The British Association for Counselling and Psychotherapy (BACP) is pleased to provide a submission to the Comprehensive Spending Review.
BACP is the leading and largest professional body for counselling and psychotherapy in the UK, with over 59,000 members. Our members are drawn from the various professional disciplines in the field of counselling and psychotherapy, working in a broad range of settings including education, private practice, healthcare, workplace support and within the third sector, as well as working with clients across all age groups.
Executive summary
- Invest in a trained, professional counsellor in every secondary school and college in England to meet the growing mental health crisis facing children and young people.
- Extend VAT exemption to all individual Professional Standards Authority registered and accredited members and registrants who are qualified counsellors and psychotherapistsremoving unnecessary barriers to access mental health support.
- Fund research into the impact of COVID-19 on care home residents and staff and how evidence-based non-pharmacological interventions, such as counselling and psychotherapy, can improve their mental health and well-being.
- Strengthen the UK’s economic recovery from COVID-19 by supporting employers, employees and vulnerable groups
- Increase in the NHS Funding Settlement to ensure NHS Long-Term Plan can be implemented in light of COVID-19.
- Enhance the role of counselling and psychotherapy within the NHS workforce.
- Investing in accessible and funded therapeutic coaching in NHS Health and Social Care settings.
- Invest in addressing longstanding mental health inequalities faced by BAME communities by investing in a national programme of community level, accessible and appropriately culturally sensitive therapy.
1) Invest in a national school and college-based counselling programme
School-based counselling is a proven intervention for children and young people experiencing psychological distress but is not currently universally accessible in all secondary schools and FE colleges within England. Schools struggle to pay for in-house counselling provision and third sector providers often work within limited geographical areas or have funding restrictions resulting in inconsistent provision. School counselling provision can change on an annual basis and is not currently sustainable for many schools.
We know that pre-lockdown, one in eight young people were struggling with diagnosable mental health issues, the latest figures from NHS Digital suggest one in six. In order to effectively support the mental health of our nation’s children and young people, now is a critical time for the Government to financially commit to a sustainable school and college counselling programme that will complement other departmental mental health and well-being strategies for this age group and greatly contribute to the building back better agenda.
BACP has a number of fully costed school-based counselling options which would ensure universal access to counselling as well as meeting the need of targeted and more vulnerable groups that have struggled disproportionally during the various lockdowns.
We have a highly trained and qualified children and young people’s counselling workforce with capacity to deliver against this ask. Our counsellors and psychotherapists work within a core competence framework ensuring the highest of professional standards.
Our workforce survey (2021) shows that approximately 19,000 counsellors have undertaken specific training for working therapeutically with children and young people. Of those trained specifically to work with young people, over half (55.5%) have indicated that they can provide additional paid client work and, on average, have capacity to take on an extra five clients per week. Extrapolating these figures suggests that our members are trained and available to work with over 51,000 additional young people per week, if funding was in place to facilitate this.
We believe that investing in this trained and available workforce would help alleviate current capacity issues linked to strains on the NHS and very much complements the flagship Mental Health Support Teams, which do not have the capacity or reach to work universally across all schools. Added to this, counsellors are often a critical part of a step-care approach working with those who do not meet CAMHs’ thresholds but have more complex needs than psychological wellbeing practitioners or school staff are trained to work with.
School-based counselling in the UK is based on a non-directive humanistic approach to counselling. Research from four pilot randomised controlled trials has indicated that school-based counselling, as typically delivered in secondary schools, brings about significant reductions in psychological distress (Cooper, 2013). Research also indicates that it is valued by pupils and school staff and is seen as being able to bring about improvements in wellbeing and educational attainment.
There is robust research evidence that school-based counselling has a significant positive impact on young people’s levels of psychological distress, self-esteem and achievement of personal goals (Cooper et al, 2021), over and above the positive effects that a school’s existing pastoral care provision can provide.
A study by Exeter and Cambridge Universities looking at the longer-term effects of school- based counselling, as typically provided by Place2Be in primary schools, found significant improvements in children’s mental health two years after the counselling intervention took place (Finning, et al, 2021).
