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Mental health charities in England are struggling to cope with the number of sick patients referred to them by GPs, with under-qualified professionals increasingly tasked with treating the seriously ill.
Experts told the Guardian that some desperate GPs were “signposting” patients to services not always equipped to deal with them.
These are provided by unregulated charities, which employ practitioners who are not always transparent about their qualifications or level of competence.
Some charities reported struggling to cope with demand, with their staff, who do not need the specific qualifications required by the NHS, finding themselves tasked with helping the sickest patients.
“The issue is that people are desperate,” said Jaime Craig, who will be appointed chair of the Association of Clinical Psychologists in May. “There’s very limited access to services, and so people go to the GP and they say: ‘Well, I’ve had a flyer from this person who’s offering counselling, why don’t you try them?’
“To be fair to GPs, sometimes their local areas don’t have an awful lot to offer in terms of mental health support and they are struggling with the amount of people coming in for psychological or counselling support.
“But there’s a big problem because the patient can’t know whether what is being suggested on a leaflet or a website is OK unless someone does some vetting.”
The Guardian has previously revealed that a lack of regulation means that anyone can set up to practise as a psychotherapist, counsellor or psychologist with limited or no qualifications. They can continue to work even after misconduct cases, with the exception of a handful of professional titles which are protected.
“It’s really quite hard if you’re outside that world to know what a qualification means – whether someone has done a two-day introduction course in counselling, or intensive psychotherapy training that’s taken years and that someone has assessed them,” said Craig. “Without regulation it’s a minefield.”
Dr Jon Van Niekerk, chair of the general adult faculty at the Royal College of Psychiatrists, said: “It is crucial that patients are referred to services equipped to meet their specific needs, with care delivered by qualified and experienced practitioners. Charities and community organisations play a valuable role in supporting mental health, but they should complement, rather than replace, specialist care where it is required.”
Amercine Maneely became concerned when an NHS dietician recommended that her daughter, who is autistic and has avoidant/restrictive food intake disorder (ARFID), should self-refer to a local eating disorder charity, First Steps ED, which receives some NHS funding, for psychological support.
Once there, her daughter was offered “one-to-one support” delivered by a “specialist support officer”. Maneely, who is a former psychiatric nurse, was surprised to learn these support officers were not qualified in psychotherapy or counselling, and declined the offer.
She said: “Clients with ARFIDs can be quite complex and risky, both physically and mentally. It wasn’t [initially] made clear that these people providing one-to-one support are not properly clinically qualified. Later, alarm bells started ringing and I became concerned that continuing this path could cause more harm than good.”
Craig said that it is not unusual in the charitable sector for there to be a “strong emphasis on lived experience”, which is very valuable, but in some cases can result in “a blurring about where that type of support stops and when someone has a professional qualification and training to offer evidence-based work”.
He said: “Ideally, you’d have both: a trained person to deliver the evidence-based therapy, and a person with lived experience to help you feel less alone.”
Daniel Magson, the CEO of First Steps ED, said the charity conducted in-depth assessment before offering support. “Our one-to-one support, provided by our specialist support officers, is free and accessible to everyone within our catchment areas. We communicate clearly that our support officers are not psychotherapists, but have accredited training.
“This approach allows patients to receive support quickly where there may be waiting lists of up to 20 weeks within other services, costing on average £100 per session. The vast majority of our patients opt for this service rather than waiting, especially if psychotherapy is unaffordable for them.
“We appreciate that support is individual, and sometimes our pathways may not be the best fit. We take all feedback seriously and use it to continuously improve.”
The reliance on third-sector organisations by the NHS can also be a problem for charities themselves. A counselling charity in Blackpool, Counselling in the Community, has estimated that it would cost the NHS £3,750 weekly to cover the therapy it provides to patients referred by doctors who are unable to get them access to overburdened talking therapies.
Stuart Hutton-Brown, who runs the charity, said that about 50% of the patients his therapists saw each week were referred through NHS pathways. He has seen letters from local GPs recommending “a course of 10 sessions with Counselling in the Community”, which patients interpret as a formal NHS referral.
Although the charity assesses potential clients to establish whether its staff have the competence to support them, and pays therapists to undertake additional training where needed, there is no guarantee that all charities will, or that their therapists are trained to NHS standards.
Hutton-Brown has written to the all-party parliamentary group (APPG) on mental health to raise awareness of problems, with overstretched GPs signposting mental health charities, private providers and community organisations.
He wrote: “Despite the crucial role we play in alleviating pressure on already strained NHS services, we receive no direct funding or financial support. This disparity raises important questions about the outsourcing of health-related services.”
Chris Webb, the MP for Blackpool, an officer on the mental health APPG and a former trustee of Counselling in the Community, said this outsourcing reflected the fact that “mental health services are woefully inadequate for the mental health crisis we are facing”.
He added: “During austerity, the third sector has stepped in to plug the gaps that the Conservatives left wide open. Counselling in the Community is a prime example of a charitable organisation providing support that should be the responsibility of the state.”
