'Mental illness here is not for the poor': Expats in Czechia speak out on World Mental Health Day

The Czech Republic is currently grappling with a mounting mental health crisis. About 15 to 20 percent of the population, or up to one in five people, suffer from various mental disorders. The shortage of clinical psychologists, with 1,500 needed to meet the demand, exacerbates the problem. This too affects expats in the country.

Experts attribute the crisis to a host of reasons including increased mental health awareness driving demand for care, academic pressures on children, the impact of the Covid-19 pandemic, and the negative influence of social media.

While there are no hard numbers about how the country's foreign inhabitants are faring amid this crisis, expats face additional hurdles due to language barriers and cost.

On World Mental Health day (Oct. 10), Expats.cz readers candidly shared their experiences, highlighting difficulties finding English-speaking mental health professionals and the high costs of private care with waiting times for appointments in some cases stretching up to a year.

The shortage of mental health specialists is attributed to low interest among young people in studying the profession, insufficient funding, and unattractive pay for professionals. The lack of mental health professionals also stems from the sheer rise in people needing to access treatment. Figures from the National Health Information Portal show that the situation is even more critical for children, with a severe lack of child psychiatrists, leading to lengthy waiting times for those seeking care.

Systemic issues ultimately affect expats – who often are in a much more precarious situation due to language-barrier issues and navigating a foreign medical system.

One person, who prefers to remain anonymous, told Expats.cz that even though they spoke some Czech it was difficult to find a doctor for their mental health issues. “A lot of them did not take new patients and other private clinics charged very high prices,” they said. They therefore briefly had to return home to access suitable medical care.

Eventually, once they found a practitioner, there was “a lack of understanding on what the life of an expat can be like.” The doctor told them to return to their home country because of difficulties acclimatizing to a new culture, which left them feeling disappointed.

“It disappoints me a little that doctors lack the preparation and ability to understand how moving to another country, eating different foods, and experiencing different weather can affect one's mental health. I think they should consider more one's cultural background,” they added.

Jindra – a dual U.S.-Czech citizen – reached out to give his experience. “When my son was 19 in 2021, he suffered severe depression and urgently needed psychiatric consultation and medication. We called all psychiatrists who were Czech and found absolutely no one. He was getting estimates of nine months to a year for the next appointment.”

They therefore had no option but to go privately. “My friend recommended an English-speaking clinic in Prague where he could be seen the same week. We paid around USD 300 [around CZK 7,000] for him to be seen by a psychiatrist, who prescribed anti-depressants straight away. Mental illness here is not for the poor,” they said.

Another parent also spoke to Expats.cz. "My daughter, aged nine, suffers from crippling anxiety that we noticed developed in the past year. I put her name on the mailing list at a highly recommended Czech neurological institute. It took a year to get an appointment."

The family was able to have two initial visits after which point the therapist informed the family she saw signs of obsessive-compulsive disorder developing and possibly the need for medication.

Another person also came forward to share their experience. “When you have a sufficient amount of money, it’s easier to find help, but even that can become very pricey if you need to see a therapist once per week. If you don’t, then you have to rely on your health insurance, and the process is exhausting – when you get accepted, it can take up to a year to see a professional,” they described.

Another foreigner who contacted Expats.cz agreed that finding an English-speaking psychologist was particularly frustrating. “I contacted my health insurer [VZP], and they gave me only information about Czech-speaking psychologists. In the end, I had no option but to see someone privately for the high price of almost EUR 200 [CZK 5,000].

“When I saw a doctor to initially explain my mental health problems, he initially seemed quite dismissive and trivialized my issues…he was on the older side,” said another person.

One expat said that they had initially found a psychologist by searching for one on Google Maps and reading online reviews. After contacting one that accepted VZP insurance, they had to wait four months for an appointment. However, she was supposedly “lost in the system” and thus needed to wait an extra two months to be seen.

“To find my therapist, who’s completely free under VZP, it took nearly two years. I had looked everywhere for someone who was accepting new patients and was covered by VZP but it seemed impossible. In the end, my psychiatrist mentioned she knew someone who could help… eventually they contacted me saying that they were accepting new patients,” they added.

Another person wrote in saying that they needed to wait seven months for an appointment with an English-speaking psychologist. Czechs do not have it must better, though, with people reporting the need to wait around half a year just for an appointment with the state healthcare system.

To address the crisis, the Ministry of Health is considering extending psychology training to more universities, but significant improvements are unlikely in the near term.

In the face of these challenges, several resources, including support groups and online therapy options, are available for individuals seeking mental health assistance in the Czech Republic.

Two people we spoke to said that when in-person appointments were impossible during the Covid-19 pandemic, they relied on an app called “Hedepy” to find an online therapist that tended to be several times cheaper than going to a private psychiatrist or psychologist.

In Czechia, individuals with health insurance like VZP can access psychologists or psychiatrists for free with a doctor's referral. However, due to high demand, these professionals often don't accept new patients. In such cases, insurance companies must ensure proper care.

If psychologists are at maximum capacity, patients should contact their insurance in writing for a solution, and referrals can also come from schools. VZP maintains a list of accredited psychotherapists and covers CZK 500 per session for up to 10 sessions. Those needing more appointments may require private care.

With winter approaching, a current cost-of-living crisis, and a nearby war, a considerable part of Czechia's expat community may need to reach out for help in the coming months for help with their mental health. The currently overburdened system puts many in a precarious position rather than ameliorating their issues – long-term reforms aim to improve the issue, but significant improvements are unlikely in the coming years.