Research also suggests that community-based counselling services for children and young people may be more accessible for marginalised groups, particularly those from ethnic minority groups and those with complex additional needs (eg being a looked after child, experiencing problems at schools, home or in the community etc), as well as being associated with significant reductions in psychological distress (Duncan, Rayment, Kenrick & Cooper, 2020). This highlights the need for counselling services to be available in a variety of settings, including schools and the community. BACP is supportive of the Fund the Hubs CSR ask and believes the combination of both school and community-based counselling access is vital for client choice.
Costs of delivering school-based counselling in England
The delivery of school-based counselling varies from direct employment by the school to the commissioning of counselling services employing a number of counsellors and working across many schools. The costs associated with these delivery methods vary greatly, mostly due to the management costs associated with outsourcing.
Following a data collection exercise around school-based counselling services, BACP has developed the following cost estimates of delivering school counselling nationally in all England’s state-funded secondary schools and academies as well as in FE College and Sixth Forms[1]. A separate calculation, based on the figures below, would also apply to counselling in special schools and alternative education settings:
- Based on our data, a typical secondary school might employ a counsellor for two days per week at a cost of approximately £14,500 per annum with a counsellor undertaking approximately 332 counselling sessions per academic year. School counsellors may also deliver additional counselling outside the school term.
- We estimate that the cost to deliver a single session of school counselling is between £34 and £47. Therefore, the total cost of a child accessing an average of five counselling sessions would be between £171 and £233; the figure of £229 is provided as an average cost of six counselling sessions in a school as outlined by the Children’s Commissioner’s Report (2017) where it is compared to £2,338, the average cost of a referral to a community CAMHs service.
- Upscaling the cost of delivering school-based counselling to all state funded secondary schools and academies in England, based on the need identified above, we estimate a national programme would cost between £76 and £104 million per annum.
- An alternative figure, if we consider the amount of young people in the last year of primary school, in state funded secondary schools and in Further Education and Sixth Form colleges (16-18 year olds), with a prevalence of need based on one in six children and young people needing counselling support, alongside the number of counsellors needed to meet demand over an academic year our estimate would be £188 million per annum.
While a figure of up to £188m to introduce a counsellor for all 10 to 18 year is a significant outlay, especially at a time of economic difficulty, school counselling is a cost-effective early intervention. School counselling provides an appropriate step-up intervention for those caught between support offered by Mental Health Support Teams, where they are in place, and those that are either waiting for CAMHs support or who do not meet the threshold. A nationally fully-funded school counselling programme will keep many children away from costly and overstretched CAMHs and crisis care and potentially have a positive impact on social care. This is before considering the costs of untreated mental illness if left to continue into adulthood.
The children of Wales, Northern Ireland and more recently Scotland, are already benefitting from national school-based counselling programmes. BACP believe that children and young people in England should receive the same access within their schools, ensuring universal access across the four nations.
To support this aim, we would urge the Government to:
- Financially commit to a sustainable national school and college counselling programme that will complement other departmental mental health and well-being strategies for this age group and greatly contribute to the building back better agenda.
- Invest in this trained and available workforce, as this would help alleviate current capacity issues linked to strains on the NHS and very much complement the flagship Mental Health Support Teams.
2) Remove VAT on counselling and psychotherapy
Adding VAT to mental health services contradicts legislation on parity of esteem between physical and mental health and it highlights a significant and unfair anomaly between the treatment of health services provided, for example, by doctors, dentists, dieticians, opticians, and the ones offered by many mental health professionals.
According to an HMRC brief issued in 2009 when psychologists’ services became VAT exempt, 'medical care' is defined as any ‘service principally aimed at the benefit of the patient and at the protection, maintenance or restoration of health of the person concerned’, including mental health. Despite this, counselling and psychotherapy services, all provided for ‘the protection, maintenance or restoration of health of the person concerned’ remain subject to VAT. HMRC’s definition of medical care therefore should also include services such as counselling and psychotherapy.
Registered and accredited individual and group practice psychotherapists and counsellors are required to register for VAT when their income from the provision of mental health services exceeds, or is likely to exceed, £85,000 in a 12-month period. Clients are typically not VAT registered and therefore cannot reclaim VAT on fees, and while therapists are entitled to claim a deduction for expenses incurred on any practice expenses (electricity, phone, rent etc), this ‘input VAT’ will not usually be significant.
