What does mental health include

Please note that health information can only support a conversation with a psychotherapist or doctor, it can never replace it.

We have put together important general information on mental illnesses for you. The links in the page overview take you directly to the information.

Mental health - soul in balance

The term “mental health” refers to our “inner workings”, that is, how we think and feel, but also how we act. Mental health means that a person feels mentally and spiritually well. A kind of ideal state in which a person can fully exploit his potential in order to cope with stress and strain in his life. Thanks to a healthy psyche, a person can be productive at work. He can contribute something to his environment - that is, to the life of his family, friends, acquaintances and neighbors.

Mental health does not simply mean the absence of mental stress or illness. There is no “all or nothing principle” here: Most of us are most of the time somewhere in the middle between “mentally healthy” and “mentally stressed” or “mentally ill”.

Mental illness - When the soul suffers

Not only the physical but also the mental health of a person fluctuates from time to time. Especially in times of heavy stress - for example after the loss of a job or the death of an important person - it is not easy to keep your balance.

People with psychological stress experience different complaints (symptoms), which are different in severity. The symptoms can have a greater or lesser influence on the everyday life and functionality of those affected. Frequent reactions to stressful situations are feelings of sadness, fear or strong inner tension, which can also be very strong for a limited time. These symptoms usually go away after a while. If they last longer or continue to develop - such as panic attacks, suicidal thoughts, self-harm or delusions - and lead to ever greater problems in everyday life, those affected and their relatives should seek professional help.

The term mental illness includes various clinical pictures that occur in different degrees of severity. A doctor or psychotherapist can find out in a detailed diagnostic interview whether and from which mental illness the person concerned suffers.

Important to know: Mental illness

  • can influence perception, thinking, moods and behavior,
  • are more common than you think
  • are not a sign of weakness,
  • can meet everyone
  • are experienced differently by everyone and
  • can usually be treated effectively.

Mental illnesses cannot be "simply" diagnosed with the help of a test, as is the case, for example, with a broken bone with an X-ray. A clinical diagnosis can only be made by an experienced specialist or psychotherapist. Before doing this, however, an examination is required to detect any physical illnesses - such as B. a thyroid disease - to be excluded as a contributory cause of the psychological complaints.

This is followed by a detailed discussion with the specialist or psychotherapist about the individual complaints (symptoms), the previous history and other physical and mental illnesses of the patient. Psychological tests such as questionnaires can also be used. This diagnostic interview is about getting the overall picture of all complaints and assigning a diagnosis to them. In this way, the doctor or psychotherapist can determine whether the patient suffers from a specific or from several mental illnesses and how severe these are. This is important because the type of therapy can vary significantly depending on the type and severity of the disease.

The assignment to a diagnosis is usually made on the basis of the "International Classification of Diseases and Related Health Problems" (ICD-10, International Classification of Diseases, 10th revision). The ICD-10 is published by the World Health Organization (WHO) and is largely legally binding in Germany. This means that psychotherapists, doctors and clinics must provide the health insurance companies with an ICD-10 diagnosis so that the treatment costs can be covered.

The ICD-10 divides mental illnesses into so-called diagnostic groups:

Diagnostic groupexample
Organic, including symptomatic mental disordersdementia
Mental and behavioral disorders due to psychotropic substancesAlcohol abuse, addiction, withdrawal
Schizophrenia, schizotypal and delusional disordersSchizophrenia, schizoaffective disorder (= psychoses)
Affective disordersDepression, bipolar disorders = "manic-depressive disorders"
Neurotic, stress and somatoform disordersAnxiety Disorders, Obsessive Compulsive Disorders, Somatoform Disorders
Behavioral problems with physical disorders and factorsAnorexia, bulimia, insomnia
Personality and behavior disordersBorderline personality disorder, narcissistic personality disorder, kleptomania = "pathological stealing"
Mental retardation 
Developmental disordersReading and spelling disorder
Behavioral and emotional disorders beginning in childhood and adolescenceADHD, Tourette Syndrome

Important to know: The diagnosis says nothing about the cause.

Mental illness cannot be directly traced back to a cause. Both biological factors (e.g. genetic stress, metabolic changes in the brain), family conditions (e.g. parents with depression) as well stressful life experiences Considered in the past (e.g. breakups, death of someone important).

The interaction of the various development factors, also known as risk factors, determines the degree of vulnerability (= susceptibility or vulnerability) of a person. It provides information on how stress or currently stressful life events - such as conflicts, serious illnesses such as cancer, puberty or separation - affect a person's organism. For some people, normal everyday demands can be overwhelming, other people only get into psychological crises when they are under extreme stress or trauma.

