Cuts to Germany’s asylum mental health services put lives at risk, experts warn
Amid anti-immigration rhetoric stoked by a fatal stabbing in Aschaffenburg, trauma specialists say refugees most need help just as resources are taken away
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It was an anxious start to 2025 for Hanna-Sophie Ulrich, the managing director of Mosaik, a specialist mental health clinic for refugees and victims of torture in Leipzig, Germany. Last summer, the government announced her budget for 2025 would be halved, effectively meaning a 60% decrease in the clinic’s services. There are 48 privately run state-funded specialist clinics like Mosaik across Germany, all of which face the same funding cuts. Ulrich believes lives are at risk. “I have a deep fear in my heart for our clients and what might happen to them,” she said. “People already feel so alone, as if their lives do not matter.”
Over the past two years, German politicians have been taking a sledgehammer to benefits and services for asylum seekers and refugees. In the aftermath of a terror attack in Solingenn in the summer of 2024, the coalition government announced a “security package” that included the removal of all social benefits for those who had been refused asylum.
Following the fatal stabbing of two people in Aschaffenburg last week by a former asylum seeker from Afghanistan, the country’s far right has renewed its calls for the “remigration” of migrants and asylum seekers. Germany’s main opposition leader Friedrich Merz vowed to impose border controls that would turn away all “illegal immigrants” if he becomes chancellor following the federal elections on 23 February.
Punitive responses such as these have raised deep concerns among asylum and mental health experts. Jacob Guhl, senior manager for policy and research at the Institute for Strategic Dialogue, a thinktank focused on tackling extremism, believes German politicians are not analysing the evidence and acknowledging the real factors that contribute to radicalisation. “They are conflating anti-migration policies and radicalisation. It’s hard to explain to anyone how cutting benefits will help stop terror attacks,” he said.
Suicide is by far the biggest risk facing people who are denied appropriate mental health care — refugees already have a heightened risk of suicide compared to the general population. However, Gunild Kiehn, a psychologist working in state-run refugee accommodation who refers patients to clinics such as Ulrich’s, warns that responding to rare acts of violence with cuts to support services is counter-productive: “When people don’t get the help they need, occasionally they may experience a breakthrough of trauma, and this can result in violent, aggressive outbreaks.”
Currently, only 3.1% of more than 2.5 million refugees in Germany have access to specialist mental health care, despite the consensus among experts that many suffer with complex trauma that requires specialist treatment. “There are whole generations now who know nothing besides war,” Kiehn said. “It’s a really challenging situation and we need specialist solutions for it.”
Ulrich agrees that refugees require “trauma-specific, language-mediated and culturally sensitive” services that are not currently available in the mainstream healthcare system.
Germany’s specialist trauma clinics for refugees, including Mosaik, are allocated a baseline annual budget of €7m, which the German parliament votes to top up each year. In 2022, their total allocated budget was €22m, taking into account an influx of refugees from Ukraine. This was reduced to €17m in 2023 and €10m in 2024. In 2025 there will be no additional budget, giving the 49 clinics just €7m to run on.
When Hyphen requested an explanation for these cuts from the German ministry for families, which oversees the allocation of the clinics’ funds, it claimed the funding shortfall was not strategic but a result of the coalition government’s inability to decide on a federal budget for 2025 — a stalemate that led to its collapse and the upcoming snap elections. The ministry added that it recognised “the important contribution” made by these clinics. However, as Ulrich points out, cuts to her facilities predated the budget crisis.
In 2024, Mosaik had one full-time and one part-time psychologist and was forced to turn patients away every day. In 2025, its reduced funding means it can no longer afford a full-time clinician. As a result, up to 40 fewer people will be able to access long-term therapy sessions.
Maryam (not her real name) has been visiting Mosaik for three years. The 39-year-old’s story is typical of the complex mental health challenges faced by many refugees. “I don’t have enough years in my life to express how grateful I am for the support I have received at the clinic,” she said. “It really saved me.”
Her parents were among thousands of Syrian Christians who moved to Venezuela in the 1950s when newly discovered oil reserves led to an economic boom. In 2019, when Maryam was pregnant with her first child, the country was in the midst of a profound economic crisis. Her neighbourhood was hit by rioting, looting and violence and she and her husband fled to Germany. The couple settled in Leipzig but rather than making her feel safer, Maryam’s experience of the asylum system only compounded the feelings of isolation and rejection she had growing up within Venezuela’s Arab minority.
“My stress and anxiety were so bad that I ended up in hospital because I couldn’t sleep,” she said. “I couldn’t function. I couldn’t even walk down the street.” After giving birth, she was terrified her baby daughter would be removed from her.
These somatic symptoms of trauma are common among the refugees Ulrich works with. “When psychological distress goes untreated it will manifest in ways such as a psychotic episode, or physical symptoms such as back pain or being unable to sleep,” she explained, adding that the experience of arriving in Germany as a refugee can worsen existing mental health problems. Ulrich added that many refugees end up living in isolated rural areas and have no private space as they are forced to live in overcrowded temporary accommodation with up to 200 other people.
Maryam got in contact with Mosaik through a friend in early 2022. After completing the 15 sessions with a psychologist offered to all clients, she attended a weekly women’s group at the clinic. She has been able to reduce the many medications she was taking and feels she is a better mother now her mental health has stabilised. “The asylum process is so complicated and burdening,” she said. “You feel so precarious the whole time because you do not know what’s going to happen to you. I didn’t realise until I came to the clinic the difference it makes to feel you have support.”
Whatever the outcome of the February vote, the next German government is unlikely to bring much relief for refugee support services. The far-right AfD, supported by Elon Musk, is currently polling in second place at 20%. Merz’s conservative CDU, currently leading the polls at 31%, has called for an end to irregular migration and insists asylum seekers’ benefits should only consist of “bed, bread and soap”.
Mosaik staff are concerned that the increase in anti-immigration rhetoric during the election campaign will exacerbate existing mental health problems among their refugee clients. Following the AfD’s success regional elections last September, Maryam’s psychologist Vania Amigo recalls her patients reporting higher rates of harassment and street-based attacks leading to a spike in stress and anxiety.
“We see a connection between being unwell, being isolated, being stigmatised and discriminated against, and eventually becoming angry and looking for structures that will welcome you,” Ulrich said. “There’s a scientifically proven link between experiences of discrimination and poor mental health.”
The German Interior Ministry, responsible for Germany’s security policy, told Hyphen that their data finds no direct correlation between cuts to mental health services and an increased risk of violent incidents, but conceded that appropriate mental healthcare, as offered by clinics like Mosaik, “would certainly be positive with regard to risk factors for radicalisation and acts of violence, and that failure to provide care could easily lead to a higher risk of people developing a mental state of emergency that might turn violent”.
With more German far-right voters and mainstream parties adopting harsher anti-immigration policies, Ulrich is concerned that the mental health of her patients will spiral just as she is deprived of the resources to assist them. Her immediate plan is to apply for philanthropic funding to keep the clinic running, but this is awarded only on a project-by-project basis. “We really need long-term sustainable funding, because this is long-term work,” she said, “although our ideal world would be one where no specialist clinics are needed because the mainstream healthcare structures are open, accessible and welcoming.”
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