This article discriminates against the mentally ill

Actively combating stigma and discrimination against people with mental illness

At the request of the board of directors of the German Medical Association (printed matter II-01) taking into account the requests of Prof. Dr. Krause-Girth (printed matter II-01b and II-01d) and Mr Wagenknecht (printed matter II-01c), the 109th German Medical Association passed the following resolution with a large majority:

(1) Mental illnesses as one of the most common health disorders are becoming a growing problem with regard to their health-political and economic significance for the world population:

According to the World Health Report of the World Health Organization (WHO 2001), depression alone already accounts for almost 12% of the world's leading causes of years of life impaired by disabilities. The ten most important illnesses also include addiction disorders, schizophrenia and bipolar disorder. Suicides are the second leading cause of death among teenagers. Due to the aging of the population, a significant increase in dementia is to be expected over the next few decades. These data are also reflected in the epidemiological studies in Germany, as published in the "Federal Health Survey" commissioned by the Federal Ministry of Health. The importance of mental illnesses becomes clear, among other things. in the fact that mental disorders are now the most common cause of early retirement. The World Bank estimates that of all mental disorders, depressive disorders cause the highest health costs. The direct costs of treating depression in Germany are estimated at 4 billion euros.

(2) The treatability of mental illnesses has improved significantly in the last two decades:

With competent treatment, the majority of all patients have a good chance of a cure or a decisive improvement in their clinical picture. This was made possible by an increasingly differentiated spectrum of social psychiatric measures, sociotherapies, psychotherapy procedures and psychotropic drugs, e.g. B. possible with anxiety disorders, eating disorders, obsessive-compulsive disorders, depression, personality disorders. Particularly in childhood and adolescence, early treatment of an emotional or psychosocial disorder has a good chance of recovery. The recurrences that are often to be expected in mental illnesses can now also be significantly reduced with consistent treatment. Even with diseases that are prognostically less favorable, such as schizophrenia, it is much more often possible to significantly alleviate the disease, if not to cure it, and thus to enable an independent, independent life.

(3) Despite the good curability of mental illnesses, those directly affected by them, their relatives and those employed in psychiatric-psychotherapeutic care are exposed to subtle and obvious stigmatization and discrimination on all levels of society.

The disdain for the curability of mental illnesses can be seen in the media coverage, in the social environment up to the private health insurers, life insurers and occupational disability insurers, who reject it with those who have a history of psychotherapy - even if the mental illness is excluded the service catalog - to conclude a contract. The low rate of diagnosis of mental illness in the primary care system found in epidemiological studies leads to a delay in initial treatment with the consequence of a potential worsening of the course of the disease. This can indicate that doctors are postponing the diagnosis in order to avoid possible later stigmatization of the patients. People suffering from psychosis are generally rated as violently above average. People suffering from depression or alcoholism are considered to be self-guilty and responsible. Mentally unstable and disturbed children are often exposed to bullying in school, whereby the aggressor's own fears are usually hidden behind the aggressions against them. Contrary to scientific knowledge, parents of mentally ill children are often assumed to have a generally faulty upbringing.

(4) In Germany, it has been proven that a large proportion of patients seek medical help too late or not at all because they are ashamed of a mental illness.

They live with the fear of being additionally stigmatized by psychiatric-psychotherapeutic treatment. This in turn significantly increases the threshold for the patient to claim professional treatment. Structural discrimination against these people has a particularly negative effect in their personal living environment, at work, on the housing market or at school. Inpatient stays and ongoing treatments are kept secret from work colleagues, the class and relatives. These circumstances, like their social isolation, contribute to a deterioration in the state of health and - associated with this - to increasing health costs. The fact that mentally ill people often take on this stigmatization and discrimination themselves and thereby intensify their suffering has already been referred to as a "second illness" (in English: "self-stigma" versus "public stigma"). The relatives, who experience themselves as outsiders of society, often have similar experiences.

(5) Internationally and nationally, the fight against stigmatization and discrimination is seen as a central goal in the care and treatment of the mentally ill.

For this reason the World Health Organization (WHO), the World Psychiatric Association (WPA), the Conference of Ministers of Health of the EU, the European Commission and many national societies, e.g. B. in England, Australia, but also in the Federal Republic of Germany and others. initiated by the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN), action programs.

The 109th German Medical Congress makes the following demands:

  • The legislature is called upon to guarantee equality and equal treatment of mentally ill people in all areas of public life, so that in Germany, too, it is possible to decisively improve the living and treatment situation of mentally ill people and their families.
  • For mentally ill and (partially) inpatient treated children, continuous school lessons must be ensured in all federal states according to their resilience.
  • Statutory health insurance companies and statutory health insurance associations are requested, in accordance with Section 72 of the Book V of the Social Code, to expressly observe Section 27 Paragraph 1 Clause 3 of the Book V of the Social Code (SGB V) (when treating the patient, the special needs of the mentally ill) and the care of the mentally ill by contract doctors to support with additional funds within or outside of the total remuneration of the Association of Statutory Health Insurance Physicians.
  • The health insurance and rehabilitation agencies are requested - in the sense of the Social Security Code IX "Rehabilitation and Participation of Disabled People" - to work better across all agencies for mentally ill people. Patients and their families must be accompanied without interruption - even when changing providers - starting from the therapy place to reintegration at work and in school or when finding a place in a home.
  • The statutory health insurances (GKV) are requested to ensure the implementation of the domestic psychiatric nursing and the social psychiatry agreement of sociotherapy as well as to enable and finance people with mental illnesses within the meaning of § 44 SGB IX access to rehabilitation sport. Scientific studies show that rehabilitation sport has been shown to help mentally ill people. You must not be discriminated against against people with other disabilities.
  • The private health insurers, life insurers and occupational disability insurers are requested to give up their previous restrictive admission requirements, especially for people who already have a history of psychotherapy or were affected by a mental illness and are cured. You must not be disadvantaged compared to other sick people
  • Medical organizations and state medical associations are called upon to provide adequate communication of the stigmatization problem and its possibilities to overcome it in the training, further education and further training of doctors and other medical professions.
  • The German Medical Association appeals to all doctors to work consistently to ensure that all mentally ill people have the opportunity to have equal, low-threshold access to all available therapy options and thus to make the indicated use of all psychiatric and psychotherapeutic support systems much easier. This also applies to people from immigrant groups, who often only find access with the help of intercultural mediators.
  • The medical profession is called upon to see itself as a representative of the interests of its patients and - together with patient and family members' associations - to take action against demonstrable structural disadvantages.

Against this background, the 109th German Medical Association welcomes the international and European action programs against stigmatization and discrimination against the mentally ill and in particular supports the "National Action Alliance for Mental Health" of the German Society for Psychiatry, Psychotherapy and Neurology, which is under the patronage of Federal Health Minister Ulla Schmidt ( DGPPN) and other action programs such as "Open the Doors" or the "Düsseldorfer Bündnis Depression" of the North Rhine Medical Association as well as other action alliances "Depression". In addition, the 109th German Medical Association welcomes campaigns aimed at schoolchildren such as the "Irre Menschlich eV" as well as other activities of the child and adolescent psychiatric societies, such as the nationwide ADHD network.