Year after year, Denmark ranks as one of the happiest countries in the world. And yet, one in five Danes struggle with depression at some point, according to the National Board of Health (Sundhedsstyrelsen).
“Any time there’s social pressure to feel good it can be even more isolating to be one of the ones who doesn’t feel very good,” Debbie Quackenbush told The Local. She’s been practicing psychology in Denmark for nearly a decade. Her Copenhagen-based practice, The Little White House, has therapists from eight different countries and offers therapy in seven languages.
And when people in Denmark do struggle with mental health, it can be confusing and take quite some time to find the proper care.
In a recent survey of more than 500 people suffering from depression in Denmark, the Depression Association (Depressionsforeningen) found that half had to wait more than two months for treatment. Nearly one-fifth had to wait more than half a year.
This may be especially true for Denmark’s internationals.
“I think it’s much more difficult for foreigners to navigate the mental health care system in Denmark than it is for Danes,” Peter MacFarlane, head of practice at MacFarlane Psychology Group in Copenhagen, told The Local. “Not only are they unfamiliar with how the healthcare system functions, but they’re also struggling to find information in their native language to learn how it works.”
Once they’ve figured out how the system works, they then face the challenge of finding a therapist willing to work in their native language.
“Any sort of specialisation, including language, would likely cause an even longer wait time,” Morten Ronnenberg, secretary general of the Depression Association (Depressionsforeningen), told The Local.
What if I’m facing a mental health crisis?
If you are facing a mental health emergency, including suicidal thoughts, sensing one’s life is out of control, extreme anxiety, drug withdrawal, or severe depression, seek treatment immediately.
There are emergency mental health services available on-demand throughout Denmark.
According to an official from the Capital Region of Denmark Psychiatry department, assistance in English is generally available. “It may not be their mother tongue, but they’ll do their best to help,” a department official told The Local.
Services range from on-the-spot assistance to admission to inpatient treatment, if needed.
What’s the first step if it’s not an emergency?
The first step for residents in Denmark with a CPR number and a “yellow card” (Danish public health insurance certificate) is to make an appointment with their general practitioner to discuss the situation.
Denmark relies on the World Health Organisation’s ICD-10 manual when diagnosing mental illness, like bipolar disorder or schizophrenia. If the patient’s GP believes they have a serious condition, they will be referred to a specialist centre – in Copenhagen, the Psykiatriens Centrale Visitation For Voksne in Østerbro – for further diagnosis so they can be properly referred for treatment.
For these serious conditions, residents have the right to examination within 30 days and treatment within 60 days, both publicly covered.
What if I just need to talk to someone?
“It’s a common misconception among foreigners in Denmark to think mental healthcare is free here,” MacFarlane said. However, that isn’t usually the case.
If you are seeking psychological help for certain reasons and have a referral from your general practitioner, you may be entitled to a subsidy of 60 percent of the psychologist’s fee, according to Danish joint public health portal Sundhed.dk.
This includes the following:
- victims of robbery or rape
- traffic crash and accident victims
- relatives of seriously mentally ill people
- people suffering from a seriously debilitating disease
- relatives of someone affected by a seriously debilitating illness
- bereaved relatives
- people who have attempted suicide
- women who have an abortion after the 12th week of pregnancy
- people who, before the age of 18, have been victims of incest or other sexual assault
- people who have mild to moderate depression and are 18 years of age at the time of referral
- people suffering from mild to moderate anxiety, including mild to moderate OCD, and at the time of referral have reached the age of 18.
As of the second half of 2021, young people between the ages of 18 and 24 can receive free psychological treatment for mild to moderate anxiety and depression.
The doctor needs to refer you within 6 months of the event, 12 months at the latest (except in the case of incest, sexual assault, and depression).
A referral grants you the right to up to 12 subsidised sessions, though those struggling with depression and anxiety can get referred for up to 24 sessions. Referrals are valid, even if you change psychologists in the process.
“The public subsidy can be very useful for people who can’t afford therapy on their own who both have a yellow card and qualify,” MacFarlane said.
What if what I’m facing doesn’t fit those criteria?
