Conference Review: Increased Cooperation and a Stronger Network The BPtK Conference “Psychotherapy in Europe – 
Disease Management Strategies for Depression

Reviewed by Kay Funke-Kaiser

Psychotherapists from 20 European countries met in Berlin on the 23rd
 of February at the invitation of the Federal Chamber of Psychotherapists 
in Germany. At the conference “Psychotherapy in Europe – Disease
 Management Strategies for Depression”, around 60 experts and 
healthcare politicians used the example of depression in order to discuss
 the status quo of the provision of care, guidelines, and good-practice
 models for psychotherapeutic care. The European Parliament quite
 clearly called on its member states in 2009 to ensure a sustained increase 
in awareness of the major importance of good mental health.

According to the European Commission’s Green Paper on Mental 
Health, more than 27 percent of adult Europeans are estimated to
 experience at least one form of mental ill health during any one year.
 Forms of mental illness are the main cause for the 58,000 suicides per
 year and thus result in more deaths in Europe than road traffic accidents.
The most widespread illnesses are anxiety disorders and depression.
 Mentally ill people continue to be stigmatised. Mentally ill people and
 those with mental disabilities encounter rejection and prejudice, which 
increase their personal suffering and exacerbate their experience of 
social exclusion. From an economic point of view, the costs generated 
by mental illness are estimated to constitute between three and four 
percent of the European gross national product, largely as a result of
 loss of productivity and the costs incurred by the social and educational
 systems as well as the criminal and justice system. Considerable
 discrepancies exist between the various member states of the European 
Union with regard to the provision of care for mentally ill people.

Mental health is a fundamental human right, as the President of the 
German Chamber of Psychotherapists Prof. Dr. Rainer Richter reiterated 
in his welcoming speech. The goal of the conference was to show the
 situation in the various European health systems of the provision of
 psychotherapeutic care. It is important for psychotherapy to learn from 
the experiences of the other European states, as the European Member
 0f parliament Dr. Peter Liese explained in his written message of
 greeting. In addition to the economic savings that would arise from an 
improvement in the treatment and diagnosis of mental disorders, the 
issue is above all that of the health and wellbeing of the citizens. In the 
process, the differences in life expectation and health that exist both
 within and between the member states must be reduced.

The European Commission also sees an urgent need to act in order to 
improve the mental health of the population, as Johanna Schmidt from 
the EU Commission’s Representation in Germany made clear.
 According to the Eurobarometer “Mental Health” that was published
 last year, every seventh person in Europe seeks professional help for a 
mental health problem within the course of a year, and during the same
 period of time seven percent of Europeans are prescribed anti-
depressants. The European Pact for Mental Health and Wellbeing that 
was made in 2008 under the leadership of the Commission has already 
left some initial traces. The Federal Chamber of Psychotherapists in
 Germany has provided strong support from the start for the work being
 done at the European level. In order for the EU to achieve its strategy
 goals for 2020 of more intelligent, sustained and integrative growth, 
however, further measures for promoting mental health are necessary.

Depression is a central challenge of the 21st century

Prof. Dr. Hans-Ulrich Wittchen (Dresden University of Technology, 
Germany) gave an overview of the epidemiology of mental illnesses in 
Europe and the current care situation. Using the example of depression,
 he demonstrated that there is a wide gap between the need for treatment 
and the reality of the provision of care. In the European Union seven
 Percent of the population suffer from uni-polar depression every year, 
but only a half to a third of sufferers are treated. Between three and eight 
percent were treated pharmacologically or at least with a minimum of 
psychotherapy, but often only after much too great a time delay.
 Psychotherapy was received by only two to three percent of patients.

Prof. Wittchen saw the provision of care for depression as a central 
challenge for Europe in the 21st century. He called for concerted action
 in order to make effective psychotherapy available to all sufferers as
 quickly as possible after the outbreak of illness. Care guidelines would 
play an important role here in order to set the right course in terms of 
health politics. This would however necessitate an increase in the
 number of qualified professionals, whereby an increase in the number 
of psychiatrists could not be counted upon. It would be more realistic 
to continue to draw on the potential of psychological forms of therapy.

Short presentations were held outlining national provision of care
 structures and innovative care concepts for people with depression in 
Austria, Finland, France, Germany, Italy, the Netherlands, Poland.
 Portugal and the United Kingdom. An increasing need for treatment was
 reported by all European countries, especially for young people. In none
 of these countries do the opportunities for psychotherapeutic treatment
 available come even close to being sufficient. In this way, with reference 
to the professions, their qualifications, powers and involvement in the 
health system as well as the psychotherapy methods applied, a Europe-
wide overview emerged.

Faster and broader access to psychotherapy

Provision of care models are being sought in several European states 
that could ensure faster access to psychotherapy, independent of age and
 social class. In order to achieve this, “Stepped Care” concepts are being
 put into practice which offer patients a range of treatment options
 depending on the severity and complexity of the illness. Prof. Dr. Glenys
 Parry (University of Sheffield, UK) presented the results of an 
evaluation of the programme “Improving Access to Psychological
 Therapies (IAPT)” which is in the meantime on offer throughout England. With this programme, therapy has become available more 
quickly. The proportion of patients treated by means of psychotherapy 
has in the meantime increased six fold. Inability to work because of
 mental illness has also sunk. There is, however, dissatisfaction among 
patients as a result of the length of treatment, which they judge as being
 too short.