Source: IDM (Institute for Didactics in Medicine)

This means:

Green arrow: If a person has no risk factors, he can cope with more stress. But: Even if there are no risk factors, a person can develop a mental illness as a result of a very high level of stress (e.g. experiences of war).
Yellow arrow: If a person has few risk factors, they can handle a certain amount of stress without developing mental illness. But if the load becomes too great, the barrel overflows in the proverbial sense.

Red arrow: If a person has many and severe risk factors, he can only withstand little stress. Even a low level of stress can trigger a mental illness. But: A mental illness can also be triggered by a very high level of vulnerability.

Prevention and early detection

In many areas of medicine, prevention (precaution, e.g. through vaccinations) and early detection (e.g. cancer screening) can prevent consequential damage from diseases. This principle has also been used more frequently in recent years for mental illnesses such as addiction, eating disorders or psychoses.

WithPreventionare measures such as stress management that are aimed at healthy people. They are intended to help reduce risk factors and thus prevent the development of a mental illness.

Measures of early detection are aimed at people who are in the early stages of a disease. The aim is to recognize mental illnesses earlier, to help those affected and their families as early as possible and to prevent or mitigate their progression. Studies clearly indicate that early treatment improves the healing process or even prevents the development of the full picture of a disease (e.g. in psychoses). In other words, the less time it takes from the onset of the disease to treatment, the better the overall chances of recovery.

Drug treatment (psychotropic drugs)

In some mental illnesses, disorders of the brain metabolism have been found. If this is the case, drugs (so-called psychotropic drugs) can be used, which intervene more or less specifically in the brain metabolism. Put simply, psychotropic drugs compensate for an existing imbalance, a deficiency or an excess of messenger substances in the brain (so-called neurotransmitters: e.g. serotonin, noradrenaline or dopamine). Some psychotropic drugs have a direct effect (e.g. tranquilizers). With some psychotropic drugs, the effect can only be felt by the patient after a certain delay, as long-term changes in the brain metabolism occur only slowly (e.g. with antidepressants).

The following table shows the most important groups of psychotropic drugs with their main areas of application:

Substance groupMost common areas of applicationImportant instructions
AntidepressantsDepression, Anxiety Disorders, Obsessive Compulsive Disorder, Chronic Pain, Sleep Disorders, Post Traumatic Stress Disorder, BulimiaImportant: Effect only occurs after approx. 2 weeks (in the case of obsessive-compulsive disorder after approx. 6-12 weeks), duration of use: in the case of initial illness after the symptoms have subsided approx. 4-9 months (= maintenance therapy), in severe cases at least 2 years (= Relapse prophylaxis), risk of addiction: none, check-ups: including ECG, blood count, kidney and liver function, discontinuation: slow dose reduction over 2-6 weeks, under medical supervision
Anxiolytics (sedatives)Anxiety disorders, psychiatric emergencies / addition to antidepressants and antipsychotics (states of excitement, aggressive external or self-endangering, suicidality, catatonia, withdrawal symptoms), sleep disordersImportant: short-term intake, intake: very precisely according to specifications (risk of overdose), risk of addiction: with prolonged intake, discontinuation: slow (weekly) dose reduction, under medical supervision
Neuroleptics (antipsychotics)Psychoses, mania, depression with psychotic symptoms, states of excitementImportant: avoid alcoholic beverages, duration of intake: 1-2 years (first illness), 2-5 years (second or multiple illness), long-term therapy (very frequent relapse), risk of addiction: none, check-ups: including ECG, blood count, kidney and liver function , Withdrawal: slow dose reduction, under close medical supervision
Mood stabilizers / phase prophylacticsBipolar disorders (mania, bipolar depression, phase prophylaxis), depression (relapse prevention in the event of suicidality, non-response to antidepressants)Important: Effect only occurs after 1-2 weeks, duration of use: in the case of the first illness after the symptoms have subsided, at least 12 months (= maintenance therapy) or longer depending on the course (= phase prophylaxis), ingestion: very precisely according to specifications (risk of overdose), Check-ups: including EKG, blood count, kidney and liver function, thyroid function

In the case of drugs, in addition to the desired effects, it can also unwanted side effects come. The attending physician explains this to the patient in a conversation so that both can weigh up the risks and benefits together. As a rule, serious side effects are rare or weaken in the course of treatment. However, since interactions with other medications can occur, patients should always consult their doctor before taking any other medication, including over-the-counter medication.