Residents who don’t fit the above criteria will usually need private insurance or will have to pay out-of-pocket for psychological treatment or therapy.
Private insurance use is increasing in Denmark, and access to mental health services is a driving factor. A recent analysis by insurance company Forsikring & Pension has found that the majority of private insurance is paid by employers. If that includes your employer, you can benefit from faster access to a broader network of psychological help.
“Most insurance companies will point you to a psychologist within their own network,” Berit Mus Christensen told The Local. She’s an authorised psychologist with her own practice in Aarhus.
“Should there be special reasons such as language barriers or other individual concerns, it may be possible to choose your own psychologist,” Christensen said, and suggests checking the terms of your insurance for specific information.
Sundhed.dk points out that some unions cover full or partial psychological treatment for work-related crises.
Can I afford to pay out of pocket?
If you’re paying out of pocket, average hourly fees range from 600 kroner to 1,200 kroner, and many offer reduced rates for students and those on lower incomes.
Group therapy also offers a less expensive option, Quackenbush said. “A lot of people are scared of group therapy, but it is highly effective and can be a great option if you can’t afford individual therapy.”
There are also some national associations offering free psychological counseling, Sundhed.dk writes.
For example, Fight Against Cancer (Kræftens Bekæmpelse) helps cancer patients and relatives, the National Association SIND (Landsforeningen SIND) helps the mentally ill and their relatives, and the Center for the Sexually Abused (Center for Seksuelt Misbrugte) helps those who have been sexually abused as children.
Higher education students can access free student counseling (Studenterrådgivningen) to work through issues like anxiety, grief, or lack of self-esteem.
Ronneberg, of Depressionsforeningen, recommends reaching out to an organisation related to the particular problem you’re facing. For example, his organization can offer advice and recommendations for people suffering from depression.
How do I find a qualified psychologist or high-quality therapist?
If you qualify for a public subsidy, you need to choose a psychologist with a “provider number” illustrating they are part of Denmark’s public healthcare scheme, according to the Danish Association of Psychotherapists (Dansk Psykoterapeutforening).
You can search for psychologists with provider numbers using psykologeridanmark.dk to find a psychologist in your area, see wait times, methods and specialisations. The website can also be helpful for those without a public subsidy, by unticking the box to search only for psychologists with provider numbers.
Unfortunately, the website is not available in English. And there’s often a wait time if you’re looking for a psychologist on the public scheme.
The website also only lists psychologists who are members of Dansk Psykologforening (The Danish Union of Psychologists), Christensen said. She recommends checking sundhed.dk for further options.
Although the public subsidy doesn’t apply for psychotherapists/therapists, some people might opt to see a therapist instead of a psychologist.
Quackenbush, from The Little White House, said it’s important to know the difference between therapists and psychologists in Denmark. “I know some good psychotherapists in town, but they are less regulated,” she said.
Therapists and psychotherapists don’t require a license or qualifications, while psychologists in Denmark must have a degree, and authorised psychologists must have both a degree and experience.
In light of this, the Danish Association of Psychotherapists requires its members to meet a number of criteria, including ethics standards, remaining professionally up to date, and receiving supervision. The association has a search feature on its website to help find therapists who meet its standards.
Ronneberg also suggests asking around for recommendations, both from their general practitioner and also friends and family. “That’s how many Danes find someone,” he said.
How do I know if a therapist is right for me?
There are several considerations foreigners might want to take into account when choosing a therapist.
Christensen, the psychologist in Aarhus, suggests looking for someone who has lived abroad themselves.
“This will ensure not only a deeper understanding of what it means to be an expat, but will also heighten the chance of understanding the Danish culture from a non-native perspective,” she said. In Christensen’s practice, she’s noticed that people struggling with social anxiety and depression, for instance, sometimes experience a rise in symptoms when they move to Denmark.
“There’s this feeling of always being the odd one out, and it can take quite a long time to make Danish friends,” she said. Cultural differences might be “a blind spot for native Danish therapists that is difficult to discover without having ‘been there’ oneself.”
Christensen also recommends finding a psychologist who speaks your preferred language. “If you are using a second language in therapy, depending on your level of fluency, a large portion of your concentration will be focused on language instead of the process,” Christensen said, adding that “psychotherapy isn’t the place to practice Danish.”
