

Behaviours that are described as addictions include addiction to gaming, internet surfing, work, sports, mobile phone usage, shopping or sex. Eating disorders are also classified as addictions: Anorexia (“anorexia nervosa”), bulimia or binge-eating disorder.

Look out for the following signs to recognise a possible addiction: very strong desire and compulsion to consume a substance or to do something again and again; loss of control; withdrawal symptoms such as sweating, trembling, palpitations, aggression, nervousness, sleep disorders; you need larger and larger quantities; neglect of other interests; continued consumption despite harmful consequences.

Depression, anxiety, stress, addiction, trauma and other illnesses are often linked. Depression, anxiety or the development of an addiction can, for instance, be the result of trauma.

Trauma is an emotional or psychological injury. Just like our body, our psyche can suffer injuries from certain events. Typical events that can result in trauma are, for instance, violent crime, natural disasters, war, flight, torture, physical or psychological violence, sexualised violence, serious traffic accidents, threats of violence, the death of a loved one and serious illnesses.

These events could be very stressful for the persons affected and might cause them to feel overwhelmed, afraid and helpless. Sometimes, these reactions and feelings can last longer, resulting in restlessness, trouble sleeping, tremors, sweating, nausea, dizziness, shortness of breath, difficulty concentrating, feelings of guilt, depression, anger, fear, etc. Many people who have had troubling experiences cannot stop thinking about the experience. One other common result is that parts of the memory of the incident(s) are missing and/or specific details are remembered too clearly.

People handle traumatic experiences in very different ways. The undesirable symptoms often subside just a few hours or days after the traumatic event, particularly when the traumatic event lasted only for a short time and the person had the opportunity to process the traumatic experience properly.

When the person cannot cope with the traumatic experience and does not receive any outside support, trauma can lead to mental illnesses such as post-traumatic stress disorder, depression, addictions, anxiety disorders, etc. 

Post-traumatic stress disorder can usually begin within six months of the traumatic event. It can have mental or physical symptoms and can also lead to additional illnesses. Typical symptoms include severe nervous tension and excessive demands, re-experiencing the event, so-called "flashbacks", feelings of helplessness or emotional numbness ("numbing"). The self-image and/or world view can also become very confused.

Only a psychotherapist can reliably determine whether you have post-traumatic stress disorder, but there are some indications you should consider. You can take a short self-test (in German) at psychenet.de to find out more.

Further information on PTSD and other mental illnesses can be found on the website of the Ethno-Medical Centre Hannover e.V. in German, Arabic, English, Spanish, French, Croatian, Kurdish, Turkish, Farsi and Serbian.

If you continue to suffer from the consequences long after the traumatic situation, it is best to seek treatment from a psychiatrist. Most forms of therapy can be carried out on an outpatient basis, i.e. the patients live at their home and visit the specialist's practice 1-2 times a week after making appointments. See the sections "What forms of therapy are available?" and "How can I find a suitable therapy offer?" below to learn more.

Tip: How can I recognise trauma in a child, and how can I help the child?

If a child has experienced a stressful situation and cannot process the experience, one or more of the following symptoms often appear weeks after the event:

• The child is afraid of being separated from their parents or staying alone.
• The child cries or trembles for no apparent reason.
• The child is often unresponsive.
• The child is not developing according to age.
• The child is terrified.
• The child avoids other children.
• The child often appears sad or depressed.
• The child is very skittish.
• The child is very restless.
• The child is often aggressive.

The most crucial step you should take is to make your child feel secure at present. You need to provide your child with a manageable and structured daily routine. Rituals help. Furthermore, you and other family members or close friends should spend time with the child as much as possible. Avoid situations that put additional stress on the child.

Please note: The child needs professional help if they show many of the above symptoms over an extended period. You can learn more in the section "How can I find a suitable therapy offer?".

Good to know: The Federal Chamber of Psychotherapists has put together a guide for parents of children who have been traumatised as refugees. The information is available in German, Ukrainian and Russian.

The psychotherapeutic consultation

To find a spot in therapy that is paid for by statutory health insurance, you must first attend a so-called "psychotherapeutic consultation" with a psychotherapist. You can contact the therapist directly or get an appointment via the appointment service of the Association of Statutory Health Insurance Physicians. There is an online form in German, or you can call 116 117, the staff speak German and English. Take your insurance card with you to the appointment.

In the psychotherapeutic consultation, you will receive a slip of paper with an initial suspected diagnosis. You will usually also find a referral code for a place in therapy on it. Sometimes you can undergo therapy with a therapist from the psychotherapeutic consultation. However, if there are no free places there, ask other therapists. You can do this personally, or ask the Association of Statutory Health Insurance Physicians to find you a therapy place. To do so, you can fill in the online form on the website or call 116 117. Enter your referral code. The Association of Statutory Health Insurance Physicians should find you a therapy place within 4–6 weeks if there is a free place available.