This requirement acts as a barrier to the expansion of private affordable counselling and psychotherapy at a time when Government is promoting the expansion of the provision of mental health services and will be needed to meet the expected demand post-pandemic. Counsellors and psychotherapists are also recognised in the NHS Long Term Plan as part of the 12 distinct psychological professions delivering NHS commissioned healthcare alongside psychologists and other mental health practitioners.
Another significant anomaly is the disparity of treatment within the mental health care professions. Whilst psychologists, art therapists and dance therapists who the Government chooses to regulate by statute, offer VAT exempt services, counsellors and psychotherapists cannot. All our trainees receive the same minimum standards of professional training and once qualified they all provide the same level of highly professional and ethical psychotherapeutic services within their own professional sphere and working to their level of competence.
As the country looks to ‘build back better’, VAT reduction is one of the measures available to facilitate economic renewal, consumer confidence and access to essential services as part of a wider package of recovery interventions.
Any additional cost, particularly during these challenging times, represents a significant barrier to vulnerable people being able to access vital mental health support when they need it and anything that provides or makes it easier for people to access mental health support should be facilitated and encouraged.
BACP believes that the removal of VAT on counselling and psychotherapy services is long overdue and would remove a needless barrier to people accessing care. In view of the highlighted anomalies and expected increase in demand for mental health support in the aftermath of COVID-19, we urge the Government to extend VAT exemption to all individual PSA registered and accredited members and registrants who are qualified psychotherapists and counsellors.
We believe the cost to the Treasury to introduce this exemption would be small. However, it would result in significant benefits in helping the nation recover from the crisis.
We would urge the Government to:
- Facilitate the accessing of vital mental health support by removing VAT on counselling and psychotherapy services.
3) Investment for research into mental health of care home residents and staff
The COVID-19 pandemic has had the greatest impact on care homes, directly impacting residents, with the frail elderly at greatest risk. The outbreak has also had devastating impact on people working in social care. When adjusted for age and sex, figures published in May 2020 showed that social care workers had twice the rate of death due to COVID-19 compared to the general population (ONS 2020).
Prior to the pandemic, The Royal College of Psychiatrists and the British Geriatrics Society have highlighted the prevalence of depression in care homes (British Geriatrics Society and the Royal College of Psychiatrists 2018. Collaborative approaches to treatment Depression among older people living in care homes). Although many people live well within care homes, it is estimated that 60% of those living in residential care have poor mental health (Age Concern and the Mental Health Foundation (2006). Promoting mental health and well-being in later life: A first report from the UK Inquiry into Mental Health and Well-Being in Later Life) and 40% suffer from depression (The Royal College of General Practitioners, 2011). According to the Department of Health, depression in care homes is particularly under-diagnosed and it has been estimated that the prevalence of depression among care home residents could be as high as 44% (Teresi J et al, 2001).
Depression has been reported to impact on the well-being of care home residents (Khader, F, 2011) and is associated with loneliness (van Beek, Frijters, Wagner et al, 2011) failure to thrive (Kumeliauskas, L et al 2013) and suicidality (Kjølseth, Ekeberg, 2012; Cuijpers, van Straten and Smit, 2006).
The prevalence of anti-depressant prescribing in care homes has been reported to be nearly four times greater than for older people living in the community (Harris, Carey, Shah, Dewilde and Cook, 2012). However, antidepressants have been found to be ineffective for people with dementia (Dudas R, et al 2018). Approximately two-thirds of care home residents have some form of dementia, therefore there is a need to find alternative interventions to support care home residents who are experiencing depression.
Additionally, a recent report has highlighted the impact care work has on the mental health of care teams and the potential value of providing time and space for care teams to speak and reflect on the impact of the work they do (Scottish Care, 2017). Care teams sometimes face long working hours, varied quality training programmes, poor pay, and demanding emotional requirements such as supporting people at the end of their lives. The UK Parliament’s Communities and Local Government Committee’s Social Care Report in 2017 found that on top of the physical and emotional demands of the job, almost three quarters of care staff are paid below the national minimum wage, with 49% employed on zero-hours contracts (compared to 3% of the workforce nationally).
Health and social care staff face a multitude of acute mental stressors due to their work and these have been greatly magnified during the current crisis. Evidence from previous pandemics suggests that health and social care workers have an increased risk of adverse mental health outcomes, including post-traumatic stress disorder and depression. Half of 1,000 health care workers surveyed across the UK by IPPR/YouGov in April reported that their mental health had deteriorated since the start of the COVID-19 pandemic. The youngest workers (18–34 years) were hardest hit, with 71% reporting a worsening in their mental health.
