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I 'Ghosted' My Therapist, but This Reveals a Deeper Problem With the UK's Free Mental Health Services

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Living in the United Kingdom has its benefits, chief of which would be the free health care offered by the National Health Service (NHS). I don’t have to worry about health insurance (unless I want to seek private health care, more on that later). I don’t have to worry if I have an emergency, as any surgery or other treatment is free. Prescription medication, routine scans, therapy — everything is free for me, and I feel incredibly privileged to have access to free health care. However, this comes with limitations that some may not consider — limitations that led to ghosting my therapist.

I’m not proud of it. I know I could’ve handled the situation better, and I am in no way advocating for this method of “breaking up with a therapist.” However, what happened reveals the reality of millions of people living in the U.K. Private therapy (and private health care, in general) will always be a stronger option for those who can afford it.

To begin, here’s a little context on how therapy works through the health service. After the initial round of speaking to a doctor, I was referred to the community mental health team (CMHT) for assessment through a psychiatrist. Then, a referral is made for therapy, prescriptions are written, and you’re left to figure it all out from there. Then comes the waiting game.

According to data released by the Royal College of Psychiatrists in 2020, two-fifths of patients waiting for mental health treatment were forced to resort to emergency or crisis services. They also found that of those on a hidden waiting list — that is, the wait between referral and second appointments — “nearly two-thirds (64%) wait more than four weeks between their initial assessment and second appointment. One in four (23%) wait more than three months and one-in-nine (11%) wait longer than six months.”

The COVID-19 pandemic only made matters worse. The NHS reached record referral numbers in 2021, with millions still awaiting treatment. A staff shortage is partially to blame, as noted by eating disorder charity Beat:

“Only 61% of urgent cases have been treated within the one-week target, and just 67% of routine cases were treated within the four-week target. 12,457 children and young people began treatment between April 2021 and March 2022 … that number has more than doubled post-pandemic. 1,946 children and young people were still waiting for treatment at the end of March 2022, which is almost 3.5 times more than March 2020. 39% of children and young people who were still waiting for treatment by late December, had already waited over 3 months.”

Waiting times aside, I was lucky to have an NHS therapist at the beginning of the pandemic, whom I saw every two weeks for over a year. She helped me begin to come to terms with a number of things, including my realization that I had been sexually abused and had been burying my mother’s emotional abuse. However, as is often the case with NHS therapy, it was increasingly clear I had outstayed my welcome regardless of how much work I still had to do. I had these huge discoveries dumped on me, then I was left to my own devices.

In our last sessions, my therapist hinted at the pressure they were under to wrap up long-term patients. Our sessions also became shorter — while they were meant to take a full hour, they sometimes finished after only 30 minutes despite having more to say and more work to be done. I was too anxious to say anything, though. I often avoid things that make me feel anxious. Then came the final session, when my therapist uttered the words I’ll never forget: “This can’t go on forever, you know — our sessions.”

Believe me, I know they couldn’t. I know there comes an endpoint to therapy for many, though there’s something to be said for continued maintenance therapy when you’re “living well.” But I wasn’t living well; I was still struggling, still trying to navigate the messiness of my life in the midst of a pandemic, still trying to comfort my inner child who was hurting so much.

I knew the next session would be more of the same. I felt humiliated. I was afraid of the “ending,” so I didn’t go. I ignored the phone calls. A letter arrived with another appointment, and I avoided it too. I didn’t even open the discharge letter when it arrived. On the NHS, you’re often discharged if you miss more than two appointments without an adequate reason.

This is the reality for millions seeking therapy through the NHS. Between six and 12 sessions are usually offered, each an hour in length. While this may be enough for mild, everyday struggles, more complex struggles can take years to overcome. I’ve seen this play out through others; my partner, who lives with complex PTSD, was only offered 20 weeks through the NHS before she was discharged. She has since sought private trauma therapy, with which there is no deadline — no maximum time period within which she must recover from decades of abuse, or else. Through personal experience, many NHS therapists only offer CBT or similar modalities; I have personally yet to find an NHS therapist able to offer more complex treatments such as eye movement desensitization and reprocessing (EMDR).

The NHS has the potential to really help people, but only with meaningful and sustainable investment.

The fact is that, while we are lucky to have the NHS, mental health services in the U.K. have long been understaffed and underfunded by successive Conservative-led governments. As noted by Trades Union Congress (TUC), the UK Conservative party “have pursued a self-defeating policy of austerity that has hampered our economic recovery and left large parts of our essential public services at breaking point.” Years of spending cuts have left our health services unable to cope with growing demand from vulnerable people while also remaining chronically understaffed. As notes, 41% of mental health trusts have staffing levels below established benchmarks. The NHS has the potential to really help people, but only with, as TUC says, meaningful and sustainable investment in not only our mental health services but across the whole of the NHS.

Given everything, I believe I’ve had my fill of NHS mental health services beyond psychiatric support and medication. I’ve been left wanting each and every time I’ve pursued NHS therapy, and it’s exhausting to have to go through one’s history with each new person when I could find a private therapist. At least, then, I won’t be afraid that they will one day end my treatment due to inadequate funding. Compared to some others, I’ve honestly been quite fortunate in my experience, too; I haven’t had quite as long a wait as some people, and I’ve had reasonably good therapists, for the most part. I’m lucky that I am also in a position to be able to afford private therapy, though only barely and through sacrifice in other areas. I don’t take it for granted, though. I know there are millions of people out there without any other choice but to remain on NHS waiting lists, only to be given the most basic of services and then released into the wild without the tools necessary for survival.

Getty Images photo via monkeybusinessimages

Originally published: May 18, 2022
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