There has been a lot of discussion recently in newspapers, mental health magazines and on social media about the quality of NHS therapy versus private therapy. This has probably come about as a result of the recent junior doctor's strikes taking place and the continuous talk that the NHS is in financial trouble. Mind has also been conducting some research with their members recently about primary care and their experiences of mental health treatment and their GP.
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| If only all therapy rooms contained a cushion like this |
Ultimately, like everything, one's opinion of NHS therapy against private therapy will be down to individual experience, rather than the whole picture. There will be exceptional therapists working in the NHS who I'm sure will be as frustrated as the next person about for how many sessions they can see patients for, and so on. So yes, all I can go on is my experience of therapy, bearing in mind I've had both NHS and private therapy for chronic anxiety and I've also had many discussions with my GP about the subject. I will attempt to describe these experiences and subsequent "advice," if you can call it that, on the back of this.
1) My GP
I first visited by GP with (what I now know was) anxiety back in 1998 ish, when I was only 11 years old. I was accompanied by my parents. All I remember about it was crying profusely and being referred to an NHS counsellor, as they called them generically then. I can't comment on the quality of the appointment given it was about 17-18 years ago.
Now this particular GP has been practising at the same surgery in my town for goodness knows how many years, so when I went the second time, on my own probably in around 2006, he at least knew me and would have been able to see that I'd been referred to a counsellor many years ago. At this point, I was once again referred to an NHS therapist and prescribed beta-blockers. I didn't have the knowledge to argue against any of this ten years ago. Then, after my incident of hell that I described in my last blog, I went back to the same GP again - 2011 - but this time with more knowledge in my back pocket. I told him what I wanted to do, and only went to see him for two reasons; 1) so he knew what was going on for his records and 2) to discuss beta-blockers, which I went onto again having come off them a couple of years before.
So overall, there were three times that I went to my GP over the course of about 13 years; I'm sure in total it was more than three times, but three batches if you like. I know when I went in 2006 I had to go back a few weeks later and get a stronger dose of beta-blockers, for example.
Positives:
- I've seen the same GP for 20 years. This means that he knows me and my profile and is familiar with my background.
- His answer wasn't to automatically prescribe anti-depressants. I've heard of a few cases involving friends when they have been to see their GP about what is clearly an anxiety condition and being prescribed anti-depressants without any other options being laid out before them. Mind's latest members magazine says that "57 million anti-depressant prescriptions were written in 2014 - a 46% increase since 2012." This is hugely worrying for me. My view on anti-depressants is for a separate blog altogether, but to sum it up, they shouldn't be seen as the first or only option for people with anxiety.
- He is generally quite an approachable person and empathetic with what I was going through, taking it seriously.
Negatives:
- He had no real suggestion of what to do other than refer me to the NHS therapist and prescribe beta-blockers, making it sound like there were no other options.
- By his own admission he wasn't an expert in mental health conditions. You could argue this is a positive, to at least admit it. But it doesn't bode well. The third time I went to see him when I told him I'd referred myself privately, he asked me how I'd done that and said 'through the charity Anxiety UK.' Needless to say, he hadn't heard of Anxiety UK or what such charities were able to offer. He did, at least, make a note of it!
Overall, though, compared to many people, this was a relatively positive experience and he at least listened to my issues, took them seriously and did his best. Ultimately it's not his fault that he wasn't educated adequately about mental health back in the day, and has probably not had the time since to learn more about it given the pressure GPs are under to work all the hours God sends!
2) The NHS therapy
As the above describes, I was referred to an NHS therapist on two separate occasions; the first time in 1998 and the second time in 2006. The former, I can't remember much about for the same reasons. It was too long ago. I remember doing some exercises at home that he gave to me that was something along the lines of drawing negative and positive characters, with the idea of reducing the size of the negative character to banish negative thoughts. How effective it was is relatively unknown, although given I had a debilitating anxiety condition for 14 years subsequent to that probably speaks for itself.
The second time I was referred was nothing short of a shambles. I've mentioned this on this website before, but from referral to seeing the therapist took 13 months. Yes, 13. Mind's latest magazine states that "50% of people wait more than three months for talking therapies." Yeah, right. Three months would have been a delight. I remember receiving a call about nine months on, just before I was due to have the appointment, saying that it had been cancelled. Little did I know it would be another four months before it would be rearranged.
This was hopeless, given that a lot can change in a mental health condition in 13 months. Indeed it had; certain symptoms had changed quite significantly, albeit I was still suffering. Moreover, had I known what the quality of the experience had been like, I wouldn't have bothered attending the appointments in the first place, as the below describes.
Positives:
- He was based locally. That sounds like a minor point but as you'll see from the private therapy experience below, an important one.
- It was free of charge.
Negatives:
- I had to wait 13 months between referral and appointment.
- I was limited to about seven sessions.
- The therapist was not very empathetic or understanding. He was quite brash compared to what you'd expect and I didn't warm to him at all. Maybe 'tough love' was his thing - well, it didn't work for me. As such, I didn't find the therapy remotely helpful, and I can say with confidence that I was no better after the seven sessions I'd had.
I have some sympathy with the therapist. It's not his fault that I had to wait 13 months, or that I was limited to so few sessions. This is the endemic failing in the NHS mental health therapy system; it's creaking at the knees. Is it any wonder that GPs prescribe anti-depressants so quickly and don't talk about other options enough, given that they know that local therapists are under so much pressure as it is? Sadly, I suffered a combination of a failing therapy system, which in 2016 looks like it's only getting worse, and a poor quality therapist at that. Overall, this experience was therefore a total waste of time.
