Why Don’t We Talk About Therapy Privilege?

Content warning: This article contains mentions of suicide that may be triggering for some readers.

With help from discourse on social media, as well as a broader awareness of mental illness, the stigma around therapy has been steadily decreasing in recent years, which can only be a good thing. Instagram is full of people either offering mental health guidance or posting about their own therapy sessions, often to tens of thousands of followers, opening up a conversation that will undoubtedly be beneficial to people whose barrier to seeking a therapist is shame.

But what’s often unsaid is that the cost of therapy can be prohibitive for those truly in need of it - that being willing to seek help is just the first hurdle that many people need to overcome.

There is absolutely no question in my mind as to whether therapists are worth the money; a good therapist is worth their weight in gold. They are, quite often, literal life-savers. The question, really, is why in a country where healthcare is free at the point of access, people are left feeling that their only option is to pay for private therapy when their illness is not as tangible or easily diagnosed as tonsillitis or a broken arm. Talking therapy is available on the NHS, but waiting lists are so long even for an assessment appointment that people’s mental health is deteriorating while they wait for treatment.

The catch-22 is that those with mental illness, dealing with trauma or upheaval in their lives are also more likely to have debt or financial difficulties, and might be less likely to be able to afford therapy. Certain mental illnesses such as bipolar, or neurodiversities like ADHD, can exacerbate financial problems in the form of impulsive, compulsive and manic spending.

There is a chicken and egg situation with mental illness and debt that is perfectly highlighted by statistics from The Money and Mental Health Policy Institute, which indicate that 46% of people with problem debt also have a mental health problem, and 18% of people with a mental health condition also have problem debt. It’s easy to see how this cycle can become a spiral, and intervention is desperately needed.

Emma*, a teacher from London, says that she was left having to accrue more debt to fund therapy and treatment for her ADHD after multiple suicide attempts:

'I was suicidal and self-harming, and all the help that I could get from the NHS was six sessions with a counsellor who I was not really able to relate to. After that, I was told that I wasn’t entitled to NHS mental health support because they suspected that I had ADHD.'

The waiting list for that support? Two years. Despite more suicide attempts, Emma was not offered any further help in the interim, and her condition got worse until she paid for private treatment.

'I ended up having to pay over £1,000 for private ADHD treatment, and have been seeing a private therapist at a cost of £60 per week since December. It’s been life-changing, but it’s impossible to afford on a teacher’s salary in London. I’ve spent an inheritance and accrued several thousands of pounds in debt to treat my own mental health.'

I myself am in therapy now, for the first time in my life. When you write any kind of memoir, as I did in 2019, it unearths things, and I had left mine in a large pile to deal with ‘later’. But I waited for too long, because I didn’t think I could afford it, and ended up experiencing a bout of depression that left me barely functioning, on antidepressants and wondering how I would ever feel ok again. The time in my life when I most needed therapy - when it might have saved me a lot of stress and also countless actual pounds - was when it felt least affordable. My debt and the underlying reasons were both the thing I needed therapy for, and the thing that was stopping me from being able to access it.

A further, overlooked issue is that Black and minority ethnicity people - who often need a therapist who understands trauma caused by racism, discrimination and the resulting economic hardship - usually have to seek this privately at a cost. Black Minds Matter, a charity that sources and funds therapy for Black people overcoming trauma, aims to ‘connect Black individuals and families with free mental health services, by professions Black therapists, to support their mental health’. A wonderful service, but one that highlights a huge flaw in the accessibility of fair and equal resources on the NHS.

'There are many inequalities in both access to treatment and the type of treatment Black people receive within mental health care, which have led to a distrust in public health services amongst Black people in the UK,' says a spokesperson from the charity. 'This means that it's incredibly important that we can offer a safe space for our community to receive professional mental health support and resources relevant to their own experiences, which are also accessible to them.'

While it’s clear that more funding and easier access is needed for prescribed talking therapy, there are other ways to access it if you’re struggling. Mental health advocate and writer Jo Love says that here are a few ways to make therapy more affordable:

'As a first port of call, it is always worth seeing if your GP can refer you, or if you can self-refer for talking therapy, as waiting lists do vary by area,' she says. 'But other options are to reach out to charities that offer free counselling or telephone listening services, seeing if your university or workplace offers a free service or asking a private therapist if they offer pro bono sessions or a sliding scale on their fees - so many do, and there’s no shame in asking.'

Sarah’s* husband was able to access counselling through a charity at a heavily reduced rate, which made things a lot easier for them:

'He saw a brilliant therapist for five years at £10 per session, which was the lowest rate on a sliding scale,' she says, 'We never would have been able to afford paying in full, as he was working part-time on low pay for childcare reasons.'

There is a cyclical nature to this problem that make it very hard to solve - the shame and stigma around financial difficulty and mental health mirror and feed into one another, and it might be difficult to reach out for free or subsidised services if you are experiencing a mental health problem that is exacerbated by money worries. But from the flood of messages I received when asking for experiences of this, from both people struggling and therapists wanting to help, I know at least two things - this is a widespread issue, and there is support out there, if you know where to look.

Helpful resources for free or subsidised therapy:

Mind

Black Minds Matter

Where To Talk

Black Minds Matter UK need long term support to ensure they can last another year .To help them do this, they're looking for monthly donors, who are willing to donate £5 per month as part of their fundraising campaign- the #BMMUK21K Donor challenge.

Click here to become a monthly donor and help BMMUK create a lasting change on Black mental health.

*Names changed