Are psychotherapy, counselling centres and self-help groups still taboo? May is Mental Health Awareness Month - to mark the occasion, REDEZEIT FÜR DICH and Appinio surveyed 3,000 people from Germany, Spain, France, the USA and the UK about their mental health and use of support services. The study shows a growing acceptance of mental health services in almost all countries, current obstacles and opportunities.

Results at a glance:

• Germans are happier: 81 per cent of Germans say they are currently (rather) happy. Just over one in three Germans (39%) have experienced an improvement in their mental health in the past year, especially young people between the ages of 16 and 24. More than half (56%) of them say that their mental health has (rather) improved in the last year.

• One in four Germans has already taken advantage of psychotherapy (27%): A further 46 per cent are considering it.

• Various barriers to access: time, money, courage and the belief that the psychological stress is not strong enough.

• The difficult trip to the therapist? ‘Talking helps to reduce mental stress’ - 91 per cent of Germans (somewhat to completely) agree with this statement. In addition, three out of four people say they sometimes or often talk to others, for example friends or family, about their mental health (76%). The survey also shows a clear trend towards seeking professional help: one in four Germans have already taken advantage of psychotherapy and another large proportion (46%) are considering doing so. The same applies to the use of medical or psychiatric help for mental health.

• Despite these positive trends, a large proportion of respondents say they do not seek help. The main reasons for this are the belief that their psychological stress is not severe enough (41%), a lack of courage to seek help (25%), as well as time (25%) and financial barriers (18%). Furthermore, many do not know where they can find suitable information (16%) or cannot find a place that is covered by statutory health insurance (14%).

• An opportunity: Two out of three Germans could imagine using online support services (65%). This shows that digital solutions could play an increasingly important role in mental healthcare.

• International comparison: The barriers to utilising mental health services vary depending on the country: While Germans and French people often lack the courage, respondents from the USA more frequently state that they cannot afford private help. In Spain, there is often a lack of places that are covered by statutory health insurance.

Comparison with our studies from 2022 and 2023

In recent years, awareness of mental health has developed significantly in Germany. This is reflected in the attitudes and behaviour of the population, as shown in a comprehensive analysis from 2022 to 2024. This development is particularly evident in the increasing willingness to talk about mental health problems, the use of online health services and the growing acceptance of therapeutic services.

• Increasing happiness rating: The average rating of overall happiness increased significantly from 2022 to 2024, from a mean (M) of 2.56 to 3.09. The largest increase took place between 2022 and 2023, as evidenced by a moderate effect (Cohen's d = 0.55). Between 2023 and 2024, the level of happiness remained stable, as indicated by a very small effect (d = 0.09).

• Increased willingness to communicate: The willingness to talk to others about mental stress increased between 2023 and 2024 in particular, which is illustrated by a moderate effect (d = 0.51). This shows a growing openness in the population to talk about mental health problems.

• Use of online help services: Acceptance of mental health services online increased from 2022 to 2024, with a significant but moderate increase between 2022 and 2023 (d = 0.30). The slight decrease in the effect from 2023 to 2024 (d = 0.08) could indicate saturation or that a certain level of acceptance has been reached.

• Use of therapy and counselling: The willingness to accept therapeutic and counselling services has also increased over the period surveyed, especially between 2022 and 2023. The increase from 73.90% to 81.10% of positive responses underlines an increasing recognition and use of these services.

These trends suggest that attitudes towards mental health in Germany are developing positively, with increasing openness and awareness of the importance of mental health care. The increasing willingness to seek help and talk about mental distress may also be due to improved availability of information sources and a decrease in the stigma around mental health. This is encouraging progress and shows that education and public health initiatives are having an impact.

Psychological help and access barriers

It is encouraging to note that 27% of Germans already utilise psychological help and a further large proportion can imagine using such services. The results thus show a growing acceptance and utilisation of mental health services, although there are still challenges to full acceptance and accessibility. Political uncertainties and socio-economic factors continue to play a major role in the mental wellbeing of Germans, emphasising the need for continued education and improvement of available services.

The study shows that many Germans do not make use of support services such as psychotherapy or counselling despite being aware of the importance of mental health. Respondents in Germany gave the following main reasons why they have not yet sought support:

• Low psychological stress: 41% of respondents believe that their psychological stress is not severe enough to require professional help.

• Lack of time: 25% of respondents stated that they could not make time for this.

• Financial reasons: 18% of respondents stated that they could not afford private help.

• Stigmatisation: 10% of respondents cited fear of stigmatisation as a reason.

• Lack of trust: 6% of respondents have no trust in the effectiveness of the support.

• Lack of overview: 16% do not know where they can find suitable information.

• Lack of places covered by statutory health insurance: 14% state that they cannot find a place that is covered by statutory health insurance.

