Mental health burden in Switzerland: 3 reasons why we fail and 1 call to action
It all started seven years ago when a dear friend of mine abruptly returned from a study trip abroad. Upon arriving home, he called me and told me that we had to meet up. We met in a café, but the usual fun atmosphere between us was absent. Over coffee, he told me that he was having obsessive thoughts that he couldn’t control or get rid of. Together with his family, he had made the decision to admit himself to a mental health clinic where he would receive intensive therapy and medication.
At the time, I was 23, and he was just 21. My friend is a well-educated, extroverted guy with a sunny personality. His diagnosis and the severity of his symptoms came as a shock. He was diagnosed with anxieties and depression which caused obsessive thoughts. I later learned that he thought obsessively about killing the people he loves most — his girlfriend, mother, brother, and friends. I didn’t understand at all. That was five years ago.
Only last year, I discovered that four more people in my immediate circle were suffering from anxiety, depression, or other mental health challenges. Not one of them ever openly talked about it.
One summer’s night, I sat on my balcony and thought: “How can it be that in such a wealthy, socially well-developed country so many people suffer from mental health issues and no one talks about it?”
“What does it say about us, as a society, when we spend more money on food delivery start-ups than fixing mental health issues?”
Ring!!! The food delivery guy snapped me out of my thoughts and out of my chair. I ordered Chinese dumplings via an app 15 minutes ago. It was at that moment that I realized that investors poured hundreds of millions into food delivery start-ups so I could get my dinner in 15 minutes instead of 30 minutes. “Imagine,” I thought, “where we could be if we focused all our efforts on fixing the bigger problems in our society.”
The problem
One day, someone close to me suffered a panic attack caused by their overwhelming anxiety. I felt so far away and lost as I witnessed someone I care about drown in a sea of negative thoughts. I was standing there watching it unfold, unable to move and unable to help.
After that incident, I decided to be more proactive. I Googled the shit out of the topic and the results were shocking. Each year, up to 20% of the European population is affected by depression, anxiety disorders, and other mental health issues: 110 million individuals. That is the equivalent to every single citizen of Switzerland, Austria, Sweden, and Germany combined. Seven out of ten people do not get treatment. You know what I thought?
“Wtf?” Apologies for my French.
“110 million people in Europe suffer from mental health issues, but only three out of ten seek treatment.”
According to the OECD, 4% of GDP is spent on the indirect and direct costs of issues related to mental health, such as people not showing up for work, dropping out of the workforce, or worse. That’s USD 30 billion in Switzerland and USD 6 trillion globally by 2030. That’s a lot of money.
Most suicides that occur are connected with a mental health issue. Every 40 seconds, a person commits suicide. Every 40 seconds. That’s a lot of pain.
So why is that? After reading deeper into the topic and talking to a dozen affected individuals, I came up with three main reasons for why things are the way they are. Let’s start with the most obvious one:
1. Stigma
The research is clear: the fact that people are afraid of being stigmatized stops them from telling anyone about their mental health issues. The reasons and drivers behind this stigmatization in societies are manifold. However, the common denominator is the fear of being considered weak and vulnerable.
This is especially pronounced in the context of a performance-oriented society like ours, where an individual only counts as worthwhile if he or she performs.
We often link our mental health issues to potentially losing a key source of human self-confidence: acceptance by our peers, by the tribe. We would therefore rather not talk about it. Everyone does this. So, everyone pretends to feel great and continues to suffer alone. Together alone, if you will.
“It’s like an inner bleeding that you don’t treat. The more you wait, the worse it gets.”
Not talking about severe mental health issues worsens the challenge, while early intervention could help. It’s like inner bleeding that you don’t treat. The more you wait, the worse it gets. Talking with the right people would make a difference, but who is out there to listen?
2. Lack of education
We are not educated at all about the things that affect our mental health. Back in school, we talked plenty about our body, but we definitely never learned anything about where phobias come from, for example.
It seems strange that we can easily recognize the symptoms of the flu, but with mental health issues, we have a blind spot. Ask yourself: Would you be able to identify the early signs of an anxiety disorder that needs treatment? Most people don’t even know what that is. I sure didn’t.