It is vital that, as the pandemic continues to be most acutely felt in care homes, that efforts to protect health and wellbeing include a thorough focus on the mental, as well as physical, health of residents and staff.
To support this aim, we would urge the Government to:
- Fund research that uncovers the hidden and devastating impact of COVID-19 on care home residents and staff and how evidence-based non-pharmacological interventions, such as counselling and psychotherapy, can improve the mental health and well-being of both.
4) Strengthen the UK’s economic recovery from COVID-19 by supporting employers, employees and vulnerable groups
The COVID-19 outbreak has resulted in one of the largest ever shocks to the UK economy and public finances. The UK economy in May 2020 was approximately a quarter smaller than in February 2020 and the Office for Budget Responsibility (OBR) assesses that the country is on track to record the largest annual fall in GDP in 300 years.
The core objective of this Spending Review is to ‘Build Back Better’, maximising health, economic and social outcomes. Investment in workforce mental health needs to be central to this objective.
Latest data for COVID-19 measures announced since February 2020 and on or before 31 July 2021 show a total cost estimate of £370 billion for measures for which government departments are responsible (where data are available).
We already know that COVID-19 is set to leave a broad and lasting legacy on our mental health and well-being, with data from the ONS (2021) showing that the prevalence of mental health problems, including depression and anxiety have increased alongside services facing increased demand. This is set against a context of staffing shortages across the NHS and social care that could well impede the system’s recovery from COVID-19.
Mental health related absence remains the most common cause of long-term sickness absence in UK workplaces. Survey data from the Chartered Institute of Personnel and Development (CIPD) and Simply Health (2021) indicates a significant increase in the number of reported instances of mental ill health this year, in both large (more than 250 employees) and small organisations (less than 250 employees). Overall, nearly four-fifths (79%) of respondents to the CIPD’s latest survey reported some stress-related absence in their organisation over the last year, although this rises to 91% of organisations with more than 250 employees.
Pre-COVID estimates from Deloitte UK (2020) put the cost to employers of poor mental health among employees at £42bn – £45bn each year; made up of absence costs of around £7bn, presenteeism costs between £27bn and £29bn and turnover costs of around £9bn.
By investing in appropriate interventions, including workplace counselling, employers can significantly reduce the costs of disruption to their business and the wider economy. Research has consistently shown the benefit of offering counselling to employees, with increased productivity, morale and resilience reported by many employers.
Research has shown that workplace counselling can halve sickness absence in organisations (McCleod, 2010) and those that have accessible services, provided as part of an EAP programme or otherwise, return to work sooner, are more resilient, productive and less likely to become long-term sick.
Earlier this year the Chancellor announced changes to the way welfare counselling provided by employers is taxed, to extend the scope of non-taxable counselling services to include related medical treatment when provided to an employee as part of an employer’s welfare counselling services.
We welcomed this move and urge the Government to go further in supporting both the physical and mental health of UK workers, such that they can play a vital role in strengthening the UK’s ongoing economic recovery from COVID-19.
To support this aim we would urge the Government to:
- Provide a dedicated package of funding for Local Enterprise Partnership’s to support firms facing closure and redundancies, including financial support to access occupational and mental health services, to reduce the negative impacts of unemployment on mental health and support transition into new careers
- Provide a dedicated Mental Health Grant programme for SMEs, for investment in mental health interventions, including non-clinical support and workplace counselling – to boost job retention, build resilience and support SME growth.
5) Increase in the NHS Funding Settlement to ensure the NHS Long Term Plan can be implemented in light of COVID-19
The NHS Long Term Plan sets out a range of ambitious targets for improving health services over the lifetime of the plan and this has been backed by a commitment to increase NHS revenue by £34bn by 2023/24.
Mental health has been prioritised as an area for particular attention within the Long Term Plan and services are due to receive an increase in their budgets of £2.3bn a year by 2023/24.
Prior to the pandemic both the King’s Fund and Health Foundation had written extensively about how the funding settlement outlined for the NHS to deliver the Long Term Plan was insufficient to both maintain quality in service provision and meet increases in demand for clinical services.
