Psychotherapy: Commission Requires Psychiatric Diagnosis
Psychotherapists oppose new diagnostic requirement
New Hurdle for Psychotherapy? National Council Committee Demands Psychiatric Diagnosis
Starting psychological psychotherapy covered by basic insurance may soon require a confirmed psychiatric diagnosis. The National Council's Health Committee (SGK-N) aims to tighten the current referral model. The move follows a sharp increase in costs. Psychotherapists warn of longer waiting times and strain on already limited psychiatric resources.
On August 21, 2026, the SGK-N submitted the motion "Mandatory Health Insurance: Targeted Use of Premiums and Tax Money" with 16 votes to 9. It demands that a confirmed medical diagnosis, issued by a psychiatrist, must be present before beginning psychological psychotherapy.
The committee justifies its proposal primarily with the sharply increased costs for psychological psychotherapy within the mandatory health insurance (OKP). Concurrently, it aims to manage therapy offerings more effectively and ensure better access to treatment for individuals with severe mental health conditions.
Changes Since 2022
The current discussion stems from a system change in psychological psychotherapy. Since July 1, 2022, psychological psychotherapists can bill their services independently and directly to basic health insurance, provided a medical referral exists. This "referral model" gradually replaced the previous "delegation model."
Before the system change, psychological psychotherapists could bill their services through basic insurance under medical supervision as part of the delegation model. The transitional arrangement expired at the end of 2022. As of January 1, 2023, delegated psychotherapy no longer exists.
The referral model was introduced to improve access to psychotherapeutic services and ensure adequate care. Today, psychological psychotherapists can work independently and bill the OKP under specific conditions.
Costs Have Risen Significantly
Data from the Federal Office of Public Health (BAG) forms the main basis for the SGK-N's proposal.
Costs for psychological psychotherapy covered by basic insurance increased from 528 million Swiss Francs in 2021 to 922 million Swiss Francs in 2024. This represents an increase of 394 million Swiss Francs, or an average of 20.4 percent per year. The rise was particularly sharp between 2022 and 2023, when the referral model fully replaced the delegation model.
According to the BAG, this cost development cannot be attributed to a single cause. Approximately 30 percent of the growth is due to higher tariffs. Almost 25 percent can be explained by the long-term increase in demand for psychotherapeutic services and population growth. Another nearly 45 percent is due to other, not directly observable factors, including the shift of services from self-pay and supplementary insurance to basic insurance.
Thus, the figures do not indicate that the introduction of the referral model alone is responsible for the entire cost increase.
The New Model Also Has Advantages, According to BAG
The BAG's evaluation therefore presents a more nuanced picture than mere cost development.
The system change from the delegation to the referral model is largely considered successful by patients and professionals. The referral practice has become established and functions generally well. Access to psychological psychotherapy is also perceived as improved.
Concurrently, the number of psychotherapists authorized to bill the OKP has significantly increased. Nevertheless, long waiting times persist, particularly for children and adolescents and in rural areas. The shortage of specialist doctors and rising demand for psychotherapeutic services further impact care.
The political discussion thus arises from a tension: Access to psychotherapy has improved, while basic insurance costs have significantly risen.
What the SGK-N Aims to Change
The SGK-N therefore intends to introduce an additional hurdle. Before starting psychotherapy billed through mandatory health insurance, a confirmed medical diagnosis, issued by a psychiatrist, must be present.
The committee majority believes this will ensure that basic insurance benefits are used more targeted. Simultaneously, access for individuals with severe mental health conditions should improve, and cost growth should be curbed.
The committee particularly criticizes that psychological psychotherapy can currently begin with a medical referral, without a mandatory psychiatric specialist diagnosis before treatment starts.
Crucially: The demand for a psychiatric diagnosis is currently a political proposal, not an existing rule. The motion must first be debated in Parliament.
Psychotherapists Warn of a New Access Barrier
Resistance is forming within the professional group against the planned tightening. Psychotherapists have launched an appeal, urging the National Council and the Council of States to reject the motion.
