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HEALTH

Why does it take so long in Denmark to see a psychologist or therapist?

An average of one in four patients has had their referrals to mental health services rejected in several of Denmark's regions. We take a look at how to navigate Denmark's mental health system and why it is under pressure.

Why does it take so long in Denmark to see a psychologist or therapist?
According to a study from the National Board of Health, the number of patients seeking hospital care for mental illness has increased 30 percent in the past 10 years. Photo: Ólafur Steinar Gestsson/Ritzau Scanpix

According to papers seen by DR News, thousands of patients have had their referrals to mental health services rejected, even though they came from a doctor.

In the region of Zealand, 36 percent of referrals were rejected up to and including April this year. In the capital region, just over a quarter of referrals were rejected. This equates to 3,500 out of 12,000 referrals being rejected in the two regions.

In the southern region, 13 percent of referred patients were rejected, according to the latest figures from last year. The Central Jutland region and North Jutland region do not register their referral rejections, but according to Danish Regions, the picture is the same throughout the country.

“Psychiatry simply does not have the capacity to treat all those in need. The consequence is that people do not get the help they need, and in the long run I actually think that people end up giving up”, chairman of the patient organisation Psykiatrifonden’s, Torsten Bjørn Jacobsen, told DR.

There may be other explanations for the referral rejections, for example if a reference is not filled in correctly. But the Danish Psychiatric Association told DR news that the lack of resources in mental heath services is the most common reason.

How can I access mental health support in Denmark?

If you are in urgent need of help, there are emergency mental health services available on-demand throughout Denmark. 

If it’s not an emergency, the first step for residents in Denmark with a CPR number is to make an appointment with your doctor, who can then refer you to mental health services.

Mental healthcare in Denmark is not free. You may however be entitled to a subsidy of 60 per cent, depending on your situation. A doctor’s referral can grant between 12 and 24 subsidised sessions.

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.  

Residents who don’t qualify for a subsidy, have to pay themselves for psychological treatment or therapy. If you’re paying yourself, 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.

It is worth nothing that the public subsidy applies to psychologists, it doesn’t apply for sessions with psychotherapists or therapists.

Morten Ronnenberg, secretary general of the Depression Association (Depressionsforeningen) recommends reaching out to an organisation related to the particular problem you’re facing. For example, his organisation can offer advice and recommendations for people suffering from depression. There are also some national associations that offer free psychological counselling.

You can search for psychologists with provider numbers using psykologeridanmark.dk or sundhed.dk.

Psychologist, psychotherapist or therapist?

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. 

Debbie Quackenbush, who owns the practice The Little White House in Copenhagen, told The Local 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.

Why is there a delay in accessing mental health services in Denmark?

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. 

There are also a limited number of psychologists on the public system. This means there can be long waiting lists.

“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 from The Little White House told The Local. 

She explained that 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. You get paid less, but you’re set for life and you never have to market your services again,” she told The Local.

The Depression Association is working to increase the number of public psychology licenses.  “Until we do that, we will continue to see this pressure on the market,” Ronnenberg from the association told The Local. 

Going private 

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 she suggested 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.

Denmark’s ten-year plan to improve mental health care

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.

According to a study from the National Board of Health (Sundhedsstyrelsen), the number of patients seeking hospital care for mental illness has increased 30 percent in the past 10 years. That’s more than double the 13 percent increase among those seeking care for physical diseases, like diabetes or cardiovascular disease.

The proposal follows a 2019 statement where the Social Democrats, Social Liberals, Socialist People’s Party and Unity Party agreed on the need to establish a 10-year plan with binding goals for improving psychiatric care in Denmark.

The binding goals include a reduction in readmissions, reduced waiting times, and an increase of the average life expectancy of citizens with mental illness. The parties also identified the need for more preventative care and psychological help to younger individuals. 

Health Minister Magnus Heunicke has called for negotiations to start in September, but is open to bringing them forward.

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HEALTH

Danish health authorities to spend on recruitment and postpone construction in 2023

Denmark’s five regional health boards have finalised budgets for 2023, with recruitment and improvement of working environments largely prioritised over expansion and construction projects.

Danish health authorities to spend on recruitment and postpone construction in 2023

The budgets will provide more money for recruiting and retaining staff, improving work environments at hospitals and on local services.

Spending on facilities has been given lower priority, meaning several construction projects are to be postponed, the collective organisation for the regional health authorities, Danske Regioner, said in a statement on Wednesday.

Regions are attempting to address a labour shortage in the health service and the new budgets reflect this, national chairperson Anders Kühnau said.

“In the regions we have great focus on patients that are waiting for treatment here and now. It is therefore our top priority to acquire relevant personnel so we can reduce waiting times for patients,” Kühnau said in the statement.

“That applies to strain at emergency departments, psychiatric departments and operatin theatres right now – but also to longer-term challenges,” he said.

Spending on local services includes boosted budgets for GP services.

Reduced spending on physical facilities is linked in part to the current climate of high energy costs and inflation.

“Prices are increasing and we must be responsible in the Regions. Specifically, that will mean that some construction projects must unfortunately be postponed. Only the most essential will be prioritised,” Kühnau said.

The suspended constructions and those that will still go ahead were not specified.

Regional budget agreements for 2023 also include funding for cyber security. Extra spending will also go on drinking water and decontamination of ground pollution.

Regions – and their elected boards – administrate public hospitals and the GP system. They also orchestrate regional mass transit and are involved in welfare and social development.

READ ALSO: What’s the difference between a municipality and a region in Denmark?

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