UK
Turn up at your GPs with anxiety, depression or insomnia and the chances are you will be prescribed antidepressants. It will of course vary from doctor to doctor, and some will have a better idea of which drug is more effective at dealing with which symptom. But access to psychiatry on the NHS is rare and usually only reserved for cases in which the doctor feels the patient is a very real threat to him/herself. The Improving Access to Psychological Therapies programme has started trying to offer more talking therapies but coverage is patchy.
Private psychiatry is formidably expensive; for anyone buying health insurance, it may be worth inquiring about psychiatric cover too. You are more likely to fall prey to depression than to get run over by a bus.
France
The treatment of depression in France is very medication-based. Sometimes doctors will prescribe antidepressants (one for the day and another lower dose to help the patient sleep at night), as well as tranquillisers.
Depression and anxiety are primarily considered neuroses and not psychoses and as such the psychotherapy is not covered by the health system. Some psychiatrists will put through a treatment (30 minutes) as a "consultation", which means it will be reimbursed. But psychotherapists charge quite a lot for their sessions – it is called "the psychotherapist's hour" and it means 50 minutes. The most that is reimbursed by the health service is 70% but some are not reimbursed at all and many can set their own consultation fees.
If someone has chronic or clinical depression that requires hospital treatment, then this will be covered by the state.
Germany
In Germany, GPs, or Hausärzte,are generally recommended as first ports of call for those suffering from anxiety and/or depression. There are no legal constraints to the kind of drugs they can prescribe, but patients are generally advised to consult a specialist practitioner before being prescribed antidepressants.
Specialists in cases of depression and anxiety can be psychotherapists, psychiatrists or neurologists, but only the latter two are allowed to prescribe drugs.
The cost of prescribed medication is usually mostly paid through the public health scheme (about 85% of the population) or private insurance. Patients have to pay 10% of the price of prescribed drugs (usually about €5 [£4]), though there can be exceptions for patients on long-term treatments.
With psychotherapy, the public health scheme pays for up to five "test sessions" for each therapist. If the patient considers these a success, the therapist can recommend short treatments (usually 31 sessions) or long treatments (usually 45 sessions), but needs to get permission from the public or private health insurance company before putting a patient through one of these courses. Maximum length for psychotherapeutic courses is usually 60 sessions. The entire cost should be met by the public or private insurance scheme.
Spain
There are minor differences between the country's 17 autonomous regions in standard procedure for treating patients exhibiting problems related to their mental health.
Primary care doctor will often offer treatment as part of their portfolio of services, especially patients who have anxiety and depression. That said, Spanish primary care doctors will typically treat fewer cases on their own than their British counterparts, usually only those presenting mild to moderate conditions. In these cases, the prescription of anxiolytic drugs (benzodiazepines, buspirone) and anti-depressants (SSRIs such as escitalopram) is typical.
There is also supportive psychotherapy available, although this depends on resources and the degree of specific training in psychiatric disorders (there are a number of Spanish doctors who are trained in psychotherapy). If a primary care doctor recommends therapy, the patient will be referred to a mental health unit, with a variable waiting time (less than a week in severe cases).
Typically, a major depressive disorder, with psychotic symptoms or suicidal tendencies, somatisation disorder or serious panic attacks including depersonalisation, are sent directly to a mental health unit.
Italy
Patients can follow two routes: first, they may seek the advice of the GP, who can refer them to a psychiatrist or a specialised health unit that deals with psychiatry. Alternatively, patients can access a specialist service directly without referral. But clinicians say that time and money means that most will be dealt with through antidepressants.
Statistics in Italy show that only 50% of those who suffer depression seek treatment; about 15- 20% of these patients seek the advice of a psychiatrist. The figures are low because there is still a lot of stigma attached to seeing a health professional.
Italian psychiatrists prescribe two treatments for depression: a drug-based therapy and psychotherapy. For the latter, psychologists and psychotherapists are involved.
