The British Association for Counselling and Psychotherapy (BACP) is the UK’s largest membership body for counselling and psychotherapy, with over 63,000 practitioner members working with people across a range of settings. BACP is committed to improving equality, diversity, and inclusion (EDI) by creating ‘a profession for the future’, addressing systemic barriers within the profession to improve access to psychological therapies for all who need them.
We’re pleased to be able to respond to the Inquiry on progress in improving mental health services, in particular we would like to draw the Committee’s attention to the following points:
The Mental Health Workforce
Growing the mental health workforce has remained one of the key barriers to achieving the aims of expanding access to mental health services since before the publication of the Five Year Forward View for Mental Health. It remains self-evident that without bringing more people into the mental health workforce, ambitions to significantly increase the numbers of people able to access services in a timely manner remains impossible to achieve.
We understand the impact of the training time lag on developing a new workforce from recruitment, through training to deployment, and undoubtedly this has contributed to consistently missed targets in workforce expansion.
However, despite this, policy makers have consistently missed an opportunity to expand the workforce more swiftly. The focus for workforce expansion has almost exclusively been on training new practitioners and there has been a chronic dismissal of the opportunities already trained practitioners, working outside the NHS and who are facing barriers to entering the workforce, could represent.
Our members, for example, represent a vast pool of untapped talent. Highly skilled and experienced counsellors and psychotherapists who are far too frequently excluded from moving into the NHS workforce and who, when they are able to find roles in the NHS, find career progression limited. They also often find themselves being paid less than other practitioners working in the same services, working with the same patients, but who deliver a different psychological therapy.
We would once again call on all stakeholders to find a way to bring more counsellors and psychotherapists into the NHS workforce. Not only are their skills and expertise a valuable asset that is being overlooked, they are also already trained and could begin work quickly – overcoming the lag from recruitment to deployment when training brand new staff. This would also meet the aims of reducing mental health inequalities (one of the four key purposes of ICS’s. Mental health inequalities is an area in which the impacts of existing initiatives are “not yet clear” (National Audit Office, 2023), and would therefore benefit from an expansion of the mental health workforce to ensure early intervention.
Children and Young People
Counsellors and psychotherapists could also take on additional work with children and young people and help reduce waiting lists across the various integrated care systems as demonstrated by a recently launched pilot via the Norfolk and Waveney Hospital Trust. A collaborative of counselling practitioners, all of whom are members of professional bodies and specialise in children and young people talking therapy interventions, are currently working with the YMCA (as lead agency) and commissioned via the Trust with referrals made via the local single point of access route to offer up to ten counselling sessions for under 18’s. All outcome measures will contribute to the NHS dataset
Our current workforce survey shows that approximately 19,000 counsellors have undertaken specific training for working therapeutically with children and young people. Of those trained to work safely, effectively and ethically with young people, over half (55.5%) have indicated that they can take on more paid client work and, on average, have capacity to take on an extra 5 clients per week. Extrapolating these figures suggests that BACP members alone are trained and available to work therapeutically with over 51,000 additional young people per week.
With the above statistics in mind, a counselling and psychotherapy workforce could compliment those areas where established Mental Health Support Teams are already in place, as highlighted in Barnardo’s recent report ‘’It’s Hard to Talk’ (2022) where expanding provision to include a referral route to counselling was a key recommendation. This would go some way to establish a more comprehensive referral pathway from lower level MHST intervention work but where a referral to CAMHS would not meet the threshold or not be appropriate. We would recommend investment in a pilot study and evaluation inclusive of referral pathway routes from educational mental health practitioners to counselling and psychotherapy interventions with a commitment to fund provision dependant on the results of any independent evaluation.
Successive Government policy has rightly prioritised increasing access to mental health services for more and more people. However, as we’ve already touched upon, without a corresponding increase in the mental health workforce, making more people aware of the availability of services is simply a recipe for increasing waiting times and increasing dissatisfaction amongst people waiting for services.
Integrated Care Boards
The evolving ICS structure and the ICSs themselves also have a critical role to play in improving people’s mental health, improving the services they rely on, reducing health inequalities and improving access to mental health services for marginalised groups in need.
ICSs should be committed to parity of esteem between physical and mental health services and funding. Making improvements to primary care mental health services should be a priority for ICSs. Not only should they look to maximise the impact that the existing NHS Talking Therapies services (formerly known as IAPT) can have for their local populations, but they should also look to augment this with additional primary care mental health services and with providers from the VCSE sector.
This could expand the range of effective mental health services available and be more reflective of the needs of their local populations. ICSs should develop a fully funded post-Covid mental health recovery plan for their area supported by a robust workforce development strategy which draws on the experience of diverse VCSE sector mental health providers.
Choice of treatment
Alongside ambitions to increase access to services, we also need to discuss the importance of choice in the ultimate overall effectiveness of psychological therapy services. There is strong research evidence demonstrating the link between eventual clinical outcomes when service users have an informed and meaningful choice of both their treatment and care pathway, but also where they receive their care, how they receive it and who delivers it.
With psychological therapies for example, it isn’t correct to assume that there is one single best intervention for any given condition. Clinical research has frequently demonstrated equal effectiveness of different psychological therapies for any given condition, however what has been shown to make a difference to eventual outcomes and can ultimately be what is more effective for that individual is the service user’s own preference for which intervention they receive.
We would therefore urge the Government to formalise this requirement for choice throughout their mental health policy ambitions. Recognising that alongside increasing access to services generally, there needs to be a meaningful choice of interventions across all services, across the whole country, for all people who access that service.
April 2023