Building accessible pathways and rethinking mental health systems

Sciana Fellow Kai Lanz shares his journey of building mental health services, what systems leadership means in times of crisis, and why early intervention is key to sustainable change

Kai Lanz is the co-founder and CEO of Krisenchat, a nonprofit providing 24/7 chat-based crisis counselling for young people in Germany. He launched Krisenchat during the first COVID-19 lockdown, having evolved it from a youth initiative he started at 16.

The platform now includes support for Ukrainian refugees and widespread psychoeducation via social media. With a focus on accessibility, scalability, and prevention, Kai aims to reshape how mental wellbeing is supported across Europe. He is a member of Sciana's seventh cohort.

This interview has been edited for brevity and clarity.

SN: What's the story behind Krisenchat? What motivated you to start it?

KL: Our Krisenchat emerged in the first COVID lockdown, out of a previous organisation that we had founded before. When the first COVID lockdown came to Germany, and we saw all the reports from other countries where it's been before, with all that is happening [in] society, especially to young people being locked at home, abuse in family, domestic violence, and at the same time most of the support systems closing down [and] schools, we said, 'Okay, we have to do something now.'

We have to provide some service and help for young people, with the three core principles: 

1. Immediate access to our chat, no registration 
2. Mental support delivered by professional experts only 
3. Open 24/7, because mental health issues often peak at night.

SN: How has Krisenchat evolved since its launch in 2020?

KL: We saw a big demand from the very beginning, from the first day. Since then, the demand has been growing every month by far. Right now, we are incapable of counselling 40% of those help-seeking young people because we lack the personnel resources to handle the enormous demand.

What we're working on now and looking into the future is from this one service that we have with the crisis counselling [is] to develop a whole ecosystem of prevention and early intervention offers that we can offer to people and [is] more scalable than the one-on-one chat counselling that digital support offers.

Next to our work there, we are already doing a lot of psychoeducation and destigmatisation on social media. We are active on all the big platforms, from Instagram, YouTube, TikTok, Twitch, [and] Reddit, to spark conversations within young people about mental health and give them concrete tips.

SN: You've expanded the service to Ukraine. What have been some of the most unexpected or impactful lessons from that process?

KL: The whole Ukraine project was completely crazy. I think the first three or four weeks of developing it were the craziest weeks of my life. We started on a Saturday morning, and it was two days after the full-scale invasion. Just very spontaneously, we said, 'Yeah, let's see if we can do something and help [with] something with all these refugees on their way to Berlin […]'

Twenty-four hours later, we were there having recruited 200 Ukrainian-speaking psychologists who were there [...] Through that momentum, that really carried forward and I think this mix of being able to provide support into a warzone and into a country that is [at] war without the need to be physically there is also an invention that can be adapted all over global health. What [other] support structures can you actually build in the digital world that can be adapted everywhere? […]

All the employees - they're in war themselves, their families are in war - and [we're] giving them a space to develop, to professionally also have a job where they feel the impact that they have on their country and their people and their communities. That is always touching my heart, and the connection that is there within the team is very strong in very challenging situations.

SN: What do you see as the biggest barriers to accessible mental health support in Europe today?

KL: Looking at the bigger picture, our healthcare systems focus on physical illnesses and their treatment. In reality, however, our mental health has an enormous impact on our level of wellbeing and should not be considered a secondary, niche issue.

Looking now at the reality of mental health care - I know the German system the best - it's very much rooted in traditional psychotherapy and individual therapy.

I think with the surge of demand for mental health support, it's not possible anymore that we provide this to everyone. We can't provide individual therapy to 20 million people in Germany. It's just not possible.

I think we really have to think further and go new ways and see how we can build more cost-effective structures that then reach a lot of people—and can reach 20 million maybe—[while] still having these traditional support offers that are really, really important and really valuable to have in such a system. But it's not scaling.

SN: What role does Krisenchat play in responding to these barriers?

KL: I think in Europe we are really focusing on our work in Germany and Ukraine right now before scaling further one basic service […] We want to give open access also to our knowledge and want other people to build up from what we can maybe help and support. So, if there are initiatives in other countries, we're also really happy to share our knowledge and platform, content, and so on for allowing that scaling to happen.

SN: This year's Sciana Challenge focuses on systems leadership in the context of scarcity. What does systems leadership mean to you in mental health?

KL: Mental health issues usually have very broad sources; you don't have only one illness that you're treating, and then you usually are good. But if you take a systemic perspective to it, there are very different settings in that people act. It can be their home; it can be a school, a workplace, a sports club, and so on. Usually, a lot of different factors contribute to a person having a bad mental illness.

So, if you really want to do system leadership in mental health, you really have to combine these systems more and think across systems—not only in healthcare, [but] in social or child and youth welfare and in education. You really need to bring these players more together—to act together—to build really good programs and services that actually address the full human and not only in one specific setting.

[The second part] is bringing together the service providers, also bringing that together with the academia, producing evidence-based solution[s] and really studying what works and what doesn't and really identifying that side also […] I think we can find new ways of bringing all these stakeholders together, but it needs very good facilitation where everyone really feels heard as well […] In terms of scarcity, it also needs prioritisation, and there needs to be hard decisions on these prioritisations.

SN: Looking ahead, what kind of system-level change would you like to see in society?

KL: We really have to make a really big effort towards moving more into early intervention and selective prevention, and prevention of risk groups. We have a big knowledge about who our demographics [are], who our individuals [are], [and] who [are] our groups that have a special risk of developing mental illness, and mental illness, compared to many other diseases, is not something that you have from one day to another, but really that develops very gradually over a longer time.

So, there can be risk factors identified very easily, where you can say, 'Okay, if we don't do anything here, then they will have an illness and need a diagnosis and need a very expensive therapy or clinical treatment.' But if we look at these risk factors before, do something, and bring them a more cost-effective early intervention, this is really the huge shift we need to see. It is these kinds of interventions that we really need to scale to the broad population.

SN: You've attended one Sciana Network residential meeting so far. What do you hope to take away from this experience?

KL: I hope to have gained more sense, capacity, and knowledge to facilitate these multi-stakeholder discussions with high-level leaders who are used to them always talking when they're in the room and being the most important voice that people listen to, but really [bringing] these senior leaders together and facilitate a process where everyone can also listen to each other and we can collect the wisdom of every perspective.

I think the second part is also understanding: 'Okay, how we can bring in the political and policy side to it and include them in these processes very early?' Instead of just being more in the position of requesting from politics, but really including them in the processes as well, from the beginning.