Diseases: Against stigma: recovery companions help the mentally ill

Severe depression, job loss, existential fears - Julia Kistner has a long ordeal behind her.

Diseases: Against stigma: recovery companions help the mentally ill

Severe depression, job loss, existential fears - Julia Kistner has a long ordeal behind her. Since she was 15, her mental illness has run like a thread through her life and at times prevented her from working and socializing.

Today Kistner can still look at this time with a positive view - because the supposed "blemish" of the illness has become a new opportunity for her: As a convalescent companion, Kistner now helps other patients to deal with mental problems and their way to a self-determined to find life.

"What has always bothered me is now becoming something valuable because I can now pass on the experiences I have had with therapy and with the clinic - the good and the bad."

support in conversations

In the clinic for psychiatry and psychotherapy at the University Hospital in Gießen and Marburg, Kistner supports patients in counseling and group discussions in accepting their respective diagnosis in order to be able to develop perspectives for themselves over time. The program is called "Standing by yourself with dignity" - the main aim is to support the participants in their decision as to whether and to whom they would like to disclose their diagnoses, and to overcome stigmata.

Kistner knows the hurdles that have to be overcome. She too experienced the fear of communicating with those around her out of concern that she would no longer be taken seriously and would be labeled as less valuable and less productive. "You put that on yourself at some point, you're part of society," says Kistner. "This self-stigma then triggers shame, so you don't like to talk about it even more." It created enormous pressure to hide problems and still work.

Clinic director Christoph Mulert knows about such problems and how stressful they can be for patients. Even the "widespread disease" depression still triggers a lack of understanding, rejection and stigmatization in family, circle of friends or employers. Even if about one in three people in Germany is affected by a mental illness every year, it is not yet far from real acceptance, says Mulert.

The term "burnout", which means exhaustion due to chronic stress, for example at work, has brought some movement. "But there are areas of mental illness where things tend to go in the other direction, such as psychoses, schizophrenia, where the blinders have become tighter." The good news, according to Mulert: "People who have depression are now more likely to seek treatment, and they get it."

education and social movement

After a riding accident in 2013, which prevented her from practicing her profession as a riding therapist, Kistner decided to start training as a convalescent companion through the so-called Ex-In movement. Ex-In stands for "Experienced Involvement". Originally developed from the motivation to help people in mental crises, it has become a social movement that, under the keyword "empowerment", not only strengthens those who are acutely affected, but also wants to enable people with psychiatric experience to play an active role in psychiatric care .

The one-year training focuses on topics such as self-determination and self-empowerment, hope, individual finding of meaning and participation in community life. This approach is called the "recovery" concept, which focuses on people with their strengths and potential instead of their deficits and assumes that those affected can live an active and contented life despite ongoing psychological problems.

Thanks to her training, Kistner has also become even more aware of what she can handle. Despite her illness, which at times made it impossible for her to even get out of bed or off the couch, she first managed to get her high school diploma and an engineering degree, later switching to horseback riding therapy and finally starting again in 2016 as a convalescent companion. In the clinic, she is part of a team of doctors and nursing staff and at the same time acts as an interface to the patients, who find in her a contact person on an equal footing.

Even formulating a request to the doctor treating you can be an initially insurmountable hurdle for some, says Kistner. Then she works out solutions with the patients and accompanies them in their implementation. In the meantime, she has completed further training to become a trainer, paving the way for other ex-patients to enter this profession.

Financing issue

However, funding is considered to be a hurdle. So far, the salaries for convalescent companions have usually been paid from the respective budgets of clinics or social organizations, health insurance companies or other organizations hardly come up with it. Ex-in representatives, for example, are campaigning for this in the Federal Joint Committee, which also laid down the core tasks of convalescent attendants in a guideline a few months ago.

According to Catharina Flader, board member of Ex-In Germany, around 2000 people have so far been trained nationwide as recovery companions, around a third of them are currently working in the profession.

From the point of view of patient representatives, that is far from enough - one or two convalescent companions per ward alone in the approximately 800 psychiatric and psychiatric departments of hospitals would be desirable, says Herbert Weisbrod-Frey, patient representative in the Federal Joint Committee. With the establishment of their tasks in the guideline, it is hoped that negotiations with health insurance companies about financing will be easier in the future.