Effects of a statutory reform on waiting times for outpatient psychotherapy : a multicentre cohort study

Abstract

Aims: Social inequality in access to mental health care is a current concern across the world. The authors determined whether differences in waiting times for outpatient psychotherapy changed after a statutory reform of the German psychotherapy law. Methods: The dates of first contact, first visit and treatment start, along with socio demographic and clinical data, were extracted from patient records in community based psychotherapy practices. Predictors of waiting times for first visit and treatment start were investigated using multilevel Cox regression models to estimate adjusted hazard ratios (HRadj). Results: Data from 1548 patient records from nine practices were extracted. Before the reform, the time span between first contact and first visit was longer for patients with compulsory education than for patients with a college degree (HRadj 0.8, 95% CI 0.6–1.0), whereas this was no longer the case after the law changed (HRadj 1.0, 95% CI 0.8–1.3). Patients whose treatment was covered by the state were at higher risk of a long waiting time from last visit to treatment start compared with patients with statu tory health insurance after the law changed (HRadj 0.4, 95% CI 0.3–0.7), which had not been the case before the law changed (HRadj 1.3, 95% CI 0.8–2.2). Conclusions: Social inequality in access to psychotherapy was reduced in part by the updated psychotherapy law in terms of educational groups; however, it increased in other aspects. This shows how political decisions can powerfully impact clinical prac tice, ultimately helping one group of patients while disadvantaging another.