How do Refugees access Psychotherapy or Counselling?

Author: Lu Kenntner

The following information solely provides an overview and is not a substitute for professional legal advice (as of August 2020). The relevant sources are provided at the end of this page, with the numbers in the text corresponding to the respective source.

General information on the health insurance system in Germany:

The health insurance system in Germany stipulates that all persons are obliged to take out health insurance (1). If a person get insured, they should also receive an electronic health insurance card. The insurance is paid for through contributions from the insured person and their employer. The contribution that the person has to pay is calculated according to their income. All people have the same right to medical care and sick pay when they are sick. This also includes psychological/psychotherapeutic treatments.

General information on health care for refugees: 

The reception directive in Art. 19 grants necessary medical and other supports, including, if necessary, suitable psychological care for asylum seekers with special needs*. Health care for refugees is generally regulated by the Asylum Act (Asylgesetz) and the Asylum Seekers Benefits Act (Asylbewerberleistungsgesetz (AsylbLG))(2). General entitlement to benefits for these groups of people is provided for according to Section 3 AsylbLG.

This includes people: who find themselves in the asylum seeking procedure, who have a “temporary residence permit” (Aufenthaltsgestattung), who wanted to enter via an airport and who are not or who have yet to be permitted to enter the country, or who have a residence permit in accordance with Section 23(1) or Section 24, Section 25(5)(1) of the Residence Act (AufentG). This also applies to persons for whom a decision to suspend their deportation was made in the previous 18 months, who have got a temporary suspension of deportation (Duldung) according to Section 60 of the Residence Act or who are obliged by order to leave the country, even if a deportation order is not yet enforceable or no longer enforceable. Furthermore, these benefits also apply to spouses, domestic partners and minors of the person in question, without them having to fulfill the stated requirements, or those who have made a follow-up application according to Section 71 of the Asylum Act or a secondary application according to Section 71(a) of the Asylum Act (3). People without legal residence status also fall under the Asylum Act (4). 

According to the Asylum Seeker’s Benefits Act, over the first 18 months the German social welfare office (Sozialamt) is responsible for ensuring healthcare for people who meet the conditions mentioned above (1). Depending on the federal state, either a medical treatment certificate or an electronic health card with limited entitlement to benefits is issued by the social welfare office. According to Section 4 of the Asylum Seekers Benefits Act, the benefits include covering the costs of “necessary” treatments for “acute illnesses and painful conditions” – what this actually means is not more precisely defined in the law. According to Section 6 of the Asylum Seekers Benefits Act, other benefits may also be granted in individual cases if they are “essential to ensure subsistence or health”. Benefits are approved at the discretion of the competent social welfare authority. It remains uncertain as to whether psychotherapy for example falls under Section 4 or Section 6 of the Asylum Seekers Benefits Act.

After 18 months of residence in Germany (provided that the length of residence has not been influenced by the person in question abusing applicable laws), the entitlement to benefits becomes the same as for someone insured by one of the health insurance providers, but the costs are still covered by the social welfare office. From this point on, qualified beneficiaries receive an electronic health card for use nationwide. Once you receive a residence permit or start to work, you become a member of the public health insurance system (5,1). 

Psychotherapy for Refugees:

As long as Section 3 of the Asylum Seekers Benefits Act regulates healthcare in this respect, access to psychotherapy or counselling will remain difficult, as it primarily provides for emergency and acute treatments. The responsible state authorities must judge the treatment to be necessary and approve it. Once treatment has been approved, there is a waiting period for therapy places. You can visit therapists regardless of whether you have been approved by your health insurance provider. Registered psychotherapists and psychotherapists in psychosocial centres must submit applications to the social welfare authorities in order for the costs of the treatment to be covered. The majority of asylum seekers and refugees are treated in psychosocial centres for refugees and victims of torture (Psychosoziale Zentren für Flüchtlinge und Folteropfer (PSZ)) during this time, of which there are 42 in Germany. These centres provide psychosocial, therapeutic and other low-threshold support services in a mostly interdisciplinary team. Admission to these centres is arranged through a waiting list system.

After being in Germany for over 18 months, refugees have access to the same benefits as they would under health insurance and can visit registered medical or psychological psychotherapists who are approved by health insurance providers. Another option is to visit a therapist who has not been approved by health insurance providers but who has been given authorization to treat refugees. Furthermore, psychotherapeutic outpatient departments at universities can be a good port of call when looking for a therapist.

For many people, enlisting the help of an interpreter can be necessary for their treatment. You can apply for the costs of using an interpreter to be covered under the Asylum Seekers Benefits Act at social welfare offices. You will be have to join a waiting list in this case as well. In your application is rejected, you can lodge an objection. After 18 months and once you start receiving health care benefits comparable to those under health insurance, the costs for language mediation are no longer covered(1). Psychosocial centres for refugees and victims of violence keep their own pool of language mediatiors.

*Those requiring special protection: according to Art. 21 of the directive, this term refers to e.g. minors, unaccompanied minors, disabled people, the elderly, pregnant women, single parents, LGBTQI* people (6), people with serious physical illnesses, people with mental disorders and people who have been subjected to torture, rape or other severe forms of psychological, physical or sexual violence. This list is not exhaustive.



Last updated: 03/09/2021 - 16:14

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