How many psychotherapists does Austria need? A systematic synthesis of treatment gap estimates

Background: Austria lacks consensus on psychotherapy treatment need, with published estimatesvarying widely. This uncertainty stems from unavailable data and the absence of routine monitoring,impeding evidence-based planning.Objective: To synthesize existing estimates of psychotherapy treatment need in Austria, comparethem against capacity estimates, and quantify the treatment gap.Methods: We systematically searched for estimates of psychotherapy need (1990–2025). Thirteenestimates from nine sources were analyzed: (1) population-based estimates derived from surveys orclinical assessments (2.1–15.9%), and (2) prevalence-based models combining mental disorder rateswith treatment readiness scenarios (30%, 40%, 50%). Each estimate was rated on three dimensionsreflecting methodological rigor and contextual relevance. Need estimates were compared againstpublished capacity data for insurance-funded and total treatment provision.Results: Treatment need estimates ranged from 2.1% to 19.1% of the population (192,738 to1,752,998 persons). Quality-weighted averaging yielded 11.3% (1,040,148 persons); high-qualityestimates (score ≥8) converged on 11.4–19%.Insurance-funded capacity covers 1–2.6% of the population; total capacity including self-fundedtreatment reaches 4–8.9%. The insurance-funded treatment gap is 77–91% (801,520–948,368persons lacking access); the total capacity gap is 21–65%. Moreover, only approximately 1% of thepopulation receives fully-funded psychotherapy meeting conventional definitions of adequatetreatment.Conclusions: Austria’s psychotherapy treatment gap is substantial to severe under all scenarios.Current insurance-funded capacity meets less than one-third of estimated need, disproportionatelyaffecting those unable to pay out of pocket. Addressing this gap requires expansion of publiclyfunded services, stepped-care models including digital interventions, and routine monitoringsystems.