Reports from the Health Foundation (Health Foundation, 2019) found that the budget settlement for the NHS would equate to an increase of around 3.3% a year over the five years, which both fell short of the 3.7% historic average for the NHS and the forecasted 4.1% annual increase required to maintain quality alongside increasing demand for services.
As a result of the COVID-19 pandemic and subsequent periods of lockdown and societal upheaval there have been many concerns expressed about how these events will have a longer-term impact on the public’s mental health. Reports from the Office for National Statistics have highlighted the impact of lockdowns on the prevalence of depression and anxiety amongst many groups in society and this is backed up by many mental health services, who report already seeing an increase in demand for their services (ONS, 2020)
It is a fair prediction that alongside pre-COVID increases in demand for mental health services there will continue to be a COVID-19 related increase in demand for the foreseeable future.
To support this aim, we would urge the Government to:
- Provide an increase in the funding settlement for the NHS to ensure that the system can both cope with a previously unforeseen increase in demand for services as well as continue to deliver the ambitions within the Long Term Plan. Without this the principles of increasing access to quality mental health services could be lost and inequalities facing people with mental health problems continued.
6) Enhance the role of counselling and psychotherapy within the NHS workforce
As the leading professional body for counselling and psychotherapy in the UK we know that the skills of counsellors and psychotherapists are frequently undervalued by the NHS and service commissioners and that they are frequently an overlooked and underused in the workforce.
Our membership of over 59,000 practitioners continually report that they have capacity to take on additional work, and we know that their skills and expertise as psychological professionals makes them a crucial solution in meeting the mental health needs of the country. Needs which are already increasing further as a consequence of the current pandemic.
Data is already showing an increase in demand for mental health services as a result of COVID-19 and at a time where workforce expansion is often given as a leading barrier to NHS mental health services being able expand quickly enough to meet the demands for help from the public. Failing to fully capitalise on the skills of a highly trained workforce only contributes to this problem.
To support this aim, we would urge the Government to:
- Fund a recruitment campaign for counsellors and psychotherapists to work in the NHS – capitalising on their vast untapped potential and bringing them into the NHS workforce so the public can benefit from their skills and expertise.
- Commitment to tackling the barriers faced by counsellors and psychotherapists in taking up roles in the NHS.
- To provide a psychological support service for NHS staff and other key workers, and to look to the counselling and psychotherapy workforce as a way of quickly bringing additional capacity and skills into the mental health workforce to meet this need.
7) Investing in accessible and funded therapeutic coaching in NHS Health and Social Care settings
Therapeutic coaching is a critical intervention which helps people gain greater resilience and capability to manage change through turbulent times, and speaks to the central priority of this Spending Review, to ‘Build Back Better’ from the pandemic. It is a vital intervention to support people to navigate a path through the challenges ahead through a structured and tailored framework which enables them to set goals, develop new ways of working and support their future growth (Mumby C, COVID-19: A coaching response, May 2020).
NHS health and care staff who supported the nation throughout COVID-19 face continued pressure as they work hard to tackle the aftermath of the pandemic. The Covida Project, a digital tool created by Roehampton University to assess the psychological impact of the COVID-19 pandemic on frontline workers including NHS staff, highlighted that many healthcare workers are facing exhaustion and burn-out and many are still traumatised from their experiences of working during the pandemic. A study from the Covida Project in May 2020 found an unprecedented quadrupling of the number of NHS staff with high levels of anxiety, depression and post-traumatic stress disorder (PTSD) compared to before COVID-19 and almost a third of healthcare workers reported moderate to severe levels of anxiety and depression. This ground-breaking study, led by Dr James Gilleen at the University of Roehampton and published in the British Journal of Psychiatry Open, surveyed 2,773 workers across all levels of the NHS from 52 UK NHS Trusts, shortly after the first peak of the pandemic in April and May 2020. These findings are mirrored by recent research by NHS Charities (April 2021): “Just over half the NHS staff surveyed reported that their mental health has declined since the start of the pandemic, with over two-thirds of these (67%) reporting anxiety and a third (35%) reporting depression”.
