Brea­king the taboo

What role does mental health curr­ently play in the Swiss health­care system?
A major one. And a growing one. Demand is incre­asing massi­vely. Espe­ci­ally among young people. They are in great need of advice, support and therapy. The issue has made its way into health policy. Its importance has increased signi­fi­cantly in recent years.

Who brought the issue into policy?
It comes from diffe­rent sides, really from the entire envi­ron­ment. When we talk to youn­ger people, it comes up. Schools and youth insti­tu­ti­ons are report­ing it. We are seeing high demand from the institutions. 

What role did the pande­mic play?
The pande­mic is behind us. Howe­ver, the increased demand for mental health services has persis­ted, espe­ci­ally among child­ren and young people. The situa­tion is retur­ning to normal slightly, but the pres­sure is still there. The increase coin­ci­ded with the pande­mic years, and a link was suspec­ted initi­ally. But this is now only partly proving to be true. The pande­mic was just one driver, among others. 

What are the drivers?
Expec­ta­ti­ons of perfor­mance are high today, and young people are expo­sed to the omni­pre­sence of infor­ma­tion via social media on various devices. This makes the gene­ral sense of inse­cu­rity in the global context tangi­ble. All of this toge­ther crea­tes pres­sure. This is also a chall­enge for us in poli­tics. After all, we of course want to ensure a good level of care in the area of mental health, too. We can say that we curr­ently have this. Howe­ver, demand now exceeds the supply we can provide. Vulnerable people in parti­cu­lar often don’t find the right service right away.

Who would that be?
These are people with multi­ple issues affec­ting them, such as trau­ma­tised indi­vi­du­als with a migrant back­ground and language difficulties.

How can this shortage of supply be effec­tively addres­sed?
We are, of course, trying to streng­then the offe­ring. On the canto­nal side, we are support­ing the services offe­red by hospi­tals finan­ci­ally, parti­cu­larly in the area of psych­ia­try. But, of course, we need to think about how we can use our resour­ces even better. Often there is a lack of direct access, espe­ci­ally for those who have a speci­fic need and are in dire need as they are disad­van­ta­ged by the multi­ple factors affec­ting them. We want to make it possi­ble for those who most urgen­tly need a therapy place to get one. We can also help by expan­ding capa­city. But to do this, we need the appro­priate specia­lists and the neces­sary funding.

Can the Natio­nal Council’s Clivaz motion help? It tasked the Fede­ral Coun­cil with ensu­ring the funding orga­ni­sa­ti­ons active in the field of mental health on a natio­nal level.
This issue has been in the works for some time. The Confe­de­ra­tion and the cantons work toge­ther in the dialo­gue on natio­nal health policy. On this plat­form, we jointly laun­ched the NDC Stra­tegy, the Natio­nal Stra­tegy for the Preven­tion of Non-commu­ni­ca­ble Dise­a­ses. Mental health is an important element in this. Each level of govern­ment bears respon­si­bi­lity in its own area.

What are the cantons doing?
For instance, we provide direct support to service provi­ders, prima­rily psych­ia­tric clinics, but also self-help, preven­tion and other support services. It is important that we also keep an eye on the envi­ron­ment of those affec­ted. In this context, we support a speci­fic cont­act point for rela­ti­ves of people with mental illnesses at the Rhein­le­ben Foun­da­tion, for instance. Rela­ti­ves can serve as support. 

So we absorb a lot at canto­nal level. Howe­ver, our services are limi­ted regio­nally. The fede­ral govern­ment, for its part, often points out that it has no legal basis to assume finan­cial respon­si­bi­lity. Under­stan­d­a­bly, this leads to a certain degree of frus­tra­tion in the Fede­ral Parliament. 

The action plan of the NCD Stra­tegy 2025–28 focu­ses on mental health and demen­tia. What does this mean in concrete terms?
This is a frame of refe­rence. We can also use it as a guide for canto­nal discus­sions. It gives weight to the issue and streng­thens its poli­ti­cal legi­ti­macy. That’s helpful to us. In health policy, too, we are wrest­ling with other policy areas for atten­tion and resour­ces. A joint stra­tegy on the part of the fede­ral govern­ment and the cantons helps define the frame­work and to know that we are all pursuing the same goals. We know what the other level of govern­ment is doing.

Of course, we look at which canton does what.»

Where do you still see poten­tial in preven­tion?
Of course, we have been invol­ved in preven­tion for some time now. But here, too, we can do even better.

Where do you see start­ing points?
We can move into other areas of life. A person’s envi­ron­ment is important. 

Preven­tion is always more than a campaign, a poster or a tool. It must have a broad impact and mani­fest itself in the individual’s envi­ron­ment. For instance, we have wide-ranging canto­nal action program­mes in which we work with Health Promo­tion Switz­er­land. Here, too, mental health is a key issue. 

One exam­ple of a campaign like this is the yellow bench with the ques­tion ‘How are you?’ in the health department’s entrance area. How has this action been recei­ved?
We’re trying to attract atten­tion with the bench. The response here is posi­tive. But we would like to have a little more reach. Howe­ver, we do note that people today are aware of the importance of mental health. It’s widely discus­sed. Fort­u­na­tely, it’s not as taboo as it used to be.

