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Talking therapies offer a lifeline for people with mental health problems – but for many are prohibitively expensive. Do you need to be rich in order to heal?

Words: Amani Omejer
Illustration: Rosanna Tasker

Private therapy costs an average £120 a month, with some people paying over £400 – that’s big money. There are options in Bristol if you’re skint and need mental health support, but it’s one of the city’s most underfunded service areas. The council spends just 1.8% of its health budget on mental health.

“It’s a national disgrace there isn’t sufficient investment into mental health services,” says Kyra Bond, director of Womankind, a Bristol-based charity offering women free therapy for up to six months. Last year its helpline took 4,500 support requests and 420 people were assisted face-to-face. “We want to offer more, but can’t,” says Bond.

An endless wait

Locally, the NHS funds Bristol Wellbeing Therapies (formerly LIFT Psychology), which gets 1,000 monthly referrals from individuals and GPs. It offers six to 12 sessions of counselling, cognitive behavioural therapy (CBT) or eye-movement desensitisation reprogramming (EMDR).

In August 2015 I referred myself for support with post-traumatic stress. A month after requesting an appointment, I had a phone assessment. Three months later I had my initial appointment. Despite appealing the decision, after three sessions I was discharged without any referral to another service. This was based on the fact that I am healing “complex childhood trauma” and that 12 sessions are not only not enough, but could also be destabilising.

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This spring I tried again. My GP made an urgent referral because I was struggling with suicidal thoughts and feelings. I waited three weeks for an assessment and the therapist ended the call by saying, “I will talk with my team and get back to you about what we can offer. I want to warn you that we still might not be able to offer you any help.”

Six weeks later, I was told they’d made the same decision as before. I have heard countless stories of similar problems with the NHS and/or Bristol Wellbeing Therapies.

In 2011 the government released a report, No Health Without Mental Health. ‘No decision about me without me’ was its governing principle. It committed to investing £400 million into psychological therapies, announcing that by 2014/5 “every adult that requires it should have access to psychological therapies to treat anxiety disorders or depression”.

“The report didn’t deliver what it was supposed to. Nobody was allocated to follow it up and ensure that what was promised came to fruition,” explains Rezina Hakim, national campaigns manager of mental health charity, Mind. The report was scrapped and two others written in its place. A new Mental Health Taskforce was also formed, comprising leading charities and service users; they created and presented the NHS with a comprehensive report in February 2016. In it, they show that the NHS is still meeting only 15% of the need for talking therapy within the UK, and aiming to increase that to 25% by 2020/21. So what about the other 75% of people?

One size doesn’t fit all

08-talk-green-houseIt’s also a question of the type of support on offer. The short-term model the NHS uses can – reflecting the advice I received – make things worse for some people. There need to be alternatives for people who don’t fit the NHS’ “one size fits all model”, explains Alexander*, a Bristol trauma specialist. “Mental health doesn’t work like that – what each of us needs is so different. Thousands of people are falling through the gaps”. It is possible to get long-term psychotherapy on the NHS, but only in cases of severe mental health challenges – and even then it’s incredibly difficult.

A few years ago, Jake* referred himself to the Cruse bereavement service after his father died. “I waited six months to be seen,” he says. “By the time a space became available, I wasn’t in the right place to be going – so much can change in your mental health in six months”. This is the story across the board: Mind’s 2013 We Still Need to Talk report showed one in 10 people waiting over a year for an appointment, with just half being seen within four months.

“There are thousands of people falling through the gaps”

In April 2016, however, thanks to the Mental Health Taskforce, the government introduced the first ever waiting times standards, investing £80 million into improving accessibility. From now on, 75% of people have to have a first appointment within six weeks of referral and 95% within 18 weeks. “We’ll still hear of people who aren’t seen within that time,” says Hakim, “but it’s a positive step”.

