Waiting for therapy: the state of access to psychotherapy and why digital tools matter more and more

Anyone in Germany who finally works up the courage to seek help often calls one practice after another and keeps hearing the same sentence: “Sorry, we have no place.” Waiting for psychotherapy is one of the most stubborn problems in the health system. At the same time, budgets are being cut. A look at the figures, at other countries and at what digital tools can and cannot do.

The need is large

Mental health problems are not a fringe issue. In the large German health survey DEGS1 by the Robert Koch Institute, 27.7 percent of adults in Germany met the criteria for at least one mental disorder within a year¹. These include common problems such as anxiety, depression or sleep disorders. Worldwide, the World Health Organization estimates that more than a billion people live with a mental health condition, most of them without adequate care¹⁷.

Supply is limited. And it is exactly in this gap that it is decided who gets help and who does not.

Germany: good care, long roads

By international standards, Germany has a well-developed system. Psychotherapy is paid for by the statutory health insurers, and since April 2017 the psychotherapeutic consultation hour has offered a low-threshold entry point². No referral is needed for a first conversation. The appointment services of the regional associations of statutory health insurance physicians can be reached at 116117 and must arrange a consultation within four weeks. If acute treatment is needed, the wait for it must not exceed two weeks⁴.

The problem starts afterwards. Between the consultation hour and the start of regular therapy there are often months. A survey by the German Federal Chamber of Psychotherapists (BPtK) of 9,432 psychotherapists found a national average of 19.9 weeks until therapy began in 2018². Analyses of billing data for 2019 found 142 days from the first consultation to therapy. About 40 percent of those who had a first consultation in early 2019 could start therapy in the third quarter at the earliest, more than ten percent only a year later³. The federal government considers six weeks acceptable, twelve in exceptional cases⁵.

Rural areas are short of places

Where you live makes a big difference. In large cities the wait until therapy started was 16.9 weeks in 2018, in rural districts 20.7 and in the Ruhr area 29.4 weeks, more than seven months². One reason is so-called needs planning, which determines how many publicly funded practice seats a region may have. Before the last major reform it provided for 36.1 psychotherapists per 100,000 inhabitants in cities, but only 12.8 in rural areas in the least favourable case⁶. “The considerable differences between town and country cannot be justified,” said Dietrich Munz, then president of the BPtK⁶.

In 2019 the Federal Joint Committee reformed needs planning, creating almost 800 new seats. The BPtK considered this too little⁷. For people in rural areas this still means long journeys, few practices to choose from and often long waiting lists.

Current policy: cutting instead of expanding

Instead of expanding supply, the opposite is currently on the agenda. The statutory health insurers are under financial pressure, and this also affects psychotherapy.

• Fee cut of 4.5 percent: In March 2026 the extended valuation committee decided to cut psychotherapy fees by 4.5 percent from April 2026. In July 2026 the Berlin-Brandenburg state social court provisionally suspended the cut, citing “considerable legal concerns” about the calculation. The main proceedings are still ongoing⁹.
• Budget cap from 2027: On 10 July 2026 the Bundestag and Bundesrat passed the statutory health insurance contribution stabilisation act (GKV-BStabG)¹⁰. According to the BPtK, outpatient psychotherapy will again be paid from a capped budget from 1 January 2027, and surcharges for short-term therapy, about 100 million euros according to the BPtK, will be dropped⁹. The BPtK calls the law a “waiting-time extension act”¹⁰.
• New professionals without funding: Since the training reform, future psychotherapists must complete paid specialist training after their degree. How these posts are funded is still not adequately regulated. As early as 2024 the BPtK criticised the federal government for writing underfunding into law⁸.

In an accompanying resolution, the coalition announced exceptions, for example for children and adolescents, people with severe mental illness and urgent cases. Whether and how these are implemented depends on a further law⁹¹⁰. As of today it is unclear how waiting times will develop. But the direction of the debate is clear: more places are not in sight in the short term.

