Julia Kistner, convalescent companion, stands in front of the Center for Psychiatry of the University Hospital Giessen and Marburg. © Sebastian Gollnow/dpa
If you have a mental illness yourself, you can often put yourself in the shoes of other sufferers. Former patients are therefore sought-after experts in the treatment of people in mental crises as recovery companions.
Gießen - Severe depression, job loss, existential fears - Julia Kistner has a long ordeal behind her. Since she was 15, her mental illness has been a recurring theme in her life, preventing her from working and socializing at times.
Today, however, Kistner can look back on this time with a positive view - because the supposed "flaw" of the disease has become a new opportunity for her: As a recovery companion, Kistner now helps other patients to deal with mental health problems and find their way into a self-determined 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 clinics - the good and the bad."
Overcoming stigmas
In the Department of Psychiatry and Psychotherapy at the University Hospital Giessen and Marburg, Kistner supports patients in counselling and group discussions in order to be able to develop perspectives for themselves over time. "Standing up for oneself with dignity" is the name of the program - the central aim is to accompany the participants in deciding whether and to whom they want to disclose their diagnoses and to overcome stigmas. Kistner knows the hurdles that have to be overcome. She, too, experienced the fear of communicating herself to those around her for fear that she would no longer be taken seriously, that she would be labeled less worthy and less efficient. "That's what you put on yourself at some point, you're part of society," says Kistner. "This self-stigma then also triggers shame, so people are even less likely to talk about it." It has created enormous pressure to hide problems and still function.
One in three is affected by a mental illness
Clinic director Christoph Mulert knows about such problems and how stressful they can be for patients. Even the "widespread disease" of depression still sometimes triggers incomprehension, rejection and stigmatization in family, friends or employers. Even though about one in three people in Germany is affected by a mental illness every year, real acceptance is not yet far off, says Mulert. It is true that the term "burnout", which means exhaustion due to chronic stress at work, for example, has brought a little movement. "But there are areas of mental illness where it tends to go in the other direction, i.e. psychosis, schizophrenia, where the blinkers have become firmer." The good news, according to Mulert, is that "people who have depression are now more likely to dare to seek treatment and get it."
After a riding accident in 2013, which prevented her from practicing her profession as a riding therapist, Kistner decided to start training as a recovery companion via the so-called ex-in movement. Ex-In stands for "Experienced Involvement german". Originally developed from the motivation to help people in mental crises, it has become a social movement that, under the keyword "empowerment", not only empowers those acutely affected, but also enables people with psychiatric experience to play an active professional role in psychiatric care.
Strengths and potentials instead of deficits
The one-year training focuses on topics such as self-determination and empowerment, hope, individual meaning, and participation in community life. The "recovery" concept is the name given to this approach, which focuses on people with their strengths and potentials instead of their deficits and assumes that those affected can live actively and contentedly despite persistent psychological problems.
Thanks to her training, Kistner has also become even more aware of what she can do. Despite her illness, which at times made it impossible for her to even get out of bed or from the couch, she once managed to get her high school diploma and an engineering degree, later switch to riding therapy and finally make a new start as a recovery companion in 2016. In the clinic, she is part of a team of doctors and nurses and at the same time acts as an interface to the patients, who find in her a contact person at eye level. Even the formulation of a request to the attending physician can become an initially insurmountable hurdle for some, says Kistner. She then works with the patients to develop solutions and accompanies them in their implementation. In the meantime, she has been trained as a trainer and thus paves the way for other ex-patients to enter this profession.
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Financing as a hurdle
One hurdle, however, is financing. So far, the salaries for convalescent companions are usually covered by the respective budgets of clinics or social agencies, health insurance companies or other providers hardly pay for them. Ex-In representatives are campaigning for this, for example, in the Federal Joint Committee, which also laid down the core tasks of recovery companions in a guideline a few months ago. According to Catharina Flader, board member of Ex-In Deutschland, around 2000,<> people have so far been trained nationwide as recovery companions, about a third of whom are currently working in the profession.
From the point of view of patient representatives, this is far from sufficient - one to two recovery 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 enshrinement of their tasks in the directive, it is hoped that negotiations with health insurance companies on financing will become easier in the future. Dpa