Psychotherapy literally means “treatment of the soul”. The aim of psychotherapy is to identify and cure or alleviate mental illness. Psychotherapy may only be carried out by psychological psychotherapists, child and adolescent psychotherapists or specialists.

There are outpatient, semi-inpatient (day clinic) or inpatient psychotherapy. In addition, in special cases (e.g. long journeys) and under certain conditions (including personal contact during initial diagnostics, indication and clarification), psychotherapy can also be offered via video treatment (further information). Psychotherapy can take place in group, individual sessions or a combination of both. There are also different methods of psychotherapy. These differ in the basic attitude of the psychotherapist, in their therapy concept and in how they explain the development of mental illnesses.

The statutory health insurance pays the costs for four of these procedures:

There is another method that is considered effective for some diseases, but the costs are not covered by the statutory health insurance.

Psychotherapy that meets the needs and ideas of the patient can usually help more than a procedure that is alien to the person concerned. It is at least as important that the patient feels that he is in good hands with his psychotherapist and that he is professionally cared for.

Anyone who opts for psychotherapy must first attend a consultation in a psychotherapeutic practice. Here you will find information on how to find a psychotherapist.

The duration of psychotherapy can be very different: it ranges from acute treatment (up to 12 hours), through short-term therapy (up to 25 hours) to long-term therapy - depending on the procedure up to 80 (behavioral therapy), 100 (psychotherapy based on depth psychology ) or 300 hours (analytical psychotherapy).

Find out more: "Paths to Psychotherapy" (Federal Chamber of Psychotherapists)

Cognitive behavioral therapy

Behavioral therapists understand “behavior” not only to be externally visible actions, but also to thoughts, feelings and physical processes. They assume that behavior is largely learned. This means that people can "unlearn" stressful thought and behavior patterns and learn helpful new patterns.

Behavioral therapy supports the patient in understanding and coping with their difficulties. In this sense, behavior therapy is a means of helping people to help themselves. The patient and therapist look together at specific problem situations in which the patient z. B. would have liked to react differently or feel differently. Using such excerpts, it should be understood why the patient behaves in the same way. The life story and current living conditions of the patient are also taken into account in these considerations. Possible solutions are worked out and tried out in the next step. The patient then checks in his everyday life how helpful the solution strategies are and brings his experiences back into the therapy. In this way, the patient and therapist work together on an equal footing. Problematic behaviors are often questioned and new ones tried out.

Further elements of behavior therapy are psychoeducation (information about the disease in question and its treatment), confrontation with feared situations (exposure), also outside of the therapy room, and the targeted training of skills and competencies (e.g. social skills such as “say no” or “get in touch” ", But also coping with stress and relaxation).

In behavior therapy, therapist and patient sit opposite each other. The meetings usually take place once a week.

Psychoanalytic Therapy

In psychoanalysis, the so-called "unconscious" is in the foreground. With this direction of therapy it is assumed that unconscious conflicts and experiences in the past (especially in childhood) cause and perpetuate mental illnesses. The unconscious conflicts determine the image that a person has of himself and others, his relationships, his feelings, thoughts and actions.

The therapist supports the patient in making these unconscious conflicts and their effects on the present visible. They should come to life again in the here and now so that the patient can understand and work on them together with the therapist.

The patient lies on a sofa and has no eye contact with the therapist. This has the advantage that the patient can fully concentrate on his thoughts, feelings and inner images. Analytical psychotherapy usually takes place as long-term therapy with sessions several times a week.

Psychotherapy based on depth psychology

The depth psychological therapy has its origin in the psychoanalysis, the forms of therapy differ however in their duration, in the therapy concept and therapy goal.

The therapy focuses on those basic psychological conflicts that are currently effective. By discussing previous experiences and behavior patterns, the patient should understand his current problems. In addition, the therapist supports the patient in activating existing but unconscious abilities in order to solve the current problems. In contrast to psychoanalytic therapy, so-called "regressive processes" (i.e. a relapse to earlier stages of personality development, which can be expressed, for example, in tearfulness and defiance) should be limited here.

In this form of therapy, the therapist and patient sit opposite each other. In depth psychological therapy, the sessions usually take place once a week.

Discussion psychotherapy assumes that everyone has the ability to heal themselves, to solve problems and to grow personally. The person concerned is the "expert of himself".

In conversation psychotherapy, the development and healing process is supported by the fact that the therapist empathizes with the thoughts and emotions of the person concerned and gives the patient feedback on what he himself has experienced without evaluating them. The therapist leaves enough space for the patient, does not suggest topics, offers him advice or interpretations. Instead, feelings that currently arise in the situation are discussed again and again. The therapist is open and honest with the patient and accepts them unconditionally. In the course of therapy, the patient should learn to understand and accept himself.

