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20 January 2021

The UK’s mental health crisis: why people are struggling to access therapy

Covid-19 lockdown measures, time, cost and stigma are barriers to getting treatment.

Living through the coronavirus pandemic – and now through a third national lockdown – is having a profound effect on people’s mental health. According to data from the Office for National Statistics released in June last year, more than two-thirds (69 per cent) of UK adults reported feeling somewhat or very worried about the impact of Covid-19 on their life. The most common issues affecting psychological wellbeing were worrying about the future (63 per cent), feeling stressed or anxious (56 per cent), and struggling with boredom (49 per cent). Mind, the mental health charity, this month reported a surge in visitors to its pandemic support page – the highest numbers since the first wave last April.

As lockdown measures have led to increased periods of self-isolation and a lack of interaction with friends or family – the ONS found that a quarter of UK adults suffer from feelings of loneliness – accessing mental health support has also become more difficult. Some services have transitioned to a virtual setting, but with varying degrees of effectiveness.

Read more: The rise of the virtual therapy session

According to Mind, around one in four people in England will experience some form of mental health problem in a typical year, while one in six suffer from a generalised form of stress, depression or anxiety in any given week.

For the many thousands of people diagnosed with a mental health condition, many others are not getting the help they need. And, independent of the pandemic, time, cost, geography and cultural stigma are all factors that contribute to why that may be the case

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For Nicola Hollingsworth, a healthcare assistant from Margate, who has attended therapy on and off for the past ten years to treat a range of issues including post-traumatic stress disorder, accessing help has been something of a “minefield”. Under-funded and over-subscribed mental health provision on the NHS, she says, means that she has not been able to find suitable long-term treatment easily.

According to The King’s Fund think tank, “mental health problems account for 23 per cent of the burden of disease” in the UK, but spending on mental health services only accounts for 11 per cent of the NHS budget. The British Medical Association, meanwhile, has warned of chronic under-recruitment in psychiatric professions

Long waiting lists for treatment are another problem, says Hollingsworth: “So your only other option then is to go private, but everyone’s [also] over-subscribed or too expensive there, so you end up stuck in this loop of either going through short-term therapy for six weeks [on the NHS], but then you have to wait six months before you can refer again, or you end up just giving up.” Currently, the most commonly offered service on the NHS is cognitive behavioural therapy (CBT), which is delivered through between five and 20 weekly or fortnightly sessions lasting 30 to 60 minutes, as either a one-on-one arrangement or as part of a group.

Britons may have become more open about therapy in recent years, but parity of perception between mental and physical health is still a way off. Geoff Heyes, head of health policy and influencing at Mind, says that a study conducted by the charity, which surveyed 16,000 people, found that many were putting off seeking help for their mental health because they were worried their problems were not “serious enough”, or because they were “concerned about placing greater pressure on the NHS.” The latter sentiment has been exacerbated by the pandemic.

Read more: It’s not just you: Why the current lockdown is having an extreme effect on mental health

In 2019, a survey conducted by People Management magazine found that of the 55 per cent of UK workers who had taken a mental health sick day and had not been honest about the reason they were off, 65 per cent feared their bosses would not be understanding of their circumstances.

Dr Richard Thwaites, the clinical lead for the First Step programme run by the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, says we must not “pit mental health problems against each other”. Currently, the NHS aims to start a patient on a mental health treatment within six to 18 weeks of referral, in line with wider NHS policy, although that might be considered too slow. “Depression or anxiety disorders might not always seem urgent,” Thwaites continues, “but this is how it feels to those experiencing them. Often the impact of anxiety disorders is misunderstood due to [a] lack of discussion around the impact on people’s lives, but what might sound at first like a ‘mild’ problem can fundamentally impact on most areas of someone’s life.”

An NHS spokesperson told Spotlight: “The NHS has been open to people with concerns about their mental health throughout the pandemic, including through talking therapy sessions, which more people are self-referring onto for both face-to-face care and online sessions  the latest data shows that nine out of ten referrals waited less than six weeks to start treatment in September.” 

But Dr Lucy Russell, founder of the They Are The Future child psychology service, says that the UK’s mental health system is “firefighting”, and reactive rather than proactive in addressing people’s needs. Her decision to leave the NHS and set up her own private practice was in part driven by “major systemic [or] cultural problems, such as a lack of focus on prevention and constant cutbacks”.

If mental health sufferers “only get seen when at crisis point”, Russell says, “their problems are more deeply ingrained by then, and therapists struggle more to help them.” This could mean they are more likely to return with problems in the future, she adds, creating unsustainable demand. “The bar for accessing NHS treatment has been getting higher and higher, certainly in children’s and adolescent services,” Russell says, “so even if children are at crisis point, they may not be seen.”

Where people have had trouble accessing therapy due to geography – an issue particularly pertinent in rural areas, or because of the pandemic’s social distancing rules – does technology, with the availability of treatment via Zoom or similar, really help to bridge the gap?

 “We know digital expansion brings a lot of positives,” Heyes says, “but we cannot forget or exclude the thousands of people who do not have the technology or skills needed to access digital services, who are already [from] some of the most marginalised [groups in society].” It is important to ensure that “nobody falls through the gaps”, he says, pointing out that “what helps one person with their mental health may not work for another.”

For Hilda Burke, a therapist with a private practice in west London, technology has helped to widen the range of therapists with a particular specialism available to interested clients, some of whom may live further away. While she also does not see virtual sessions as a panacea, she feels that digital options have helped with convenience, flexibility and even privacy. They may help with “people juggling things, minding kids, home-schooling, all that.”

For a client to leave their home “for two hours or whatever” to travel to a therapy session “would be impossible for a lot of people” Equally, for those who might not want to tell family or flatmates that they are receiving treatment, it is easier to explain that “mummy’s in a meeting” in the other room than to explain why they might have popped out for a couple of hours. “It’s much easier to kind of just assimilate in their [client’s] day,” Burke says. “So that’s a positive, but it isn’t the same as being in a room with someone.”

Read more: Why mental health is a human right

Nicholas Smith*, a university student who has engaged with talking therapies and used the Samaritans helpline on and off for a number of years, reiterates that the sometimes long waiting lists “can be really frustrating and difficult to navigate if you are struggling.” He thinks there could be more clarity on what different kinds of therapy exists, and where it is available. “I’ve not always known where to go for help, who to talk to, who to contact first, and how to actually start that process of seeking therapeutic support.”

Given the “financial realities” of accessing therapy, Smith suggests that the Samaritans helpline, which is free to call, could be a useful stop-gap. Samaritans is not a substitute for professional therapy, but it does offer a “non-judgmental” sounding board. People can “call up, any time, night or day… You might be in a genuine crisis or you might just feel very flat and on your own, but they are there, they listen, and they care.”

Russell wants to see an evolution in the language people use to describe mental health treatment. “It worries me a little that people might think they can ‘fix’ themselves with therapy, only, without doing underlying work on their lifestyle,” she says. “Therapy is not a quick fix.”

Russell believes the “medical model” of mental health is a problem. “The idea that we diagnose a condition and then treat it,” she explains, “reinforces the firefighting approach.” She is an advocate of the “lifestyle medicine” movement, which encourages greater education on the importance of sleep, exercise and a healthy diet. Russell continues: “I think the next frontier is normalising the reality that mental health and physical health are very similar.”

Should employers consider helping to subsidise some mental health support for their staff? Russell is emphatic: “I think all employers would see a return on their investment. Mentally healthier staff means more productivity, lower staff turnover, fewer sick days.”

*Name has been changed.