The subject is no longer taboo?
The more open approach is palpa­ble in any case. This change is under­way. This is also reflec­ted in the poli­ti­cal envi­ron­ment, where we have more initia­ti­ves in this area. We live in a society in which mental well­be­ing is much more of an issue. We address it more expli­citly. This is a process that I really welcome.

The subject has evol­ved in recent years.
We are clearly talking more about the subject. We have also been able to over­come the stigma, at least in part. Today, we can talk expli­citly about mental health and mention issues such as depres­sion. That is progress per se. 

But we have to be careful about the analy­sis. To what extent is there actually more problem pres­sure today – and what is down to percep­tion, due to the fact that we talk about it more openly these days? That doesn’t seem clear to me yet.

In other words, the ques­tion is, how signi­fi­cant is the increase actually?
We are curr­ently in a situa­tion where there is a great deal of demand. It is important to work out what the real increase is compared to previous years. Before, much was simply igno­red and suppres­sed. It is posi­tive that we are taking a more active approach to this issue. But when it’s easier to talk about it, it’s important to clarify whether there really are more cases. Both are likely to apply: There are more cases and the number is incre­asing some­what due to the chan­ged approach to the issue, which makes the cases more visi­ble. Poli­ti­ci­ans then accuse us of not taking enough action. Of course, we can always improve and do more. But we also have to measure it out. We cannot focus the entire canton on health policy.

How do you deal with stress yours­elf? You yours­elf were in the spot­light during the pande­mic. Did you never reach brea­king point?
Not really. Things worked very differ­ently, espe­ci­ally in poli­tics. But I was able to draw a lot of energy from the crisis. I didn’t perso­nally expe­ri­ence that period as risky. But it was, of course, a high pres­sure phase, which also left its mark. I notice this, for exam­ple, when I get on the train and still wonder whether I have a mask with me. 

Were there never any risky or stressful situa­tions?
We had situa­tions that were stressful in nature. For exam­ple, when it was unclear whether cross-border commut­ers could conti­nue to work in the health­care sector, how we would orga­nise this and how we could support them. Not knowing when the vacci­na­tion would arrive and how much strain there would be inten­sive care units was also diffi­cult to bear. But these stressful situa­tions didn’t put me under any strain or para­lyse me perso­nally. I have found a way in work and in poli­tics to cope with this burden.

What helped?
The fact that I have a very sound perso­nal envi­ron­ment helped a lot, of course. We were not affec­ted by any serious illnesses around us and we didn’t have any diffi­cult family situa­tions. Howe­ver, my family also expe­ri­en­ced peri­ods of isola­tion and quaran­tine. Then it suddenly became more challenging.

In the extreme situa­tion of the pande­mic, employ­ers were also asked how they protect their employees. Irre­spec­tive of the pande­mic, it is an issue where mental health is proba­bly less obvious than protec­tion from acci­dents?
In the Occu­pa­tio­nal Health Manage­ment Forum, we engage in dialo­gue with employ­ers. That’s very important. After all, mental health-rela­ted absence has a massive econo­mic signi­fi­cance. Raising aware­ness in the work­place is key. Employ­ers need to reco­g­nise that this psycho­lo­gi­cal dimen­sion exists. A company should make every effort to avoid extre­mely high- pres­sure situa­tions. It should create a mentally healthy envi­ron­ment. We can offer even more in the form of trai­ning, infor­ma­tion and concrete colla­bo­ra­tion. Of course, it’s easier for big compa­nies with profes­sio­nal HR depart­ments than for SMEs.

Do you also see poten­tial in colla­bo­ra­tion between busi­ness, the non-profit sector and public autho­ri­ties?
We alre­ady have a good working rela­ti­onship with non-profit orga­ni­sa­ti­ons. I mentio­ned Health Promo­tion, but Gsün­der Basel and other asso­cia­ti­ons and foun­da­ti­ons are also important part­ners for us. So is the world of work, but this colla­bo­ra­tion isn’t quite as struc­tu­red and estab­lished yet. 

Are there major diffe­ren­ces between cantons as to who gets invol­ved and how?
We have natio­nal campaigns such as ‘How are you?’ with a broad range of stake­hol­ders. Each canton must imple­ment the programs co-funded by Health Promo­tion Switz­er­land within its own frame­work. The cantons have diffe­rent start­ing points, such as whether the muni­ci­pa­li­ties are doing some­thing in this area. If this isn’t the case, as is the case with us, the canton takes over. Of course, we look at which canton does what. That’s the good thing about fede­ra­lism. We can compare and learn from others. That’s motivating. 

Does an urban canton have diffe­rent chal­lenges than a rural one?
That might well be the case. Urban envi­ron­ments are conside­red rather mentally chal­len­ging, espe­ci­ally for young people. The compo­si­tion of the popu­la­tion raises other ques­ti­ons. In Basel-Stadt, we have a high propor­tion of single-person house­holds. People are often older or even very old. This carries a certain risk of loneli­ness. Two years ago, howe­ver, a survey showed that the elderly popu­la­tion does not perceive itself to be parti­cu­larly affec­ted by loneliness. 

Of course, migra­tion also plays a role. We have a lot of people with a migrant back­ground. This isn’t neces­s­a­rily linked to trauma, but it can be. Language barriers can also make access to the health­care system more diffi­cult. We have to take all this into account when coming up with the offe­rings for the programmes.