Patients must be well cared for – especially in psychiatry. Because that increases the chances of healing and reduces suffering. In order to ensure a high quality of care, the Federal Joint Committee (G-BA) introduced one some time ago Guidelines for staffing in psychiatry and psychosomatic medicine enacted But experts fear that this will worsen the situation instead of improving it.
The task of the G-BA is to ensure that those with statutory health insurance receive the medical services they need. According to the staff guidelines, there must be a minimum number of nurses, doctors and therapists in psychiatric and psychosomatic clinics to treat people with depression, obsessive-compulsive disorders, addictions and other conditions.
The guideline has been in place since 2020, but from next year the G-BA wants to take step-by-step action: clinics that do not meet the minimum staffing levels will receive less remuneration. This is to prevent some hospitals – as has happened in the past – from deliberately not having enough staff in order to save costs and increase their profits at the expense of the patients.
But the well-intentioned plans of the G-BA could worsen the situation of the sick rather than improve it, experts and those affected fear. The German Society for Psychiatry and Psychotherapy, Psychosomatic Medicine and Neurology (DGPPN) has therefore drawn up a position paper against the “clinic sanctions” together with more than 20 associations, including the German Depression League and the Action for the Mentally Ill.
In the nursing crisis, it is difficult to find enough staff
The number of nursing staff or occupational therapists that a clinic needs, according to the calculations of the G-BA, in order to meet the requirements for good treatment, could sometimes not be achieved even with the best will in the world, says DGPPN President Andreas Meyer-Lindenberg. In recent years, the number of people with mental illnesses has risen sharply, and given the shortage of nursing care, it is therefore very difficult for the clinics to find enough qualified staff. He is outraged that the clinics are threatened with repayments for a situation that they cannot do anything about because of the personnel guidelines – “instead of receiving support in this difficult situation”.
From the point of view of the DGPPN, there should be even more treatment places missing than today because of the regulations. Especially if higher penalties should take effect from 2026. The G-BA intends to determine whether and to what extent this will happen at the end of 2025. The repayment or penalties should be due as soon as the requirements are not met in just one of six professional groups, complains Thomas Pollmächer, head of the Center for Mental Health at the Ingolstadt Clinic. All that is missing is a nurse or an occupational therapist, and fines are imminent.
According to Pollmächer, clinics could only help themselves by not occupying beds. But then they lack income and a downward spiral begins: innovative treatment options would have to be reduced, employees would lose motivation, nursing staff would be even more difficult to recruit, and even more beds would have to be reduced.
The concerns of the G-BA can be understood, but it is particularly important for the patients to uphold the minimum standards. “Personally, I can understand why, in view of the real shortage of skilled workers, especially in nursing, there is a demand for a further suspension of the loss of remuneration,” says Karin Maag, impartial member of the G-BA and responsible for the quality assurance department there. “But that would also mean we would lose the incentive for hospitals to qualify or hire staff. And we continue to finance inpatient care for which the minimum staffing standards are not met.”
The G-BA accommodates the clinics by only billing on a quarterly basis. In this way, short-term staff shortages or bottlenecks during vacation periods can be buffered. But it is now like this: “A good care also includes sufficient staff.”