Does the Swiss mental health system need to change course?

Prof. Richter, how good is the mental health of the Swiss population?

Switzerland performs well in European and international mental health comparisons. Mental health problems are slightly on the rise, but not to the degree often portrayed in today’s media. The Global Burden of Disease, an international study that includes regular assessments of mental health, confirms that not much has changed in Switzerland since the early 1990s. Even during the Covid pandemic, Switzerland performed well in a comparative study of 25 European countries and ranked among the top five in terms of mental health. The situation is essentially stable.

What has changed in recent years and decades, however, is the number of people seeking help. Today, far more people are using psychiatric services, particularly children and young people. We have long waiting lists for both inpatient and outpatient services. This circumstance is causing a great deal of uncertainty and concern, particularly because mental health issues in young people usually persist throughout their entire lives.

What factors are contributing to this increase in mental stress?

For one thing, we are seeing a rise in loneliness, particularly among young people, which is in part connected to media technology. Young people are spending more time at home, meaning that they’re interacting less in real life and more in the virtual world. We’re seeing far fewer teenage pregnancies, for example. Whilst this is positive news in itself, it can also be seen as an indicator of fewer social interactions.

Added to this is people’s general sense of unease and anxiety about the future, triggered by various crises and conflicts, but also as a consequence of digitalisation and AI.

And last but not least, the destigmatisation of mental health, which is actually a positive thing, is also contributing to more people seeking help. Nowadays we’re thinking much more about our own wellbeing and observing ourselves much more closely, partly due to the influence of social media.

You describe the situation in Switzerland as stable on the whole, and yet on the surface the numbers look alarming: according to the 2025 Health Report by the Swiss Health Observatory (Obsan), between 20 and 40 percent of the Swiss population will experience depression at least once in their lifetime.

I think it is important to put this figure into proper perspective. The data for this report comes from the Swiss Health Survey, in which nine symptoms of depression are surveyed using a questionnaire (PHQ-9). When these responses are analysed, it does indeed appear that there’s an increase.

At the same time, we must bear in mind that a certain degree of low mood, exhaustion or inner tension is simply the normal human experience. In stressful life situations – such as following the loss of a loved one – reactions of this kind are to be expected. Today, however, there is a significantly greater tendency to pathologise ‘normal’ symptoms of this nature and treat them with medication, which further boosts the figures.

So it’s important to bear in mind that 80–90% of people experience depressive symptoms at least once if not repeatedly in the course of their lives. This is a normal part of life and shouldn’t always be seen as an illness.

Nevertheless, ever more people are seeking professional help. So how can we become more resilient?

That’s very difficult – there isn’t just a single lever to pull. We’re seeing a growing trend towards individualisation and the psychologicalisation fuelled by media discourse, particularly among children and young people through social media.

We would need to raise awareness and provide support for children and young people – as well as for those in employment – at an early stage, without immediately pathologising their experiences. It is crucial that those affected by mental health difficulties remain integrated in social systems. If young people drop out of school or training, or if adults are absent from work for long periods due to sick leave, this creates major problems in the long term. Once someone falls through cracks in the social fabric, they find it much harder to reconnect. We now know that for each additional day of being unable for work, the barrier to returning to an apprenticeship or a job becomes that bit higher.

This development is particularly serious among young people. The 18- to 24-year-olds currently make up the group with the highest number of disability benefit applications. This is a major problem for the individual concerned, but of course it is also a challenge for society.

That’s right: mental health issues are now the second most expensive category of illness, just behind neurological disorders. According to Obsan, they generate annual costs of over 23 billion Swiss francs. What can we do about that?

As already mentioned, prevention is a key issue. We need to start much earlier. Although Switzerland has one of the best and most expensive healthcare systems in the world, it lags behind in prevention and continues to focus heavily on treatment rather than early intervention. Yet we know from epidemiological studies that around half of all first-time cases of mental illness occur by the age of 19 or 20. There’s a great deal happening during this stage of life, and yet people find it hard to implement preventive measures consistently.

This system was held on to for a long time, partly due to misdirected financial incentives. Hospitals had to offer as many beds as possible to remain financially viable, and of course these beds then needed to be filled. As a result, treatments were carried out on an inpatient basis that could just as easily have been provided on an outpatient basis – albeit at significantly lower costs. Things are changing in this area, but all very slowly. The cantons would need to be prepared to reduce the number of beds, and health insurance funds would need to pay more for outpatient services. But we haven’t reached this point yet. Balancing the books remains the top priority. And mental illness continues to be viewed in much the same way as physical ailments – with the understanding that they should be treated in hospital.

Could outpatient care make the (financial) difference?

Absolutely. Many acute mental health crises could also be treated at home, which would be significantly cheaper: there’s no need for a whole team to be on call 24 hours a day, nor for infrastructure or catering. And the patient can remain in their familiar surroundings, which is usually what they want. When we take them out of this environment and treat them in a clinical setting, we often achieve exactly the opposite of what we actually want, which is to keep them in the social system as far as possible.

That would require more staff. Which brings us to the issue of skills shortage.

Outpatient care models could even help to alleviate the shortage of skilled staff. Working on an acute psychiatric ward is, after all, often not very appealing. In outpatient models, care staff work independently and on their own terms, and are only required to work night shifts in exceptional cases. Existing outpatient services generally employ well-qualified staff.

To what extent is BFH involved in developing new approaches?

BFH conducts research in various fields, always with a focus on improving psychiatric care. Also in the field of psychiatric home care, for example. We recently published our initial findings (link to German site) on the effectiveness of outpatient care, which show that it mostly reduces the numbers of hospital admissions.

We are also developing new methodological approaches to involve people with lived experience of mental illness and the patient perspective more closely in the research process. Until now, the patient perspective has received very little attention. The School of Health Professions has its own Institute for Collaborative Healthcare dedicated to this. We try to involve those affected right from the project design stage. One example is a project at Soteria Bern (possibly the smallest psychiatric clinic in Switzerland). A staff member with personal experience of mental illness is present during interviews and is also involved in the project design and data analysis – a major advantage when interpreting data.

We are also pursuing research on the topic of coercion and human rights, which paints a contradictory picture: although the new Child and Adult Protection Act of 2013 sought to reduce coercion, in practice it is actually being used more frequently in psychiatric care. This is linked, among other things, to a decrease in the willingness to take risks and to the growing perception that mental illnesses are dangerous in themselves. When people feel insecure or afraid, their willingness to accept coercive measures increases. It’s a phenomenon we observe not only in Switzerland, but in other countries too.