The System That Eats Itself: From Wirtschaftswunder (economic miracle) to Wartezimmer (waiting room)

Background. Germany’s mental health care system, despite high health expenditure and a long tradition

of psychosomatic medicine, has entered a period of severe structural strain. The Robert Koch Institute panel

data show that the share of adults at or above the depression-screening cut-off rose from 7.5% in 2020 to

14.8% in 2023 (RKI, 2025; Hapke et al., 2025). Mental illness–related work absences reached a new

historical maximum in 2024 (DAK-Gesundheit, 2024), and average waiting times for outpatient

psychotherapy now exceed twenty weeks in rural regions (BPtK, 2025).

Position. In this Personal View, I argue — as the owner of a private psychosomatic clinic group operating

inside this environment, and as the president of an academy concerned with the next generation of clinicians

and researchers — that the German mental health field has entered a dead loop in which rising demand,

contracting public capacity, structurally unprofitable private capacity, a two-tier insurance system that

rations access by tier, and a workforce that is itself burning out, mutually reinforce one another. I draw on

the sociology of burnout (Han, 2015; Ehrenberg, 2010), the individualisation thesis (Beck & Beck-

Gernsheim, 2002), the empirical literature on family-system and psychosomatic care (Minuchin et al., 1978;

Linden & Bernert, 2014; Köhler et al., 2023), and the value-based healthcare framework (Porter & Teisberg,

2006) to make the case that a holistic, individualised, family-centred model of psychosomatic care is both

clinically necessary and, in the medium term, economically rational.

Personal vision. My driving purpose, in everything I do at the Verus Care Group and at Singularity

Academy, is to help families and children find a way out of what I have come to call the mental disorder

trap — the recursive cycle in which an underfunded system, an exhausted workforce, and a culturally

normalised disease vocabulary together imprison individuals and their families inside diagnostic identities

they cannot escape and that the system, as currently configured, cannot help them resolve. I am especially

concerned with mothers and children, because the next generation’s mental health is decided largely by

what happens inside the family system in the early years.

Conclusion. The essay proposes five concrete reform directions: reform of the PEPP/PsychVVG

reimbursement regime so that high-quality psychosomatic inpatient care is not structurally unprofitable;

properly financed psychotherapy and psychosomatic further-training pipelines; national investment in

routine PROM/PREM measurement for mental health; a reframed cultural conversation about sick-leave

and rehabilitation; and the formation of a private-clinic-owner forum to coordinate sector-level reform.