“We are simply not educated at all when it comes to our mental health.”
Have you ever talked to someone with depression? My initial reaction was to put on a sad voice and say something like: “Oh, you shouldn’t worry. You will get over it. Believe me. Just be strong.”
It’s a reaction that shows the right intentions but also a lack of real knowledge and understanding. A sad voice? No one would sneeze when someone else has the flu to show empathy. “You will get over it?” No one would suggest allowing an open wound bleed until it stops. And the idea that “you have to be strong” has definitely crossed the mind of the affected individual already. You can bet on that.
If you talk to affected individuals, they will tell you that at a certain point, they talked about it — mainly with the people they trust, like family and friends. But they rarely found anyone who could really relate or help. So, they chose to keep it to themselves again. For many, they didn’t want to be seen as a burden.
Most people, like myself, simply do not know how to help. How could we? Instead, we wait until the situation escalates and turn to professional help. At least we try.
3. The system
The healthcare system is geared heavily towards “sick people”, whatever that means. If you are physically sick, you go see a doctor and you get treated. Makes sense. However, when you think about it, that same system requires someone with the early stages of a mental health issue to wait until they are severely sick to get treatment, which only makes things worse.
In Switzerland, everyone gets health insurance coverage. Actually, you don’t “get it”, you buy it. Costs range between USD 250 and USD 500 per month. Generally, when the Swiss seek mental health treatment, they expect their health insurance to cover it. This is great, but if they don’t cover it, you might begin to tell yourself that insurance is not that important (after paying USD 6,000 a year, the willingness to pay for healthcare decreases). However, when it comes to mental health, it is more complicated. Stay with me here:
To get mental health coverage from your basic health insurance provider*, you first need to see a doctor who will issue an official diagnosis for insurance-covered treatment.
Once diagnosed, the insurance company only pays for your treatment when you get treated by a psychologist who is directly employed by a doctor, which is legally limited to a certain number. The psychologist then has to treat you in the respective doctor’s office, which is limited by available physical space, too.
“The current system is creating a bottleneck, causing long waiting times and other barriers to entry for early mental health treatment.”
So, even though Switzerland has the highest density of psychologists across all OECD countries, only about 30% are employed under the circumstances described above. There are not enough psychiatrists — and therefore not enough psychologists working for them — which can leave patients suffering for months before getting an appointment.
This process was designed to keep treatment quality high, but no matter how well-intended, it creates long waiting lists and immense hurdles for early intervention. Especially when you consider that A) the topic is stigmatized and people don’t want to be declared sick in the first place, B) people are not educated enough to realize they really need help, and C) many do not have people around them who could encourage them to seek early support (see A).
In addition to that, companies in Switzerland generally do not offer a lot of support for the mental health treatment of their employees, which we will examine further in a separate post.
*The Swiss government is now working on a change in the law, strongly backed by the Psychologist Association. Find out more.
*Some insurance companies pay partial expenses for psychotherapy treatment through an extra plan (e.g., 20% per session. If not, you pay around USD 180 / h out of your pocket. Here is a list of all insurance companies and what they cover.
Call to action: there must be another way
Sadly, the problems are not limited to the three examined in this post. There are many more, and it will require a multi-dimensional approach to fix these issues in the long run.
However, there is a glimmer of hope on the horizon. Insurers are offering more options related to early prevention, policy changes are in the making, the topic is becoming more openly discussed, and companies are starting to spend more on corporate healthcare, too. We have the chance of a generation to bring about change. Employers, insurance companies, communities, therapists, entrepreneurs, the state, and affected individuals must join the discussion to make the whole system better.
My friend from the beginning of the article? After intensive mental health care, he recovered and finished his studies. Today, he is working at a great job and has learned how to live with his challenges. Through his treatment, he got to know his mind better, knows how to anticipate attacks, has exercises to go through, and sees a therapist once a month.
He says: “If I could do one thing better, I would get help earlier and talk about it with friends and other affected individuals. Because I know there are many others out there who would love to talk.”
Let’s do that. Let’s finally do that.
P.S.: I’m happy to hear your feedback and challenging thoughts. We have launched initiatives in and around setting people’s minds free. You can find us at www.thefearless.company.