Dr James Gilleen of the Covida Project team has recently highlighted the ongoing risks to the mental health of NHS staff: “As the UK continues to see COVID-19 infection numbers rise at a similarly alarming rate as those seen during the country’s second wave, it’s combined with a renewed strain on the NHS and its staff. Together these are considerable psychological burdens and create a perfect storm for the mental health and well-being of NHS staff. Despite this and similar findings from other studies, still not enough is being done to protect NHS staff mental health and wellbeing and we fear it will continue to suffer in the months to come. With this comes the real risk that large numbers of staff will burn out or even quit the NHS.”
Recent research from the King’s Fund (February, 2021) highlighted that those in health and care settings remain ‘at an increased risk of developing mental health problems, such as post-traumatic stress disorder, depression, anxiety and compassion fatigue’ underlining the importance to recovery through access to psychological support.
Coaching through Covid (CfC), a non-profit coaching organisation has provided pro-bono support to over 500 NHS staff across 69 Trusts, delivering over 1,300 sessions. CfC’s analysis found that NHS frontline workers were reporting anxiety, burnout, staff in distress, low confidence with decision making, lack of time for self-care and setting boundaries as the biggest challenges they are facing (Coaching through Covid, words and experiences of frontline health workers in the NHS and in social care, May 2021).
We would like Government to use this spending review to invest in the wellbeing of all NHS and Social Care Staff, through a programme of free to access psychologically-informed coaching delivered by counsellors and psychotherapists, extending the reach of existing volunteer provision to all staff. This would provide a compassionate skilled listening ear, a safe space in which to offload and make sense, building resilience and helping clients to navigate and lead through uncertainty and turbulence (McKinsey, The path to the next normal Leading with resolve through the coronavirus pandemic, May 2020).
The Scottish Government has invested in a similar programme of digital coaching as part of an £8 million package this financial year to support the mental health and wellbeing of the health and social care workforce in Scotland (Scottish Government, A Programme for Government, August 2021). This free service provides a safe space to explore how to lead and support others during these challenging times. We believe a similar service should be made available to our health and care workforce in England.
This would play a positive role in helping the NHS to achieve its commitments in the NHS People Plan. In particular, around looking after NHS staff, developing new ways of working and delivering care, growing for the future and supporting our NHS people for the long term. Ultimately contributing to making the NHS the best place to work.
The following testimony from a Senior NHS Head of Children’s Services in London highlights the extensive benefits of the therapeutic coaching support brings to healthcare professionals working on the frontline.
“As a senior lead in the NHS the pandemic required us all to work in a totally different way. Redeployment of staff, realigning of services and working in a virtual world. Susie provided a place for me to break down the barriers I had created and then use the materials as building blocks which are now enabling me to a stronger and more resilient person. I set out looking for support on focusing on priorities, I achieved my objectives and much more.”
According to BACP’s latest Workforce Survey (September 2021), 2.5% of our 57,000 members indicated that they undertook coaching as part of their practice, highlighting a significant workforce to support wider roll out of this intervention across England if funding was in place.
To support this aim we would urge the Government to:
- Invest in a programme of funded and accessible therapeutic coaching provided by qualified counsellors and psychotherapists to help the NHS and Social Care workforce cope with the ongoing mental health challenges they are facing, enabling self-care and promoting wellbeing.
8) Invest in addressing longstanding mental health inequalities faced by BAME communities by investing in a national programme of community level, accessible and appropriately culturally sensitive therapy.
According to Public Health England (PHE) and the Office for Budget Responsibility (OBR), the Covid-19 pandemic has disproportionately affected people from BAME[2] communities, who have had consistently higher rates of infection and death than the non-BAME population.
Analysis by the Office of National Statistics (ONS) found that Black people in England and Wales were more than four times as likely to die as White people of the same age to die from COVID-19. The ONS adjusted its figures to filter out the effect of the region where people lived, deprivation, household composition, socioeconomic status, education, and health and disability. Once these factors were adjusted for, there were still disproportionate deaths among Black and Asian people.
The pandemic, therefore, has provided a unique opportunity to address the health inequalities and disproportionate impact of the pandemic on the mental health and wellbeing of BAME communities.
The disproportionate impact of COVID-19 on the mental health of BAME people is also likely to worsen disparities that already exist in the way BAME individuals experience mental health care. People from BAME groups are less likely to seek help for their mental health; this may be due to cultural stigmas associated with help-seeking; BAME people feeling that clinicians have a poor understanding of different cultural needs, and even expecting or experiencing racism within services.