You will then have the opportunity to get to know the therapist first. There are so-called "trial sessions" for this purpose. It is critical that you feel comfortable with your therapist. You have the choice of which therapist is right for you. And you can get to know different therapists before you decide.

Tips for the search

Finding a therapy place is not always easy: most therapists do not accept new patients or do not have any free appointments that they can offer at short notice. It can therefore take some time and research to find a suitable therapist in Germany. To make the process easier, here are some tips to help you:

1. Ask your GP: GPs can be a good first port of call. They can inform you about possible treatment options and refer you to a specialist or psychologist if necessary. Good to know: You can also get a referral for psychotherapy consultations from your GP, but you don't have to - you can also contact therapists directly.
2. Use search engines and directories: To find therapists in your area, you can use search engines or directories. You can use filters to narrow down the search according to your needs and location. There are also various websites online where you can search for therapists. You can also specify suitable search filters there to make your search more precise. Some websites you can try, for example, are Therapie.de, Psychotherapeuten-Vereinigung, psych-info.de or bptk.de.
3. Chamber of psychotherapists: There are several chambers of psychotherapists in Germany. These chambers have a list of recognised therapists. You can search for therapists in your area on the website of the relevant state chamber. To find your regional chamber, visit the website of the Federal Chamber of Psychotherapists.
4. Ask for recommendations: You can ask friends, family, colleagues and people in your community for recommendations. People who have already had positive experiences with a therapist can provide valuable tips.
5. Contact your health insurance provider: Ask your health insurance provider about possible therapists and forms of therapy. Some health insurance companies have their own referral centres. However, they can also provide you with lists of contracted psychotherapists.
6. Contact the staff of psychotherapiesuche.de: They will help you find a therapy place. Call 030 / 2 09 16 63 30 and tell them where you live and what you need. The staff will then help you to find the right therapy in your area in your language. Their service is free of charge.

In Germany, there are many forms of therapy that are covered or paid for by the statutory health and long-term care insurance funds. These include behavioural therapy, psychodynamic psychotherapy, analytical psychotherapy (also known as psychoanalysis), systemic therapy and EMDR for the treatment of post-traumatic stress disorder.

Remember that successful therapy depends not only on the method, but also on the relationship between you and the therapist and your trust in the therapy.

Good to know: Therapies are offered as outpatient therapy directly with a therapist in the practice, as partial inpatient therapy in a day clinic or as inpatient therapy in a clinic. You can find more information in German at psychenet.de.

Forms of therapy funded by health insurance 

• Behavioural therapy is a form of psychotherapy that was developed in the USA. It is based on the assumption that personal behaviour is learned and can therefore be unlearned. This form of therapy focuses not only on external behaviour, but also takes into account feelings, thoughts and evaluations of oneself and the environment. In behavioural therapy, you work together with a therapist to identify and understand problematic behaviours and then learn positive behaviours step by step. This therapy is effective for various psychological issues and is covered by statutory health insurance in Germany. You can feel the benefits of this form of therapy after a short time.
• Psychodynamic psychotherapy is a special form of psychotherapy that is based on unconscious conflicts that play an important role in psychological problems. In this therapy, therapists often look into the past with you in order to better understand the causes of your symptoms. In contrast to psychoanalysis, Psychodynamic psychotherapy tends to focus on a specific conflict and sets clear goals that you want to achieve. The sessions usually take place in a seated position and your therapist takes a more active part in the conversation. This therapy is also more time-limited, usually once a week and a maximum of 100 sessions.
• Psychoanalysis, in addition to therapeutic treatment, is also about developing a theory of how our personality works. Psychoanalysis describes how unconscious ideas in our head can influence our thoughts, actions and feelings, leading to inner conflicts. This theory also deals with how mental illnesses arise, for example internal conflicts, developmental problems and traumatic experiences. Psychoanalysis often involves lying on a couch while the psychoanalyst sits behind the patient. This form of therapy goes back to Sigmund Freud and sees mental illnesses as the result of repressed feelings and conflicts from the past that block healthy development. The aim is to uncover and resolve these unconscious conflicts. In psychoanalysis, the therapist takes a reserved role, speaks little and is sometimes not in the patient's field of vision. In this therapy, you lie down in order to remain as uninfluenced as possible and freely report what is going through your mind - this is called "free association". Usually up to 3 sessions a week are offered, and the entire therapy can last up to 300 sessions.

Good to know: Although a maximum number of sessions is covered by health insurance, this does not mean that every therapy session has to last this long.

