Mental Health Services · NHS

Treatment for Mental Health: Private vs. NHS?

Over the years I’ve had both private psychotherapy and NHS treatment for my mental health (including CAMHS, psychiatrist’s, a social worker, CPN’s, an occupational therapist and inpatient treatment). With that in mind, I thought I’d do a bit of a comparison between private therapy and NHS treatment for mental health.

Privately, I had a good experience, and while I’ve had some negative experiences on the NHS, I’ve also had really good treatment, especially under the ‘Recovery Team’. I don’t necessarily think one is better than the other- I think there are advantages and drawbacks to both avenues of treatment. Here’s a few things I’d say about each!

**DISCLAIMER: I have no experience of private health insurance, or any other aspects of private treatment, other than therapy, so can’t make a full comparison between the two. I also want to point out that I’ve been lucky- both in that I was able to attend therapy privately and that I’ve had a really good experience with the NHS. Mental health care in the NHS is still hugely hard to access due to chronic underfunding and remains very much a postcode lottery in lots of cases. The list of advantages of NHS treatment then is very much an idealist list, and based on my personal experiences.

Advantages of private treatment

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  1. More flexibility- I found my private therapist was far, far more flexible than NHS services have been. Particularly if they’re self employed, they can set their own hours. On a couple of occasions I was able to see my therapist after 5pm, he worked over lunchtime, I was able to make or cancel appointments last minute, he had more availability because he didn’t have the same number of meetings or amount of paperwork to do that NHS staff have, and if sessions went over time, it was no biggie
  2. You do the choosing- if you’re paying for private therapy, you have more of an opportunity to ‘choose’ who you work with. If you don’t click with someone, you’re more within your rights to find someone else to work with. While you’re entitled to ask for a second opinion or a new worker in NHS services, it’s not always possible for this to happen. Privately, you’ve a bit more leeway- don’t like someone, you don’t have to go back. If you don’t find a particular approach helpful, you can leave- something that might have you discharged from services altogether in the NHS. Due to limited NHS resources, people can quite often be told “it’s this therapy/worker, or nothing”
  3. Confidentiality- confidentiality applies to ALL therapeutic or care settings, but if you’re under an NHS team, things will be documented in your medical notes and passed on to people who need to know. In a crisis situation for example, your key worker might decide to involve your psychiatrist or crisis services, or a family member* (this has been the case for me, but some people have had the opposite experience). I found that because my therapist worked entirely separately from NHS services, crisis’ were dealt with between him and I only. I felt more able to be completly transparent and honest with him, knowing that he wouldn’t jump to conclusions or involve more people, when really, I just wanted to vocalise how I was feeling
  4. Less clinical- this will vary from place to place, but in my experience, private therapy was far less clinical- from how my therapist greeted me, to what he wore, the mug of coffee waiting for me each week, his lack of note taking, to the fact therapy was held in his converted garage with sofas, lamps instead of full lights in winter and a little fire. And while it will depend on what model a particular therapist follows, I found my private therapist was far less interested in diagnostic labels and the medication I was on than NHS services have been
  5. No time limits- the NHS therapy I had didn’t actually have a time limit, but a lotttt of NHS therapy offered does- X sessions of counselling, X sessions of CBT, 6 months/a year of DBT. At CAMHS, if I hadn’t made sufficient progress with one type of treatment or while under a particular ‘tier’ after a certain amount of time, I was moved on. Pre-bipolar diagnosis, my private therapist did speak to my psychiatrist at the time, and my therapist fed back that my psych was very much ‘deadline focused’ and was looking for an end point. In a private setting, while there can be ‘goals’ or ‘aims’ set, there’s no set in stone date to meet them- and that can give the patient more time to address all the things they need addressed
  6. No waiting lists- it wasn’t long between first being recommended my private therapist and beginning to see him for sessions- a couple of weeks really. I was on a DBT waiting list for a year and by the time I was taken off it, the course still hadn’t started. My ‘urgent’ CAMHS referral took a month or so, my transfer to adult services took several months, then a couple more between my initial appointment and subsequent allocation of a SW. After my bipolar diagnosis, it took three months plus a second admission to be allocated a CPN. And my experience of waiting lists has been nothing in comparison to those who wait far longer than a few months- and even years- to get anywhere near a psychiatrist or start seeing a specialist worker. All to often, people don’t even get a referral to specialist mental health services because of pressures on funding

Advantages of NHS treatment

  1. Cost free- this is the big one. Private healthcare is expensive. Depending on where you live, a session with a private therapist could cost £60. If you’re paying that every week over the course of several months or years, it’s a HUGE amount, and something that isn’t feasible for most people. If you needed specialnhsist therapy, a psychiatrist or a hospital admission it gets even more costly
  2. Accessibility- in theory, the NHS is accessible to everyone in the UK (in practise, some areas are better serviced than others, so ease of accessing that care varies from place to place). Private mental health care is not as ‘widespread’ or as easily accessed. Aside from the cost, some places just don’t have private services on offer- The Priory doesn’t operate in Northern Ireland, for example. My private therapist was 40 miles away, and if you look at it practically, private therapists aren’t going to be widely available in rural localities because there wouldn’t be enough of a demand for them- while NHS services are available to all people in all areas. The NHS can also offer a greater range of specialist outpatient services- accessing a privately trained therapist in a more ‘niche’ therapy (such as EMDR or DBT) would be both more difficult and more costly
  3. More communication between your ‘team’- while for the most part I liked that my therapist was completely separate to my NHS treatment, there were occasions where liaison between the two would have been beneficial. CMHT have regular ‘team meetings’ where everyone involved in your care discusses it. I’ve been finding it helpful that no matter who I have an appointment with, they know what’s been happening and they’ve been kept up to date. It gives more continuity of care and means I don’t have to sit and explain everything that’s happened to whoever I’m seeing the way I would’ve done when I was seeing my therapist alongside the CMHT. It also means things happen faster- if I see my CPN and she feels I need my meds changed or extra support, that can be arranged pretty quickly, something that couldn’t happen with my private therapist who had no input into that aspect of my care
  4. Access to other services- over the years I’ve had referrals made to quite a few different specialist services as a result of being under the CMHT. At one point I had specialist self harm input, I had a referral to the PD team for assessment, specialist psychotherapy, the recovery college, an OT, a pilot weight loss group, and the option of a CBT referral. And while being under NHS mental health services in no way means access to specialist treatment is a given or a possibility (we all know how stretched things are), in my (very lucky) experience the NHS has been able to offer me a whole lot of things beyond ‘just’ talking therapy that have helped my recovery. Things like the recovery college and group workshops or support groups offer psycho-education and peer support and are things that wouldn’t necessarily be available privately. Support workers, CPN’s, OT’s and social workers all have different roles and can provide different types of support to service users to help treat all aspects of a person’s mental health, but still under one ‘umbrella’ team

 

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