The results make it clear that the perception of low psychological stress is the most frequently cited obstacle. Many people may underestimate their symptoms and the need for support. Lack of time and financial barriers remain significant barriers, while fear of stigmatisation and lack of confidence in the effectiveness of support are also important barriers.

Influence of the political situation

A decisive factor influencing the mental health of Germans is the current political situation. According to the study, half of Germans say that the political situation influences their mental well-being. This is particularly relevant in light of recent political developments, such as the fight against the pandemic and economic uncertainties. The older generation in particular appears to be sensitive to the political mood, which points to the importance of political stability for the emotional well-being of citizens.

Stigmatisation

The study shows that a large proportion of the population regularly talk about their mental health, which is a positive sign for the reduction of stigma around mental health. This emphasises the importance of open conversations and social support. This trend is supported by the increasing availability and use of online support services, which provide low-threshold access to psychological support.

Need for political and health measures

The results of this study show that despite the progress in mental health care and the increasing acceptance of the topic, significant challenges such as political uncertainties and socio-economic barriers remain. There is a need to develop integrated and accessible healthcare services to further promote mental health in Germany. This requires a reduction of stigmatisation and an adaptation to the specific needs of different population groups. Health policy measures should be based on scientific evidence and societal trends in order to promote a resilient and mentally healthy society.

In view of the current health policy and social situation, such as the COVID-19 pandemic, economic uncertainties and political tensions, the importance of mental healthcare has increasingly entered the public consciousness. The study helps to raise awareness of the need for comprehensive mental health care and provides important data for the design of health policy and preventive measures.

Digitalisation and its effects

‘Digitalisation has a complex and multi-layered impact on mental health, with both positive and negative aspects. Integrating digital solutions into mental health care can help to improve access to help. At the same time, political measures should be taken to create a healthy digital infrastructure that ensures the protection of privacy and the responsible handling of information,’ says Karen Tippkötter from REDEZEIT FÜR DICH. Cyberbullying and online addiction in particular are increasing problems, as is the pressure to be present online. Aspects that can have a negative impact on mental health.

Specific population groups and their challenges

Certain population groups, such as older people or migrants, face specific challenges in relation to their mental health. These include loss of social contact, physical limitations and adapting to new cultural environments. It is important to provide specific support systems and services for these groups in order to promote their mental health and enable them to lead a dignified and fulfilling life.

Neighbouring country France: therapy grouches?

Mental health services are also becoming increasingly popular internationally. In the USA, one in three people have already taken advantage of psychotherapy (33%) - a further 40 per cent can imagine undergoing psychotherapy in the future. In France, participation in mental health services is comparatively low. Only 13 per cent of respondents state that they have taken advantage of psychotherapy. French people are also much less likely to talk to others about their mental health: Almost one in two French people said they never or only rarely talk about this (46%) and significantly fewer French people agreed with the statement that talking helps to reduce mental stress. The barriers to utilising mental health services differ from country to country. While Germans and the French often lack the courage, respondents from the USA more frequently stated that they could not afford private help. In Spain, there is often a lack of places on the statutory health insurance schemes.

The survey also revealed interesting international comparisons on the subject of digitalisation in an international context: in France, 42 percent of respondents see online services as an option, while 58 percent remain sceptical. In Spain, 50 per cent of the population are open to online support services, although many prefer face-to-face interaction. In the UK, online support services are popular with 71 per cent of respondents, indicating a high level of openness to digital healthcare services. In the USA, the acceptance of conversations about mental health and online services is particularly high compared to the other countries (74%).

Political and cultural developments

The importance of mental health has been recognised at a political level in recent years. More measures have been taken to improve care and access to psychological help. This is reflected, for example, in the introduction of online psychotherapy and the recognition of mental illnesses as equivalent to physical illnesses. The promotion of mental health has become an important political issue that aims to improve people's quality of life and reduce the economic impact of mental illness.

Cultural changes and social norms are also important. There is now a greater awareness and acceptance of mental health issues in society, leading to a decrease in the stigma surrounding this issue. This allows for open conversations and easier access to support services for people with mental health issues. However, there are still challenges, such as prejudice and discrimination, that need to be overcome to ensure the full integration of people with mental illness into society.

Overall, various social developments and political measures play an important role in the promotion of mental health in Germany, Europe and the USA. Social acceptance and openness towards mental health, the integration of digital solutions and the provision of support systems for specific population groups are helping people to better understand their mental health, talk about it and gain access to adequate support. However, a continuous effort is needed to address the challenges and make mental health a central concern at individual, societal and political levels.

Citation: The surveys were conducted by Appinio from 2 to 14 May 2024. 1,000 people were surveyed in Germany, and 500 people each in France, Spain, the USA and the UK, aged 16 to 65, nationally representative of the age and gender of the national population.