Looking across borders

How do other countries do it? Each system has its own hurdle. Sometimes it is the wait, sometimes the number of paid sessions, sometimes simply money.

Simplified overview, as of November 2026. The systems differ in many details, such as co-payments, private insurance and regional differences.

USA: when therapy is a question of money

The USA has no uniform statutory insurance system like Germany. Whether and how much an insurer pays for psychotherapy depends heavily on the plan. Many practices do not bill insurers at all. In a survey by the American Psychological Association (APA), a third of psychologists said they accept no insurance. The main reasons were low reimbursement rates, administrative burden and unreliable payments¹³. Patients who go there pay themselves.

The consequences show in the figures of the US health agency SAMHSA: only 52.1 percent of adults with a mental illness received treatment in 2024¹¹. On top of that comes a shortage of professionals. About 137 million people live in areas officially designated as underserved, and by 2038 the agency HRSA projects a shortfall of almost 100,000 full-time psychologists¹².

England, Switzerland, Australia: other routes

England relies on NHS Talking Therapies, a free, standardised programme people can also refer themselves to without seeing a GP²⁴. The target: 75 percent start within six weeks. In June 2026 the figure was 85.2 percent¹⁴. Since July 2022, Switzerland has paid for psychological psychotherapy through basic insurance when a doctor orders it, for up to 15 sessions at a time¹⁶. Australia subsidises up to ten individual sessions a year through Medicare¹⁵.

Worldwide the gap is far larger. According to the WHO, there are only 13 mental health workers per 100,000 people on global median, and mental health receives only about two percent of health budgets on average¹⁷.

Why digital tools are becoming more important

As early as 2011, Yale psychologist Alan Kazdin and Stacey Blase did an uncomfortable calculation: classic individual therapy alone will never be able to meet the huge need. “Individual psychotherapy, the dominant model of treatment delivery, is not likely to be able to meet this need,” they write. What is needed is a whole portfolio of routes, including technology, self-help and services outside traditional practices¹⁸.

A lot has happened since. Research shows what digital tools can do:

• Guided online programmes work: A meta-analysis by Swedish psychologists Per Carlbring and Gerhard Andersson with Dutch psychologist Pim Cuijpers found across 20 studies that guided internet-based CBT achieved, on average, effects similar to face-to-face therapy¹⁹.
• Apps show small but reliable effects: An analysis of 176 randomised trials found small, stable improvements in symptoms of depression and anxiety from apps²⁰.
• Support makes the difference: A team led by Ulm psychologist Harald Baumeister showed that online programmes with human support usually work better than those people use entirely alone²¹.
• Part of regular care: In Germany, tested digital health applications (DiGA) can be prescribed and are paid for by health insurers²².

The biggest advantage of digital tools is access. They are there immediately, even at night, even in a village with no practice nearby, even for people who do not yet dare to talk to anyone about their problems. They cost little or nothing. And they can be a bridge: to use the waiting time well, to understand what is actually weighing on you, or to find the courage to seek help in the first place.

Not every app is the same

App stores list very different things under “mental health”: tested prescription DiGA, meditation and self-help apps, and apps for coaching and self-reflection. What each group can and cannot do is explained in Therapy app or coaching app?. A concrete comparison of well-known apps with strengths, weaknesses and ratings can be found in Mental health apps compared.

Where MindMotion stands

MindMotion is not online therapy and does not provide psychotherapy. We are a tool for psychological self-reflection, closer to coaching. The idea: many people are stuck in conflicts that keep repeating in daily life, at work, in their relationship, with friends. That does not always need therapy, but it often needs a nudge to look more closely. MindMotion helps you connect such conflicts with inner patterns and try out small new steps, free, without sign-up and without a waiting list.

Which change factors from psychotherapy research we implement and where our limits are is shown openly in What makes change work.

Frequently asked questions

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MindMotion is still in development, and we want to make it better together with you. Start the Mind-Check, pick a conflict from your daily life and see which pattern lies behind it. And tell us honestly what helps and what is missing.