Alone in Berlin: How mental health services are failing refugees across Germany

Alone in Berlin: How mental health services are failing refugees across Germany
In-depth: The specific mental health needs of refugees in Germany are being exacerbated by limited access to care and uncertainty about the future, with dire consequences, reports Asher Kessler.
6 min read
08 December, 2017
Many fear that vulnerable refugees may become radicalised, or even turn to suicide [Getty]
In September 2015, The German Federal Chamber of Psychotherapists found that between 40-50 percent of refugees were experiencing mental health issues. Two years later, refugees and activists across the country are increasingly concerned by how difficult it remains for refugees to access mental health care.

For some it is too late. In June, the German government announced that more than 400 refugees had attempted suicide since arriving in Germany. In reality the number is probably much higher, considering that municipalities such as Berlin, which take a high proportion of refugees, do not keep data on suicide attempts.

One of the biggest problems many refugees struggle with is PTSD. Most refugees have experienced hugely traumatic events, whether in their country of origin or on their journey through Turkey and Eastern Europe.

Eli Wael, a Syrian refugee who now works for Give Something Back To Berlin. "There is no psychological help, not much," he told The New Arab. "And that is a big problem for most people."

This is an issue which affects people across Germany. In Dresden, Claudia Nikol, the head of communications for ABC Tische, an organisation which works with refugees, believes that Germany is "facing a period of really disillusioned refugees".

"It is really hard for them because they feel really desperate, overwhelmed by everything. I think this is a very good ground for becoming radicalised or many of them thinking about committing suicide; they are really down."

They come from countries where you make your own way and then they come here and get forced into a system where you can't take any decisions anymore… They become very passive

Today, the everyday life of refugees has been transformed into a set of integrative steps. Whether it is dealing with the complex bureaucratic system, the slow periods of free time or the extreme difficulty of finding accommodation, many refugees feel as if they have lost their own agency.

Anne-Marie Kortas is the CEO of Angehört, an organisation which gives legal advice to refugees. "They come from countries where you make your own way and then they come here and get forced into a system where you can't take any decisions anymore," she says. "They become very passive."

Most refugees arrive hoping to quickly learn the language, find a job and integrate into society. Instead, they face what feels like unending periods of free time. One refugee in rural Germany tells The New Arab "the quiet is killing me - I don't know about the other guys but it is killing me. Free time, free time, free time, we have too much free time. I have work seven hours a week. I could do it in two days but I do it in four, or else I have to spend five days at home alone."

Next month his job contract will finish, forcing him to leave his flat.

Increasing uncertainty over many refugees' future asylum status causes greater anxiety among the community. Since 2016, the vast majority of asylum seekers are given only temporary "subsidiary protection", meaning many refugees have to reapply for asylum every year, leaving them in constant anxiety over their future. Many perceive deportation as death, and with only a one-year visa, this very real fear cripples everyday life.

Refugees marched in Athens earlier this year to protest
Germany's banning of family reunification, a law
which has left 
many refugees isolated and vulnerable [Getty]

The rising prevalence of subsidiary protection has had another damaging psychological effect.

Since 2016, the German government stopped accepting family reunification applications from anybody with subsidiary protection. The consequence of this is that tens of thousands of refugees, mostly men, are now stuck in Germany without the ability to reunite with their families, who may still be in danger.

Countless refugees suffer from depression, distraught over the separation from their loved ones.

Claudia Nikol argues that this denial of reunification rights is the biggest factor encouraging psychological problems amongst refugees. "I think one of the biggest mistakes is not to allow families to come over," she said. "I think you could save a lot of psychotherapists if they had their families."

The reality is that very few refugees who want and need psychological help are able to find it. Tarek, a Syrian refugee living in Berlin, has many friends who have been waiting for months to see a therapist. He tells The New Arab that the mental health care system for refugees is best explained through a joke: "Mohammed goes to the doctor and says that he is depressed and needs psychological help. The doctor replies that he will put him on the waiting list and see him in seven months. Mohammed thanks the doctor, but tells him not to worry - he will have killed himself by then."

As bad as the waiting lists are in Berlin, Anne-Marie Kortas stresses that, outside of the capital, access to psychological care is even more difficult. "Cities like Berlin have some infrastructure for it," she said. "But you have big waiting lists. While in many other cities the biggest problem is translation. You have maybe doctors, and also psychologists who would like to help but no one to translate."

I have work seven hours a week. I could do it in two days but I do it in four, or else I have to spend five days at home alone

Language barriers stop the vast majority of German therapists from being able to offer their services. Although many refugees have learned a remarkably high level of German, it is one thing to work in another language and a completely different thing to express your most personal and complex emotions.

The German government have funded schemes such as one run by MSF to train a greater number of Arabic and Farsi-speaking therapists, quite often from the refugee community itself. Yet without expanding the scale of this scheme, the vast majority of those who seek help will not be able to find it.

One source who works with refugees for the German government told The New Arab that psychological care "is not one of [the government's] points of concern".

"Right now the German system does not really do much for that [psychological care]. I think that they just prefer to ignore and hope that people will function."

An increasing worry among activists and refugees in Germany is that the failure in the past few years to create an adequate mental health care system for refugees is increasingly undermining other integrative efforts. Without creating mechanisms which can help thousands of refugees deal with depression, PTSD and anxiety, Germany is quickly finding itself in a position which it desperately sought to avoid: thousands of alienated, lonely refugees, who are lost and without hope.

*The names and locations of some refugees have been changed.

Asher Kessler is a freelance journalist who has written for Huck Magazine and The Huffington Post.

Follow him on Twitter: @Ashkwondo