Moreover, there is evidence that BAME people are less likely to be offered suitable therapies, and Black persons in particular are more likely to be involuntarily hospitalised or over-medicated in UK mental health services. If a BAME mental health crisis were to occur due to COVID-19, BAME people may not seek support from services which are currently ill-equipped to respond compassionately or appropriately (COVID Trauma Response Working Group).
Recent data from the IAPT programme (Baker, 2018) suggest that, compared to people from white backgrounds, people from most black and ethnic minority communities are less likely to; use IAPT services, to complete treatment, to reliably improve and achieve full recovery.
The issue of accessibility of appropriate mental health support is longstanding. A 2002 study, ‘Breaking the Cycles of Fear’ (Sainsbury Centre for Mental Health, 2002), concluded that Black people ‘are put off from using services because of an understandable and realistic fear of heavy-handed treatment as well as the fear that our mental health status will lead to stigma and discrimination from all communities’. As a result, Black people are deterred from accessing support where it is available, and are more likely to reach a crisis stage, which results in hospital admission and traumatising responses from services and/or the police.
In its 2019 report Racial disparities in Mental Health, the Race Equality Foundation calls upon policy makers and commissioners to provide better access to talking therapies according to local need, and engagement with Black and Minority Ethnic communities to ensure the therapies are culturally appropriate and geographically accessible. The report encourages practitioners in all disciplines to increase understanding of cultural and faith beliefs of Black and minority ethnic communities and how this impacts on beliefs and behaviours around mental health. The report also recognises the importance of the role of the voluntary, community and social enterprise sectors in supporting people from BAME communities, filling the gap where statutory service is missing or inadequate to meet needs.
To support this aim, we would urge the Government to:
- Provide real and sustained investment in timely, effective, culturally appropriate mental health services, tailored to counteract the impact of trauma and multiple disadvantages still pervasive in our society. These should be delivered alongside sustained action to address diversity within the mental health workforce.
- Offer clients full and informed choice when accessing psychological therapies. This should include choice around therapists (for example based on those characteristics protected in the Equalities Act 2010 (HM Gov, 2010), as well as therapy type, appointment times and location of intervention.
- Commission local and focal projects that allow access to therapy for diverse and/or disadvantaged communities by piloting and evaluating an ‘in-reach’ project delivered in partnership with a diverse community organisation: to test strategies and approaches to increasing the accessibility and acceptability of counselling to people in marginalised communities who have found barriers to engaging mainstream services.
[1] These figures are based on:
- 3,470,000 kids in secondary school in England (11 – 18)
- 683,333 (estimated) number of kids in year 6 – based on Besa statistics (https://www.besa.org.uk/key-uk-education-statistics/)
- 707,000 number young people aged 16-18
- Prevalence rate of 1 in 6 young people with a mental health problem = 16.67% (https://www.centreformentalhealth.org.uk/sites/default/files/2021-02/CYP%20mental%20health%20fact%20sheet%202021.pdf)
- 67% of 3,470,000 secondary school pupils aged 11-18 is 578,449
- Would cost between £98,914,779 to 134,778,617
- 67% of 707,000 college pupils (16-18) is 117,857 – (Richard AoC)
- Would cost between £20,153,547 and £27,460,681
- 67% of 683,333 year 6 pupils is 113,912 (aged 10-11)
- Would cost between £19,478,952 and £26,541,496
- Total estimated cost - £138,547,278 and £188,780,794
- Total number of children and young people worked with – 810,218
- Total number of counsellors FTE – 5,064
- Based on avg 5 sessions per kid / max of 20 kids a week / 40 working weeks a school year = 160 kids per academic year per counsellor
- 810,218 (1 in 6 prevalence) divided by 160 kids per year/ per counsellor
™Matt Smith-Lilley®
[2] BACP recognises the limitations and problems of using catchall umbrella terms such as ‘Black, Asian and Minority Ethic (BAME)’. We are always open to being challenged and are committed to doing better when it comes to understanding and addressing matters of discrimination and privilege. For the purposes of presenting the findings of this research we have included respondents from different ethnic groups which fall under the BAME umbrella. However we recognise that there are distinct and unique identities and challenges facing different communities referred to as ‘BAME’, which can be obscured in research that aggregates non-White groups together as ‘BAME groups’.
