New Doors to Psychotherapy Bridged by Family Doctors, Apps, and AI: Insights for Japan from the Neumünster, Germany Case

1 Neumünster Dispatch: The "New Norm" in Seeking Psychotherapy

In Neumünster, Schleswig-Holstein, northern Germany, a pilot program is in operation where family doctors serve as the entry point, registering patients directly into a public insurance booking portal to compress the average waiting time of about 4-5 months. The referral includes a six-digit "Akut-Code," allowing therapists to immediately grasp the urgency. Additionally, local counseling centers prescribe app-based self-help materials, providing feedback on usage to family doctors, transforming the "waiting for treatment" period into an active learning phase for patients.

Key Points

• Family doctors = Primary care treat mental health as a "personal matter"

• *Zero digital burden

• AI chatbots summarize patients' mood diaries, shortening the interview time for the next consultation
  
  
  
  

2 Nationwide Trials of "AI Therapists" in Germany

The Central Institute of Mental Health in Mannheim has developed an AI app for minors to learn emotional regulation. Similarly, the Karlsruhe Institute of Technology is conducting clinical trials on a safe interactive chatbot. While there is growing expectation for these as tools to "supplement the lack of face-to-face interaction" due to their 24-hour availability and low cost, concerns about emergency response capabilities and personal data protection are also being raised.deutschlandfunkkultur.detaz.de

Expert Opinions
"AI should focus on 'accompanying' rather than 'treating.' It should always be used under human supervision."
― Filippo Martino, German Clinical Psychologist

3 How the Waiting List Was Shortened ― The Impact in Numbers

(State Health Department Preliminary Figures, April 2025)

As the numbers show, the waiting list was shortened by about 40%.The doubling of the self-help implementation rate is attributed to features such as automatic homework reminders and gamification that makes progress "visible." zdfheute.de

4 Current Situation in Japan: Difficulty in Booking, Uneven Distribution, and the Barrier of Medical Fees

In Japan, it is not uncommon for urban clinics to have initial psychiatric appointments booked one to two months in advance. The number of psychiatrists per 100,000 people is about the same as in Germany, but because medical fees are designed to focus on short outpatient visits, there is a tendency to try to manage by "volume supply," resulting in shorter interview times per patient. note.commhlw.go.jp

Why is it difficult to make an appointment?

1. Approximately 90% of clinics are "run by a single director"

2. The compensation system for psychotherapy techniques is limited

3. Counseling is often non-insured, leading to a heavy financial burden
   
   
   
   

5 Possibilities and Challenges of Utilizing Digital Health

5-1 Policy Aspect

• Reimbursement route for app and program medical devices (Dtx) established in the 2024 revised Medical Care Act

• However, adaptation examples for depression and anxiety are limited to two cases, with insufficient awareness
  
  
  

5-2 Clinical Aspect

• Reports suggest the effectiveness of automatic CBT task suggestions and emotion recording

• False detection rate of self-harm risk detection algorithms in emergencies is a challenge
  
  
  

5-3 Ethical and Legal Challenges

• Risk of "proliferation" of apps with insufficient proof of effectiveness

• Responsibility when a chatbot suggests a misdiagnosis
  
  
  
  

6 Application Scenarios for Japan

1. Primary Care Physician + Certified Psychologist Model

   • Internal medicine clinics serving as family doctors conduct initial evaluations → refer to psychologists
     
     

2. Insurance-reimbursed app prescriptions

   • Used while waiting for face-to-face consultations, data automatically sent to electronic medical records
     
     

3. AI Triage & Follow-up

   • Extract risk groups through anonymous chat and prioritize referrals to specialists
     
     
     
     

7 User Feedback (Hypothetical Case Study)

30-year-old Company Employee A
"I was delaying visits due to work being busy, but I was able to use the app immediately after the family doctor's consultation, and my sleep and mood stabilized in three weeks. The initial interview with the specialist was also smooth as 'information was already shared.'"

8 Professional Perspectives

• Clinical Psychologist: "AI summaries speed up the understanding of the current situation at the beginning of sessions, allowing more time for the actual treatment process."」

• Psychiatrist: "By supporting screening with the app, it becomes less likely to overlook truly acute patients."
  
  
  
  

9 Checklist for Safe Use

10 Summary and Recommendations

• By layering digital tools starting with family doctors, the "waiting time gap" can be transformed into a "preparation period"

• AI is not a replacement for treatmentbut a complement, and expert supervision should be mandated

• In Japan, the trinity reform of "family doctor role," "app prescriptions," and "data collaboration" is urgent
  
  
  

Recommendations

1. Training of general practitioners responsible for initial assessmentsand designing incentives in medical fees

2. Expand the clinical trial sandbox for app medical devicesand have small municipalities take the lead in implementation

3. Create "AI Mental Health Usage Guidelines" jointly with patient groups to enhance literacy
   
   

List of Reference Articles

• shz.de "Suche nach Psychotherapie: Hilfe von Hausarzt, Apps und KI" (2025-06-)

• Tagesschau "Psychotherapie: Kasse machen mit Kassensitzen?" (2024-12-13)tagesschau.de

• Ärzte Zeitung "Im Schnitt vier bis fünf Monate beträgt die Wartezeit auf einen Psychotherapieplatz in Deutschland" (2020-02-21)aerztezeitung.de##H

• Deutschlandfunk Kultur "KI in der Psychotherapie – Chancen und Gefahren" (2025-05-30)deutschlandfunkkultur.de

• taz "Kann KI fehlende Therapieplätze ersetzen?" (2025-06-12)taz.de

• ZDFheute "Gesundheits-App mit KI: Hilfe bei psychischer Belastung" (2025-04-02)zdfheute.de

• Instahelp Magazine "How Long Does It Take to Find Psychotherapeutic Support?" (2025-02-)instahelp.me

• Ministry of Health, Labour and Welfare "About Mental Health Care (Part 2)" (2023-12)mhlw.go.jp

• Ryohei Matsumoto "Why is it difficult to make an appointment with a psychiatrist (psychosomatic medicine)?"」note (2021-10) note.com