Expats and mental health: Psychiatrist, psychologist, or therapist in Czechia?

From language barriers to loneliness and isolation, homesickness, adjustment issues, finding work, making friends, and building support networks, expat life can be challenging.

Understanding the Czech mental healthcare system is a common concern among expats. Although Prague is increasingly international, expats often face difficulties with the Czech healthcare system due to a lack of English-speaking professionals and long waiting times. The complexity of specialist referrals and insurance coverage can also make accessing adequate care challenging.

In some cases, it’s clear which type of professional to seek. However, in other situations, even taking the first step can be an obstacle. Have you ever found yourself being referred from one specialist to another without getting the answers or support you needed? Do you wonder whether you need a family doctor, psychiatrist, therapist, counselor, coach, or a support group?

Accessing support is not always a straightforward process. You can see multiple specialists at the same time or try out different ones. Other sources of support include friends, family, community, and various organizations.

A psychiatrist is usually the first point of contact, especially for more severe mental health conditions. Among all mental health professionals, a psychiatrist is the only medical doctor and can, therefore, prescribe medication.

Problems they deal with: Suppose you’re looking for faster symptom relief and are interested in antidepressants, antipsychotics, anti-anxiety medication, or ADHD medication. In that case, a psychiatrist is your best option, as their primary role is medication management. Keep in mind that a psychiatrist does not provide talk therapy.

Do I need a referral? Another advantage of seeing a psychiatrist is that you don’t need a referral and can book directly. However, English-speaking psychiatrists are often at full capacity with long waitlists, and their services are usually not covered by insurance.

If you’re feeling like your mental health condition in one or more of the above issues is mild to moderate …and you’re not interested in taking prescription medication but would rather talk to someone about your issues and receive support consistently. You might be best suited to speak with a psychologist or psychotherapist.

Problems they can help with: A psychologist can help you manage issues such as anxiety, depression, relationship problems (breakups, divorce, infidelity, loss), loneliness, burnout, adjustment issues, work-life balance, stress, etc.

How does psychology work? Psychology is regulated in the Czech Republic, where the professional has at least a master’s (postgraduate) level education in psychology and relevant work experience and supervision. Psychologists have an in-depth understanding of various mental health difficulties, and some can also diagnose disorders. Psychologists receive training in a variety of treatments and offer therapy sessions in which you can discuss your problems and learn effective coping strategies.

Do I need a referral? No. You don’t need a referral; you can book directly with these professionals. It’s not common for their services to be covered by insurance, although some insurance companies like VZP have started providing some financial support for mental health services. In some cases, VZP will co-pay 500 CZK per session for up to 10 sessions.

Alternatives: Psychotherapy is also regulated in the Czech Republic, where the professional has completed extensive training in a psychotherapeutic approach (e.g., CBT, psychoanalysis, systemic therapy, Gestalt, psychodynamic). Psychotherapists do not necessarily have degrees in psychology (though they may), but all hold a postgraduate-level degree in social sciences. Psychotherapists, like psychologists, provide long-term talk therapy or counseling for a range of difficulties.

If you’re feeling like your mental health condition in one or more of the above issues is relatively mild—and you feel like you can mainly cope on your own—but would like some support, especially in life situations involving significant transitions, expat life, relationship problems, breakups, burnout, work issues, etc.: You might be best suited to speak with a coach or therapist.

Important to know: These are unregulated professions in the Czech Republic. Anyone can work under these titles, which can be a disadvantage since professionals in these roles are not legally required to have any specific education or training. While the regulations regarding these professions are becoming stricter, there is still a gap in the system.

What can they help with? However, this does not mean that individuals working under these titles cannot be helpful. Counselors, therapists, and coaches can support milder mental health issues. Look for professionals who specialize in areas such as relationship issues, intimacy, sex issues, work-life balance, stress, burnout, or personal development. Generally, counseling and coaching focus on more surface-level issues, while therapy offered by a psychologist or psychotherapist tends to address longer-term and severe concerns.