As for adults, systemic therapy could perhaps also be introduced as a health insurance benefit for children and adolescents with mental disorders.

On behalf of the Federal Joint Committee (G-BA), the Institute for Quality and Efficiency in Health Care (IQWiG) evaluated the benefits and harms of systemic therapy in children and adolescents with a mental disorder.

In the following areas of application, advantages of systemic therapy were shown compared to the respective comparative treatments: anxiety disorders and obsessive-compulsive disorders, eating disorders, hyperkinetic disorders as well as psychological and behavioral disorders caused by psychotropic substances. In mixed disorders, it proved to be comparable to guideline therapy. On the other hand, IQWiG sees a disadvantage compared to other therapy options for the application area affective disorders.

Systemic therapy is already covered by health insurance for adults

Systemic therapy is a psychotherapeutic method for treating mental disorders. The guiding principle of systemic therapy is that social relationships – especially within the family – play an important role in the development and treatment of mental disorders.

Unlike analytical psychotherapy, psychotherapy based on depth psychology and behavioral therapy, systemic therapy is not one of those psychotherapeutic procedures in Germany that are used and reimbursed as an outpatient service in statutory health insurance for the treatment of children and adolescents. Systemic therapy for the treatment of adults, on the other hand, was included in the relevant psychotherapy guidelines of the G-BA in 2019 and is therefore one of the so-called guideline therapies.

Against this background, the G-BA commissioned the IQWiG in August 2021 with the benefit assessment of systemic therapy as a psychotherapy procedure in children and adolescents with a mental disorder.

Positive effects in five application areas

The IQWiG assessment “Systemic therapy as a method of psychotherapy in children and adolescents” is based on the analysis of 42 randomized controlled studies. Compared to the preliminary report, five evaluated studies were added. Most of these studies can be assigned to seven application areas. IQWiG considered the other studies in a separate additional area called “mixed disorders”.

In the evaluated studies, systemic therapy was not only compared with other psychotherapy methods and medications, but also with other supportive measures.

The Institute sees positive results in five application areas across all comparisons

In the application area of anxiety disorders and obsessive-compulsive disorders, systemic therapy in combination with guideline therapy shows advantages over guideline therapy alone.

• In the application area of eating disorders, there are advantages in favor of systemic therapy both in the comparison of “systemic therapy versus psychotherapy that does not correspond to guideline therapy” and in the comparison of “systemic therapy versus other treatments”.
• In the application area of hyperkinetic disorders, systemic therapy in combination with drug treatment is superior to drug treatment alone.
• In the area of mental and behavioral disorders caused by psychotropic substances, systemic therapy has advantages over guideline therapy.
• In the defined area of mixed disorders, the benefits of systemic therapy are comparable to guideline therapy.

In the application areas of social behavior disorders and mental illness due to emotional deficiencies in early childhood, it cannot be deduced from the studies whether systemic therapy has advantages or disadvantages compared to other treatments.

In the field of affective disorders, studies show disadvantages of systemic therapy compared to guideline therapy.

The assessment was made more difficult by the fact that either no studies or only a few studies were available in the two important comparisons “systemic therapy versus guideline therapy” and “systemic therapy versus drug treatments”.

The G-BA decides whether systemic therapy will also be covered by health insurance for children

“Even if the data is sometimes sparse: As with adults, there are indications of a benefit of systemic therapy in several areas of application in children and adolescents compared to other treatments – sometimes even compared to guideline therapy,”.