Who Gets What, Where? The Postcode Lottery of Free Counselling
Juliet Appleby, counsellor and counselling psychology trainee
Imagine that you and your two small children are living in one room in a bed and breakfast hotel in a town in North-East England. You’ve left your partner because of domestic abuse and fled 50 miles to an area you don’t know. You have no support and your children are finding the change difficult. You’re cooped up in a small room, it’s difficult to cook, you have no table and only one highchair for your baby. Your three-year-old sits on the floor or the bed to eat. You’re struggling to provide any kind of routine, and none of you are sleeping well. You’re feeling anxious, stressed, and distressed. You go to the GP who refers you for CBT, which you can’t attend because you have no childcare. Things get worse for you and your children but you have no-one to talk to about how bad you feel.
Imagine instead, that you’d gone to a neighbouring town that has a women’s centre that offers 20 sessions of free counselling. You can take your children to the centre where they’re looked after by a children’s worker while you have counselling. There’s space for your children to play, new toys, and a garden for them to explore. There are support workers, a food bank and a clothes store, and the chance to top up on nappies and other household items. Your 20 sessions of therapy come to an end, and as you don’t feel ready to stop, you’re offered a further 10 sessions. You keep the same therapist and continue without a gap in therapy. You and your children start to feel better. Your and their future has been shaped by your decision to move to this neighbouring town.
For many people across the UK, free counselling is largely dependent on postcode. I live in Manchester, and while some services are offered across all 10 boroughs of the metropolitan area, many are borough-specific. This includes the eight sessions of bereavement therapy only available from a national organisation in Trafford, or the 20 sessions of therapy offered by an older person’s charity to those who live in the City of Manchester only.
Access to counselling, if you were the woman who’d fled domestic abuse, would depend on both a service being available, and on your GP knowing about it. While some service lists have been compiled there is often a lack of information about what is available, with access dependent on GP knowledge and informal information sharing. The fear of being overwhelmed and ending up with an unmanageable waiting list may also make services reluctant to advertise, further reducing information about what is available.
Access may also depend on the level of need. The voluntary sector is often only able to provide free therapy because it uses unpaid trainee therapists. Services may have just one or two paid and qualified members of staff assessing clients and providing safeguarding cover. As a result, vulnerable clients are often screened out to reduce risk, with the effect that clients with more complex needs end up with limited access to therapy. If the woman above were at high risk of self-harm or had a diagnosis of serious mental ill health, she might be considered too high risk for the women’s service.
In addition to the right postcode and an ‘acceptable’ level of risk, clients may also find their access to free therapy limited because services in their area only cater for certain ages or experience: for example young people, or those who have been bereaved. Even when eligible, access may still be difficult: there may be no therapists who speak particular communities’ languages, sessions may only be available during working hours, public transport may limit access, or childcare may make it impossible to attend.
Many counsellors and counselling psychologists gain their training hours by providing free therapy with voluntary organisations. Many, like me, will feel troubled by the largely arbitrary access to therapy among their clients. There are, however, three concrete steps that we could take to widen access, whether we are therapists, service commissioners, or work for the third sector. The first is to ensure that up-to-date lists of local services are available online and that these are promoted widely. The second is to encourage voluntary organisations to offer more in-house supervision and safeguarding support from experienced therapists. This might allow clients with more complex needs to be considered for a service where they will be seen by a trainee. Third, there could be a greater provision of free nationwide online counselling. As this is cheaper to provide, savings could be put into training and supervision, developing trainee competence, and focusing on safe, high-quality counselling. Professional associations and regulatory bodies such as BACP and BPS could support this by accepting a greater percentage of online training hours. These actions could help increase more systematic access, including to those with more complex needs, regardless of postcode.