• Systemic therapy emerged from family work in the 1950s. Its basic idea is that most problems lie not just in one person, but in the family or social environment. The treatment focuses on the relationships between the people affected by the problems and uses various techniques, such as constellating family members in the room to represent the relationships. Sessions can be irregular and are based on the needs of the client. Since July 2020, systemic therapy has been included as a recognised guideline psychotherapy in the catalogue of services provided by statutory health insurance companies. Systemic therapy has been proven to be effective for various mental illnesses such as anxiety, depression, schizophrenia, addiction and eating disorders.
• EMDR therapy is a method that helps traumatised people. Unlike other forms of therapy, patients are not forced to relive the terrible experience over and over again. Instead, EMDR therapy uses rapid eye movements, tapping or other methods to process the stressful memories. Patients think about the stressful event while the therapist applies these methods. The aim is to treat the painful memories and reduce the intense feelings associated with them. It is important that experienced therapists carry out EMDR therapy and adapt the treatment to the patient's needs.

Creative approaches such as art therapy, music therapy, movement therapy, occupational therapy or relaxation techniques (e.g., yoga) can also be included in the therapy.

In addition to these and other forms of therapy, doctors can also prescribe medication such as antidepressants, etc. Those affected also receive support in everyday life, e.g. with professional integration or problems in the family during therapy.

For most, it is more comfortable to go through therapy in their mother tongue. If you cannot find therapists in your language, you can also use the help of interpreters. The Social Welfare Office or Jobcenter can cover the costs for the interpreters if you cannot afford it. To get financial aid, you need to submit an application. Seek advice from a counselling centre for more information. You can find counselling and support from the Refugee Council or Pro Asyl. Visit fluechtlingsrat.de to search for Refugee Council in your area. You can reach Pro Asyl by emailing beratung@proasyl.de in English or German. You can also search for a counselling centre in your area on proasyl.de or our search engine on the Local Search page.

Good to know: The health insurance does not cover the costs of interpreters' services. 

The answer depends on whether you are already a member of a health insurance company or not:

• I am a regular member of a health insurance company: In principle, health insurance companies usually cover therapy costs. However, if you are a member of statutory health insurance, you must ensure that your therapist has what is known as "health insurance approval" ("Kassenzulassung"). To start therapy, a doctor or psychotherapist must first make a so-called "suspected diagnosis" ("Verdachtsdiagnose"). This diagnosis should be sent to your health insurance company, which will either confirm or reject your request for therapy. It is best to talk to your family doctor directly first.
• I am not currently covered by a health insurance company: If you are not a member of a health insurance company, for instance, you can apply to the Social Welfare Office for cost coverage. Ask social workers in your accommodation centre or a counselling centre for help. You can also search for a counselling centre in your area on proasyl.de or our search engine on the Local Search page.

However, many applications to the Social Welfare Office are immediately rejected because the authorities are reluctant to pay for therapies for people with an uncertain residence status. If your application is not rejected immediately, an assessment and evaluation will be carried out by doctors commissioned by the Social Welfare Office. These experts decide whether the Social Welfare Office should cover the costs of your therapy.

If the Social Welfare Office rejects your application: There are free therapy places at special treatment centres for refugees whose therapy is not covered by the Social Welfare Office. But it is pretty challenging to find a place in one of these treatment centres because there are not enough of them. You can find the addresses of these treatment centres on the website of the nationwide working group of psychosocial centres for refugees and victims of torture ("Bundesweiten Arbeitsgemeinschaft der psychosozialen Zentren für Flüchtlinge und Folteropfer"). The website is available in German and English. You must inquire directly at the specific centres to see in which language they provide service and whether there are any vacancies.

If you need someone to talk to, contact the staff of virtualsupporttalks.de for support. The volunteers speak German, English, Ukrainian and Russian and will listen to you. To reach them, you can contact them via email. The staff will then call you within 24 hours. The service is free.

You can also contact a telephone counselling service. You can reach the "Muslim Counselling Telephone" (Muslimische Seelsorgetelefon) day or night by calling 030 44 35 09 821. The employees speak Turkish, Arabic and Urdu. On the phone number 030 44 03 08 454, you can reach the employees of "Telefon Doweria" in Russian day and night. Their service is free. You may only have to pay some regular service fee for the phone call. Alternatively, you can reach the employees of a German-speaking telephone counselling service day or night by calling 0800 111 0 111 or at telefonseelsorge.de. The employees speak German. Their service and the phone call itself are free.

In principle, anyone can help by being present and listening. But it is more useful if you inform yourself beforehand.

• You will find a "Guide to Psychological First Aid" in German, English, Ukrainian and Russian at IOM. Among other things, you will find essential advice on dealing with traumatised people and tips on correct body language.
• At mhfa-ersthelfer.de, you will find 20 essential tips in German, English, Russian and Ukrainian for people looking after refugees. Even if you personally are/have been a refugee, this information can help you better deal with other affected refugees.
• On the Refugio München website, you will find information in German on how you can best help while taking sufficient care of yourself at the same time.
• At the "Nationwide Working Group for Psychosocial Centres for Refugees and Victims of Torture", you will find extensive practical guidelines in German on how to deal with a traumatised person.
• You can also participate in events organised by the project "Razom - United at Ipso". The webinars deal, among other things, with self-care and coping with trauma and its consequences. You can register for various webinars on ipsocontext.org.