3) Private therapy via self-referral
In about 2010, I referred myself to a private therapist. I still had chronic anxiety, although at the time I didn't realise I was as bad as I was. The main reason I went to the private therapist was to 'resolve' my eating out problems, which were causing me great distress and preventing me from socialising properly. What I know now, of course, is that eating out problems are just an output of a wider, more chronic anxiety condition overall. At this time, its main way of manifesting itself was eating out. However, I didn't find this out through the private therapy.
In this instance, I didn't speak to my GP first. I just went straight to the therapist and, having read up about Cognitive Behavioural Therapy (CBT) by this point, my only criteria was to see a CBT specialist and that it was local. After some web searching, job done... or so I thought.
Positives:
- She was based locally.
- I was seen less than two weeks after making first contact. Slightly different to 13 months...
- Compared to the private therapist, she was more approachable as a person and generally had a kinder nature about her.
Negatives:
- I was limited to eight sessions (although that was probably a good thing - see below)!
- I had to pay; I think it was £35 a session, but I could be wrong. £35 x 8 = £280 in total (yes I had to use a calculator to do this).
- I didn't really appreciate this at the time, but the therapy I was getting wasn't actually CBT. I knew at this point that CBT was what I needed, but having never experienced it before, I didn't know what to expect. What I got was counselling. The sessions were dominated by trying to work out why I was experiencing what I was experiencing, rather than trying to deal with the problem first. When my Grandad died and how, surprisingly, had nothing to do with why I couldn't go to the local Wetherspoons and eat scampi and chips. The counsellor was so desperate by the last session that we just spent an hour listening to sounds of the sea.
So sadly, the negatives by far outweigh the positives again. The key lesson here is, just because you're going privately, don't assume you won't meet the same restrictions as in NHS therapy and don't assume the quality is automatically going to be better.
4) Private therapy via charity
When I had my meltdown in 2011, I knew I needed help, but of course I'd already experienced poor NHS and private therapy and didn't quite know what I was going to do. Thankfully, I stumbled across Anxiety UK and read what they could offer. Admittedly, I thought it was too good to be true. Anyway, I chose to go down this route; I went to my GP as described above just to let him know the score and to go back onto beta-blockers and then wait in anticipation (an anxiety-filled mess of anticipation, granted) for my first appointment.
Positives:
- I was seen within two weeks of referral, this despite an admin error which occurred at the start!
- I had access to an unlimited number of sessions. I had fifty in total, which gives you an idea of the sort of help I needed.
- The therapist was excellent. For a start, I was getting CBT not counselling. Yes we talked about my past (I generalise), but probably not until the 20th session or something like that. I was given the tools to help with my anxiety condition. I was given the power back in my own hands. And I was given a shed load of homework to do, which is a good thing of course! (I will emphasise at this point that as a patient you have to put in to therapy what you want out of it, as long as you get the opportunity to do so).
- She was also excellent because she made you feel like her friend. Between sessions, she must have seen scores of other people, and yet remembered everything we'd spoken about the week before. And, because of the 50 sessions, she got to know me as a person. She was also warm and welcoming on each occasion. What was clear was that she enjoyed her job.
- Webcam therapy was offered (see below).
Negatives:
- Anxiety UK didn't have a therapist based in my town, which at the time was hopeless because I could barely leave the house, let alone travel any distance. The person I saw was based in Glasgow, which is about 260 miles away from me... because they were able to offer webcam therapy. This didn't really matter in the end, as the therapy I obtained was almost as good as the therapy I would have got if it had been face to face.
- It cost £20 a session, x 50 sessions = £1,000. I didn't need a calculator for this one. I was also lucky; the pricing structure was based on household income; at the time I was living with my parents who were both retired so I was able to obtain the cheapest bracket. It was also £5 a session cheaper via webcam. It was £35 for the next band up, which would have been £1,750, so a significant difference. That said, it was worth £10,750 if I'm being honest, given the effect it had on me, as many of these blogs have described.
What's the key message here though? The lady I saw privately practised with a few patients at a time - the rest of the time, she was an NHS therapist in Scotland. This proves that excellent NHS therapists do exist, although no doubt she may have been constrained to the same restrictions all NHS therapists suffer from. In fact I recall her talking to me about this one time, saying that she dabbles in private therapy just so she can offer a less restrictive service at least to some patients.
To say my therapy experiences have been mixed would be an understatement. Based on my experiences, whether NHS therapy is any poorer or not in terms of quality is debatable, although in terms of logistics, such as waiting times, it is certainly much worse. The most frustrating thing is that I had to pay £1,000 to find good quality therapy. WHETHER YOU CAN GAIN ACCESS TO GOOD QUALITY THERAPY SHOULD NOT BE BASED ON HOW MUCH MONEY YOU ARE ABLE TO SPEND, and this is the main problem with mental health therapy in this country, in my opinion.
Ultimately, though, I strongly believe it is down to the individual therapist that you happen to be paired with, whether it be NHS or private. My overarching advice would be, therefore, not to give up if your first experience of therapy is poor; keep striving for better until you get what you need. If you can't afford to pay £1,000 of course, then you might be restricted. See capital-letter bold font rant above.
Best wishes
Al
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