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.
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
It’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.