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The punishing price of mental health support
Slow Views

The punishing price of mental health support

Monday 11 October 2021

One hour of private therapy costs more than half a household’s daily budget. The government must boost the NHS’ capacity to tackle Britain’s mental health crisis


How much could you afford to pay for an hour of therapy? Half a day’s wage? The price of a weekly shop? Or a tank of petrol? 

The cost of private mental health support – if you can find a therapist who isn’t fully booked – is, for many, inaccessibly high. Tortoise research reveals that a one-hour session with a therapist registered with the British Association for Counselling and Psychotherapy costs, on average, £51.81. That’s more than half what an average UK household spends in a day.

Some therapists registered with professional bodies like the BACP or United Kingdom Council for Psychotherapy (UKCAP) charge as much as £165.00 – more than a quarter of a UK household’s average weekly expenditure – for just one hour. For many families, this simply will not be an option.

And yet: anyone in need of mental health care this winter may have to start making some unforgiving calculations. With 1.6 million people on a waiting list for NHS England’s mental health support, and eight million in need of care but unable to get onto the list, publicly funded treatment is all but impossible to find.

In England, waiting time targets agreed in 2014 as part of a plan for achieving better access to mental health services by 2020 have been missed across the entire service. One in nine people needing treatment wait for more than six months. “It simply isn’t good enough that so many people are waiting for mental health treatment and ending up in crisis,” said Dr Kate Lovett, Dean of the Royal College of Psychiatrists, responding to these “hidden waiting lists”.

At a summit of health leaders last week, Sajid Javid, the health secretary, said that “there’s never been a more important time to talk about mental health”. So let’s talk about the government’s efforts to tackle staff shortages. Let’s talk about valuing the care of mental health workers properly. And let’s talk about incentivising recruitment into psychiatry specialities, and offering better financial support and training to those who come onboard.

These are not entirely new issues. In 2017, the NHS highlighted the shrinkage of mental health nursing capacity compared to other parts of the service, and said that immediate action was necessary. The government made commitments that year to boost the number of mental health specialists.

And yet: early in the pandemic, in April 2020, the British Medical Association reported that the government’s efforts to boost and support the mental health workforce had fallen short of existing goals. Hospitals, mental health services and community providers currently report a shortage of nearly 84,000 staff across the service.

These staff shortages have a serious impact on the well-being of existing workers. Despite mental health workers already providing care at capacity, NHS survey data reveals they were the only staff category in the service to work more unpaid hours worked last year – with 60.5 per cent at some point working unpaid to support the service.

A Royal College of Nursing and Association of Clinical Psychologists survey in 2020 found that 52 per cent of practitioners were too busy to provide adequate care to all their patients.

It should be noted that the government has since promised an additional £2.3 billion in mental health service funding by 2023 to cope with the backlog of demand created by the pandemic. Approximately 7,000 psychiatric nursing preceptorships – a way of supporting newly qualified nurses into their full-time roles – have been planned in order to increase the number of clinical practitioners. Some 695 trainee clinical psychologists placements are also planned this year.

But plans to attract staff must be met with plans to keep them. As Professor Ian Cumming, the chief executive of Health Education England notes: “Unless we have enough skilled staff to fill the newly created posts and are able to retain them, we will fail.”

Dr Clare Gerada, Chair of Doctors in Distress and former chairperson of the Royal College of General Practitioners, argued at a Tortoise ThinkIn earlier this year that mandated mental health support and enforced absences that allow staff to rest could help stop the churn of already experienced and capable workers. 

The NHS doesn’t give information on the real number of psychiatrists, carers and counsellors joining the service – at present, they only “offers a limited number of child psychotherapy training posts,” and a “small number of NHS trusts” as training providers. Much focus has fallen on mental health nursing; with plans to address shortages, grants to nursing students and subsidies to universities offering more nursing placements., more are needed to ensure that trainees actually practise as part of the NHS and can endure the experiences for more than a few months. 

It’s no wonder that the cost of therapy is so high. There’s so much demand, particularly after the past year and a half, and so little supply. The government doesn’t just need to encourage recruitment – and fast – it needs to make sure that any new recruits stay in the NHS. Otherwise, this most crucial part of the health service is bound to fail for millions of people around the country.