My Thoughts on the UKCP & BPC Report Released this Week
February 13, 2015
This week the United Kingdom Council for Psychotherapy (UKCP) and the British Psychoanalytic Council (BPC) released a report indicating that 94% of therapists in the private sector had seen clients that had been let down by the NHS or fallen through the net. This significant figure suggests people with enduring mental health problems are being forced to turn to private services due to a lack of funding and resources, or assumedly going without if unable to fund private treatment. The report breaks the figures down further suggesting 56% of clients found waiting times to be too long, 58% couldn’t get the help they wanted, and 63% felt the therapy provided was too short.
As a private practitioner (UKCP registered) who has previously worked in the NHS, these findings are not surprising to me. I frequently meet clients who inform me that they have found their way to my office after meandering various services never quite finding what they are looking for. I am always encouraged when these clients arrive having not given up on psychotherapy or themselves, and are willing to try again. I guess it’s our human spirit to not want to accept misery as a final destination, and a part of our humanness I admire and want to work with as a therapist.
However, I am not convinced that clients seek private therapy just because the same service isn’t provided by the NHS. The psychotherapy situation is an incredibly intimate encounter, and private therapy I do believe increases this sense of intimacy. The word ‘private’ quite literally coming into its own here describing not only a paid for service outside of statutory provision, but a private relationship chosen by the client and protected by the therapist. In my experience, privacy is often high on client’s priorities, especially in this digital age where information sharing is changing the way we interact faster than we can really keep up with. Private therapy provides a private space, a space for clients to call their own, to own, and to have held for them. I am not sure the NHS setting will ever be able to offer this level of intimacy let alone fund the length of treatment some clients require. I’m not just talking about clients with complex presentations who we may expect to require longer-term therapies, but often high-functioning individuals with deep seated (yet well hidden) underlying unhappiness who also may require longer-term interventions. In fact, these individuals sometimes take longer to engage in the therapeutic process because they are used to being self-reliant and use strategies to hide internal distress for fear that should it be seen it may lead to collapse, therefore they enter therapy to only hide within it until a depth of trust is gained.
Relational-Developmental Psychotherapy (as I practice) requires the development of a relationship between therapist and client that includes genuine human to human contact. Like all relationships this cannot be forced; we would not expect two people to decide to marry, become best friends or trust each other implicitly within 6-10 hours of meeting, so why expect therapist and client to have achieved so much in this time? Trust for many can take a significant amount of time, and the question is can the NHS ever afford to fund this level of therapeutic relationship for the thousands if not millions that may wish to access it. Just imagine the cost; 6 months therapy (26 sessions), four years therapy (208 sessions), more? Each clinical hour of individual therapist time costing approximately £40-£50 per hour? I think this level of funding sits far outside the reaches of the NHS, and therefore we are likely to forever be saying the NHS isn’t providing what we need. And why is each hour so expensive? because therapists don’t see 37.5 clients a week, a clinical hour is face to face time, but many more hours go into clinical practice; supervision, note writing, research, clinical training ect meaning the cost of each session must cover preparatory and reflective practice as well associated environmental costs, subsequently the therapists hourly rate drops dramatically.
Given the above, I’m not sure it is fair to always accuse the NHS of not being enough. Mental Health is a huge dilemma for our country and certainly more needs to be done. However I’m not sure if we are asking the NHS to perform the impossible. Ok, maybe more can be offered within the NHS to bring down waiting times, but bring down waiting times, increase therapy length, and offer more therapeutic choice? I’m not sure this is possible, not any time soon anyway, the sums involved are just too large and the NHS just doesn’t have the means. Whichever way we look at it, I am not sure the NHS will ever get it right for every client in the same way not every private therapist is right for every client.
So what’s the solution? We can’t just accept the NHS doesn’t offer adequate services and therefore clients must pay high private fees. We would never accept this with physical health problems and we shouldn’t for mental health, rather I think we should acknowledge that the NHS should do its best to do as much as it can, for as many as it can, for as long as it can, but that there is a limit to what it will ever be able to provide. I would then like to see statutory, voluntary and private sectors working together rather than in isolation offering a variety of services at graded pricing. Services such as the one for which I am a Director offer low-cost therapy in the private sector for those on low-income, again this still not enough as many people are unable to financially contribute to their therapy at all, but if the NHS funding isn’t going to miraculously appear there are other things we can be doing to provide these services and bridge gaps.
In our country, as with many others, we have so many people who need talking therapies and equally many many therapists looking for work, as always money stands in the way of what would otherwise be a beautiful match and until vast sums are invested into talking therapies the situation will remain as it does.
I make no apology for my neither supportive nor slanderous view of the NHS in this article as we so often enjoy a dead fast opinion. Believe me if I had one I’d share it, but I do not see the topic to be so black and white. Do I think the NHS can do more? Yes, do I think it can ever deliver psychotherapy like the private sector can? No, is the NHS to be blamed? No, the NHS is trying to provide what it can of an extremely expensive treatment, but psychotherapy will never be like other medical interventions it’s just too relational for that.