According to Medinside, by the evening of August 25, over 2,000 people had signed, most of them psychotherapists. They fear that a mandatory psychiatric diagnosis could complicate access to treatment.
The experts argue, among other points, that psychiatric resources are already scarce. An additional examination before each psychotherapy could therefore create new bottlenecks and extend waiting times.
Psychotherapists also view the diagnostic process differently from the committee majority. Mental illnesses are not always clearly recognizable during the first consultation. Symptoms can overlap, change, or only be correctly classified over several sessions. Comprehensive diagnostics may therefore require anamnesis, clinical observation, differential diagnostics, and sometimes multiple discussions.
Experts Aim to Develop the Referral Model
Opponents of the motion therefore do not call for a return to the former delegation model. Instead, they want to simplify and further develop the current referral model.
Their goal is more direct access to federally recognized psychological psychotherapists. They envision collaboration with psychiatry occurring according to clinical need, rather than being mandated as an obligatory control step before every psychotherapy.
Psychotherapists do not dispute the need to ensure quality and cost-effectiveness. However, they doubt that an additional psychiatric diagnostic requirement is the appropriate instrument for this. In their assessment, there is no evidence yet that such a requirement improves quality or effectively reduces costs.
Specialist Shortage is a Problem
The discussion coincides with an already strained care situation. The BAG explicitly highlights the shortage of specialist doctors in its evaluation. Concurrently, long waiting times persist, particularly for children and adolescents and in rural areas.
A mandatory psychiatric assessment before beginning any psychological psychotherapy could therefore create an additional bottleneck. Whether this effect would actually occur, however, is a political and health policy debate, not yet an established consequence of the motion.
Proponents of the motion, however, argue that psychiatric specialists can better assess whether a mental illness with corresponding treatment needs is present before a therapy funded by basic insurance begins.
Second Motion Aims for Better Data
In parallel with the psychotherapy motion, the SGK-N submitted a second motion. It was adopted with 13 votes to 9 and is titled "Regular Data Collection on Mental Illnesses and Mental Well-being."
This aims to improve the data basis on the prevalence of mental illnesses in Switzerland. The committee views this as a foundation for better planning of future care and more precise monitoring of mental illness developments.
This motion is also not yet a new legal regulation. Both proposals must first be debated in Parliament.
What Happens Next
With the adoption of the motion by the SGK-N, the discussion has just begun. The committee approved its demand with 16 votes to 9. Now, the National Council will address the proposal. Should the motion be adopted there, the further parliamentary procedure would not yet be complete.
Until any potential change in law or ordinance, the current referral model remains in effect. Psychological psychotherapists can thus continue to work independently and bill mandatory health insurance under the existing conditions.
Between Improved Access and Rising Costs
The debate highlights a fundamental issue in Swiss health policy: improved care can simultaneously lead to higher costs.
The BAG's evaluation shows that access to psychological psychotherapy has generally improved since the system change. Concurrently, basic insurance costs rose from 528 to 922 million Swiss Francs within three years. The reasons are diverse, ranging from higher tariffs and increased utilization to the shifting of previously privately funded services to basic insurance.
Given this development, the SGK-N aims for more control. Psychotherapists, however, fear that an additional psychiatric hurdle will create new bottlenecks precisely where long waiting times already exist.
Thus, two objectives conflict: Basic insurance should remain affordable, while people with mental health issues should receive access to appropriate treatment as quickly as possible. How this balance will be struck is likely to become the central point of contention in the further parliamentary process.
Sources
- Swiss Federal Assembly, SGK-N: "Curbing Cost Growth in Psychological Psychotherapy," August 21, 2026.
- Federal Office of Public Health (BAG): "New Regulation of Psychological Psychotherapy Has Become Established," June 24, 2026.
- Federal Office of Public Health (BAG): Second Monitoring Report on the New Regulation of Psychological Psychotherapy.
- Medinside: "Psychotherapists Mobilize Against Mandatory Psychiatric Diagnosis," August 26, 2026.