Systemic (family) therapy

Systemic family therapy takes into account the relationships between the members of a family when considering a mental illness. The problem or the illness, but also the strengths are not only seen in the individual, but in the entire "system", that is, in the family or among colleagues. Systemic treatment can be carried out as family therapy, but also as couples therapy or individual therapy.

In systemic family therapy, the independence and self-esteem of each individual family member is to be strengthened, the understanding and exchange between family members is to be improved, and damaging relationship patterns are to be recognized and changed.

Guidelines are systematically developed aids for doctors and psychotherapists to help them make decisions in specific treatment situations. They are based on current scientific knowledge and methods that have been tried and tested in practice. Guidelines are divided into so-called level classes that provide information about their quality and effectiveness. Further information on the methodology of guideline creation is available at www.leitlinie.de.

Learn more: Mental Illness Guidelines.

Swell:

Federal Chamber of Psychotherapists (2018) Paths to Psychotherapy. Available at https://www.wege-zur-psychotherapie.org/ [Status: Feb 2021]

Caspar, F., Belz, M. & Schneider, F. (2016). Psychotherapy. In F. Schneider (Ed.), Klinikmanual Psychiatrie, Psychosomatik und Psychotherapie, 2nd updated edition (pp. 195-223). Heidelberg: Springer Medicine Verlag.

German Society for Psychiatry, Psychotherapy and Neurology (DGPPN), German Society for Bipolar Disorders (DGBS) (2012). S3 guideline / bipolar disorder. Available from: http://www.awmf.org/leitlinien/detail/ll/038-019.html [as of September 2012]

DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW (ed.) For the guideline group Unipolar Depression. (2015). "S3 Guideline / National Care Guideline Unipolar Depression - Long Version; 2nd Edition." Accessed: Sep 12, 2016, http://www.awmf.org/leitlinien/detail/ll/nvl-005.html

German Society for Psychiatry, Psychotherapy and Neurology (DGPPN), German Medical Association (BÄK), National Association of Statutory Health Insurance Physicians (KBV), Working Group of Scientific Medical Societies (AWMF) (2015). S3 Guideline / National Care Guideline Unipolar Depression. Available at: http://www.awmf.org/leitlinien/detail/ll/nvl-005.html [as of November 2015]

German-speaking Society for Psychotraumatology (DeGPT), German Society for Psychoanalysis, Psychotherapy, Psychosomatics and Depth Psychology (DGPT) eV, German College for Psychosomatic Medicine (DKPM), German Society for Psychosomatic Medicine and Medical Psychotherapy eV (DGPM), German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) (2019). S3 guideline / post-traumatic stress disorder. Available at: https: //www.awmf.org/leitlinien/detail/ll/155-001.html [as of August 2019]

Founder, G. & Benkert, O. (Eds.) (2012). Manual of psychopharmacotherapy. (2nd, completely revised and updated edition). Berlin: Springer Verlag.

Laux, G. & Dietmaier, O. (2012). Practical psychopharmacotherapy. (6th, revised and supplemented edition). Munich: Urban & Fischer.

National Institute for Health and Care Excellence (NICE) (2005). Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. London: NICE. Available at http://www.nice.org.uk/CG31 [as of November 2005].

National Institute for Health and Care Excellence (NICE) (2014). Psychosis and schizophrenia in adults: treatment and management. London: NICE. Available at http://www.nice.org.uk/Guidance/CG178 [as of March 2014]

National Institute for Health and Care Excellence (NICE) (2011). Generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults. London: NICE. Available at http://www.nice.org.uk/CG113 [as of January 2011]

WHO (2018). International Classification of Diseases and Related Health Problems (10th Revision, German Modification). Available at: https://www.dimdi.de/static/de/klassifikation/icd/icd-10-gm/kode-suche/htmlgm2018/ [as of November 2017]

Source Stress-Bild: IDM (Institute for Didactics in Medicine)

Written by:

Dr. Lisa Tlach (graduate psychologist), Prof. Dr. Martin Lambert (specialist in psychiatry), Dr. Nina Weymann (psychological psychotherapist), Dr. Sarah Liebherz (psychological psychotherapist), PD Dr. Jörg Dirmaier (psychological psychotherapist), Prof. Dr. Dr. Martin Härter (doctor and psychological psychotherapist)

Date of creation: 08/15/2011
Date of the last content revision: 02/01/2021
Date of the next content revision: 02/01/2022