Prof. Dr. Pim Cuijpers (Free University of Amsterdam, the Netherlands) compared the effects of low- and high-intensity therapy within the
 framework of Stepped Care models. According to this under certain 
conditions, low-intensity measures such as self-help conducted and
 supervised on an internet basis can be effective on a level similar to 
psychotherapy “face-to-face”. He described internet-based therapies as
 an innovation in the care of mentally ill people, whose success, however, 
depended on the individual needs and resources of the patients. Low-intensity care and treatment programmes cannot and should not fully
 replace face-to-face psychotherapy. One should however make use of 
them because there will never be enough treatment on offer from
 qualified practitioners for traditional psychotherapy in relation to the
 demand for care.

Prof. Dr. Jaakko Seikkula (University of Jyvaskyla, Finland) reported 
on investigations in Finland into the effects of a need-adjusted treatment
 model for the treatment of depression. Originally developed for the care
 of schizophrenia, the need-adapted treatment promises to be successful
 in treating depression, too. He demanded more flexibility in the care of
 depression instead of restriction by means of treatment guidelines in
 order to make a better fit possible between treatment methods, therapist
 characteristics and patient needs; this could for example translate into
 differing levels of involvement in treatment for family members.

Podium Discussion

The contributions by the scientists regarding possible innovations in 
psychotherapeutic care and the descriptions of the actual care situation 
in Europe gave rise to three central questions during the podium
 discussion, which was led by Andrea Mrazek, M.A., M.S. 
(boardmember of the Federal Chamber of Psychotherapists in

The first question was concerned with the nature of psychotherapy. A 
comparison of the development of psychotherapy with that of the
 industrial revolution served as a provocative key metaphor. As in the
 industrial revolution, psychotherapy will undergo a development from 
an individualised cottage industry to a standardised replicable product
 with minimal differences in quality. But, can ten sessions of manualised
 short-term therapy, which is what is being offered in the way of services
 by some health care systems, actually be described as psychotherapy,
 and above all, is it effective? One position held with regard to this was 
that psychotherapy is evidence-based treatment. As such, internet-based
 interventions are psychotherapy if they can show a corresponding effect.
 On the other hand, the position was held that psychotherapy is defined
 by its mechanism of action and as such is characterised by the
 psychotherapeutic relationship, the competence of the psychotherapist,
 and the fit between the treatment offered and the individual needs of the
 patient. Effects reveal themselves here in particular in long-term

The second central question concerned the profession of
 psychotherapists. Which competencies should a psychotherapist have 
and what is his task? The various positions on the nature of
 psychotherapy were naturally reflected in the answers that followed. For
 the one person a psychotherapist is someone who is comprehensively
 trained for the job of conducting evidence-based psychotherapeutic 
treatment. This does not rule out, it was stated, that psychotherapeutic 
treatment can be conducted in other professions such as nurses. For
other people only someone who is competent to ensure treatment that is 
oriented towards the individual patient’s need can be a psychotherapist.

Finally, the third question was concerned with how it can be possible to 
use the strengths of intensive psychotherapy, in particular for people
 with severe and complex limitations to their health, while at the same 
time providing for the growing need for treatment despite limited human
 and financial resources. It was in addition established that only two of 
the three criteria “fast”, “cheap” and “good” could be achieved at the
 same time in relation to the provision of psychotherapeutic care and never all three together. The resources available would dictate which
 strategies for providing care for mentally ill people could or should be
 used. These could for instance also justify low-threshold interventions
 and interventions via new media and/or in largely standardised form.

The search for the best strategies for the provision of psychotherapeutic
 care – and in this the participants in the podium discussion were
 united – will concern all European health systems equally, for it must
 be their goal to offer quality-assured care for mentally ill people and to 
no longer accept the existing gaps in care provision. In order to include 
psychotherapeutic expertise sufficiently in the process, those who are
 employed in the field of psychotherapy in Europe should work more
 closely together in future.

European Network

The desire for greater cooperation was at the centre of Prof. Richter’s
 concluding words: the conference showed how psychotherapy’s
 potential could be employed to an even greater extent in the provision
 of care. At the same time, however, one had to conclude that 
psychotherapy does not occupy the place within the political initiatives 
for the improvement of mental health in Europe that it should have 
according to current scientific findings.

Prof. Richter proposed the setting up of a network for psychotherapeutic 
care in Europe, with the purpose of giving psychotherapy a voice and 
an address. A network of this nature should be able to profit from the
 experience and expertise of all those who are largely or exclusively 
employed in psychotherapy within their health care systems. The first
 step to be taken towards forming this network could, he suggests, be the
 creation of a mailing list by means of which all those being interested 
can communicate about the arrangement of the network, further 
initiatives, and hopefully also a follow-up conference. In the name of 
the Federal Chamber of Psychotherapists in Germany as the organisers 
of this conference, he offered to take the initiative in setting up this 
network: a suggestion that was very much welcomed by the participants.

Contact: Kay Funke-Kaiser

Phone: ++49 30 2787850