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„We Pay Much More Attention to Them Than Before“
MEDICA.de talked to Rainer Hellweg, Managing Senior Physician at the Department of Psychiatry and Psychotherapy at the Charité Campus Mitte, about work incapacity, the resulting costs, and the so-called model of Hamburg.
MEDICA.de: Mister Hellweg, how expensive is a patient with burnout?
Rainer Hellweg: The term „burnout“ is blurred and sums up many different problems. In general, however, the problems summarised under „burnout“ often strain a patient for years, in many cases the treatment also takes a lot of time and, therefore, is very expensive. Mental diseases are more and more frequently stated as the cause for early retirement. They already rank first in women’s statistics, even ahead of backache and cardiovascular diseases.
MEDICA.de: Why do a rising number of people suffer from mental diseases?
Hellweg: There is one thing I have to mention about the figures: today, we pay much more attention to mental diseases. Talking to elderly people, one can often find signs of mental diseases they passed through in younger years. Only, the symptoms were not recognised in those times. We have become more sensitive in this respect, diagnose such illnesses more often. This is positive because affected people get treated at an early stage and, ideally, get cured. On the other hand, it means tremendous costs.
MEDICA.de: What does that mean for the German health system?
Hellweg: Personally, I believe that our health system cannot carry on like this. Unless the health insurance premiums are not vastly raised or the therapies become considerably less expensive, in 2020 not everybody who needs it will get a therapy financed unconditionally.
MEDICA.de: What do you suggest?
Hellweg: Patients should do their bit, in terms of money and behaviour. As far as reasonable, I would demand of mentally ill people that they participate actively in their therapies. Some of them, for instance, receive early retirement benefits but do not show up to their therapy. If patients do not comply with their professional treatment, cutbacks of payments should be considered. Furthermore, I would distinguish mental diseases clearer from trifle ones: if someone cannot sleep during the time of his diploma thesis, stressed as he is, this could simply be a normal reaction. In this case, there is no need for a psychotherapeutic treatment. Neither would someone who suffers from a common cold go to see the physician. Who would like to call on such services anyway should pay for it. And the society should discuss the question: should we not preserve and provide new jobs that are suitable for mentally ill people, instead of letting them drift into unemployment and early retirement? That would save costs and improve the situation of most of the ill people, too.
MEDICA.de: But those patients are often incapable of working.
Hellweg: Jobs that they can accomplish would do them good though. I have hardly met a patient who would not be glad deep down to perform a task again. It would mean a perspective in life. However, there are few professions left, such as gatekeeper or janitor, that mentally ill patients can carry out without excessive stress. Additionally, many employers perceive affected only as a risk factor taking too many sick days. Companies, therefore, should get strong incentives to also employ such people.
MEDICA.de: Are there any examples?
Hellweg: Programmes such as the “model of Hamburg“ already try this for quite a while. The programme allows for a gradual reintegration into the working life after a long time of incapability to work due to an illness. If a company decides to re-employ an affected person, it does not have to pay the wages in the beginning. The employee is financed by the health insurance and starts with a few hours per week, with the possibility to raise them up steadily to full time. That is a step in the right direction.
MEDICA.de: In fact, more and more people take sick leave due to mental diseases. Normally, they stay out of office for several weeks instead of some days, as it is the case with other diseases. That is a huge burden for companies. What can be done to change this?
Hellweg:For one, the companies could improve the working atmosphere – take care for positive conflict solving, little negative stress, or facilitate sports. In theory, this already exists oftentimes, yet practically it is not implemented very forcefully. On the other hand, people should increase their frustration tolerance. They should learn to judge things not always one-sided, that is negative, and not to take every unfriendly word personally. Already in the kindergarten this should be started. The children could learn in games that loosing means not the end of the world. In school, stress management could be taught. Many health insurances do already offer such courses. This preventive approach should be strengthened. Unfortunately, large scale studies are still missing to prove definitely that such measurements reduce the number of mentally ill patients and the resulting costs.
The interview was conducted by Anke Barth.