Sliding scales and steps forward

Free services reliant on statutory grants and funding are left vulnerable to government cuts and the challenge of continuous fundraising. Of solutions independent from grants, sliding-scale systems are the most popular and sustainable. Therapists charge higher rates to those who can afford it and lower rates or nothing to low-income or unwaged people. The Free Psychotherapy Network (FPN) of UK therapists offers free or low cost therapy, encouraging the spread of more sliding-scale and pro-bono therapy clinics.

Therapists must earn a living and feel respected for what they do, but some choose to earn less than if they were running a full-cost private practice. “Our therapists earn less, but have a passion,” explains Bond.

Healing shouldn’t be a privilege of those who can afford it. We’re yet to see the “mental health revolution” David Cameron has talked about, but speaking with Mind and service providers, the government’s attitude to mental health is changing. Reports from the government and NHS often describe how they are striving for “parity of esteem” between mental and physical health (in other words, for them to hold the same level of importance).

If money was invested into improving prevention and early-stage support rather than continuing to fund the short-term quick-fix model that’s in place, and the reports written were followed up, then perhaps this parity of esteem would be reached. The Mental Health Taskforce and other mental health organisations have produced strong material showing the need for change and ways to implement it, it just comes down to the government’s ability to listen and then do.

*Interviewees requested to be kept anonymous.

Long-term counselling/psychotherapy services available in Bristol
FREE
  • Womankind: Up to six months psychodynamic therapy for women; no waiting list but you need to call up regularly to see if spaces have become available. Helpline: 0345 4582914 (free from mobiles) or 0117 916 6461; offers up to 50 minutes with a therapist; open Mon-Fri 10am-12pm, Mon & Tues 8-10pm, Tues & Wed 1-3pm.
  • Free Psychotherapy Network: A list of counsellors and psychotherapists offering free or reduced-rate therapy to people on low income or benefits in the UK.
  • Bristol Wellbeing Therapies (formerly LIFT Psychology): Six to 12 sessions, sometimes clients are offered another set of six or 12; long waiting lists (average of four months but can be more); can refer yourself or via your GP; after receiving treatment you can refer yourself again six months later if you need to.
  • Off the Record: Free mental health support for 18-25 year olds in Bristol.
LOW COST
  •  Low Cost Counselling: Long term therapy; suggested fee of £12.50 a session, but you can pay more or less depending on your circumstances – they don’t want people turned away through lack of funds; no waiting list; counsellors come to your home but you can see a counsellor in a location nearby if preferred.
  • The Swan Project: Long term; £10 a session if unwaged, £15 waged; approx. two weeks wait for initial assessment; average six to eight week waiting list; specialise in addiction but work with anyone.
  • Network: Pay what you can counseling.

 

 

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  • Sarah says:

    I’ve been in psychotherapy now for nine years and counting. It sounds like a long time but it isn’t when you’ve been severely unwell. I was lucky to see someone for £20 a session (still a struggle, particularly when I was a student, but manageable), but after she left I now see someone at £45 a session so I can only afford to go once a fortnight. I’m still one of the lucky ones.

    People who haven’t been to therapy don’t realise what a minefield it can be to sort out. It absolutely can be destabilising to get into deep issues for 12 sessions and then be cut off with no referral. Many psychotherapy practices say that people with severe mental health needs need to stay in therapy for at least 2 years to even see if it’s working. Who can afford that at full price? Therapists that offer on sliding scales don’t usually offer this for longer than a few months (like I say, I was lucky).

    I know that therapy has turned my life around and I also know that, sadly, I’m not done yet. As well as the huge hit to my bank balance, I do have to cope with people telling me I’m delusional, that “if you’re still there after nine years, it hasn’t worked” and that I’m wasting my time and money. It’s so hurtful to have to put up with this kind of stigma on top of the financial cost. There needs to be a complete shift in thinking on the subject, particularly within mental health services who are firmly fixed on the 6 – 12 sessions model.

  • Barbara Hacking says:

    Having counsellors in Primary Care ie working alongside GPs was working well . Then the government changed the system. Ask GPs how it worked for their patients and how it worked for them – they are the ones who know!

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