Revisiting community-based mental health services
BACP From the Board blogs

When I first qualified you would find a counsellor available at most GP practices. While the word wellbeing was not in regular use, this suggests that mental health was recognised by primary care practitioners as having an importance alongside the physical health of their patients. The number of sessions offered was limited but the counsellor's salary came out of the practice budget and so was offered at no cost to the client.

Over time contracts changed, healthcare budgets were reconfigured, and the increased complexity of commissioning led to some services being centralised. What had been locally based was replaced by a unified service centrally funded and centrally managed. Counsellors who had worked in their local GP practice for many years did not see a role in services which some felt had become increasingly manualised, where personal relationships seemed no longer to be a priority.

The provision of acute psychiatric care delivered on an inpatient basis is expensive and requires a level of organisation possibly best provided through centralised structures. The next tier of specialist mental health provision frequently involves multi-disciplinary teams working across health and social care with each having their own regulatory framework. In a way these reflect the structures that deliver physical health through acute, emergency and secondary care services. What's missing for me is the third tier that would correspond with primary and community care.

Post pandemic, that tier of community based mental health services that can quickly respond to need before it becomes acute has an ever more important role to play.

In my conversations with trainee counsellors about to qualify, few see their future within existing organisations. While the prospect of paid employment is appealing, working within a structured environment of conflicting pressures feels at odds with their core beliefs. There is a lot of talk about setting up on their own, even though for many it seems a daunting prospect, and our regular surveys show that the majority of our members continue to work in private practice.

Like so many of these members I work within my local community, and the clients I see share a commitment to improving their own mental health even if it means doing so at their own expense. Currently, there are thousands of us providing millions of therapy hours every year. Sadly, we know that there are many more people who would wish to get in touch but cannot afford to do so.

We operate within regulatory and ethical frameworks, managed by organisations such as BACP, and can evidence our commitment to best practice and further development through regular supervision and ongoing training.

I would suggest that the delivery model for this tier of community-based mental health services already exists. Perhaps all that's really needed is a different funding model.

GPs are independent contractors, paid under contract to deliver a range of specific services.

As the NHS in England undergoes another restructuring to create integrated care systems, maybe it's time for us to talk with local healthcare leaders about how the community based mental health services we already provide could be funded differently.

Best wishes, 

Michael