Christensen can treat patients in Danish, English and Dutch. The Little White House offers therapy in Danish, English, German, Italian, Russian and Polish, among other languages. MacFarlane said the psychologists at MacFarlane Psychology Group can work in English, Danish, Spanish, German, and Norwegian.
He recommends asking for an initial phone consultation of 10 to 15 minutes with prospective psychologists. This gives you a chance to tell them what you’re struggling with and ask how they might help you.
“See if they can answer in a reasonable, clear way that allows you to see how your therapy might progress,” he said. It’s also an opportunity to ask about their qualifications, for example, whether they’ve treated people with similar challenges in the past.
If you get started with someone and it isn’t a good fit after a couple of sessions, MacFarlane recommends trying another psychologist.
“People act like switching means they’ve wasted their time and now they have to start over,” he said, “but that’s not the case. Every time you talk through your problem, you’re working through your problem.”
What about online therapy?
Although Covid-19 has exacerbated mental health issues, it has also resulted in the proliferation of online therapy options.
“A lot of platforms have sprung up out of Covid,” Quackenbush said. She cautions people to do their research before choosing a therapist online just as they would finding an in-person provider. “Some people have had good experiences with online therapy, but not all platforms vet their therapists as well as they should.”
Ronneberg, of the Depressionsforeningen, said it’s also important to think of how the issues you’re facing might be impacted by the method of therapy. For example, is it better for people suffering from anxiety of public spaces to engage in therapy from the comfort of their home, or to push out of their comfort zone?
“Depending on the challenges you face, there may be something lost when you opt for online therapy,” Ronneberg said. “But, then you have to weigh that against the opportunity to get a faster consultation.”
Christensen has found online therapy to be a solid alternative that might be a good fit for some, especially if you can’t find a psychologist who speaks your language locally.
Although MacFarlane isn’t a big fan of teletherapy, he sees its value, particularly for those living in more remote parts of Denmark where they are unlikely to find a psychologist who meets all their needs nearby. “Then, I think it’s an option worth looking into,” he said.
However, he stresses the importance of one’s relationship with their psychologist or therapist, adding that it’s hard to build that rapport online. “If you can start face-to-face for a few sessions and then move online, I think that would be better,” he said.
How long will it take for me to ‘get in’ to see a psychologist in Denmark?
Although this depends on demand, all three private psychologists contributing to this article said they can usually see new patients within a week or two.
The Little White House keeps five open consultation slots per week for new patients, and MacFarlane Psychology Group can see patients much faster if they have an urgent need.
“Psychologists working outside of the public agreement often have significantly shorter waiting lists than the ones inside,” Christensen said.
Those seeking care with a public subsidy are likely to have to wait longer to find a psychologist.
Why does it take so long to see a psychologist or therapist in Denmark?
Put simply, there just aren’t enough public psychologists in Denmark, MacFarlane said. There is a limited number of public licenses available, and it’s difficult to become part of the public system.
“We would love to accept public patients, but Denmark has a closed referral system and it’s very hard to get on their provider panel,” Quackenbush said. “People literally wait for a provider to die for an opening to come up.”
Quackenbush said the rationale behind limiting the number of psychologists on the public system is to guarantee them work. “It’s an incentive to take public clients, since those are paid at a lesser rate,” she said. “You get paid less, but you’re set for life and you never have to market your services again.”
It’s also a way to control the use of public resources, Christensen said.
When it comes to publicly subsidised depression and anxiety treatment, each psychologist has an upper limit that they can request reimbursement, currently around 305,000 kroner per year. That means they can only accept so many publicly subsidised patients facing those challenges.
The Danish Psychologists’ Association (Dansk Psykolog Forening) is working alongside Denmark’s Ministry of Health on a 10-year plan to improve psychiatric care in Denmark, including better and more timely treatment.
And Ronneberg’s organisation, Depressionsforeningen, is working to increase the number of public psychology licenses. “Until we do that, we will continue to see this pressure on the market,” he said.
However, his final word is one of hope: “I think the key message is that you can get help, even if it takes some time.”