25 September: Our call for schools counselling investment in Government spending review
Our call for Government investment in schools counselling
Our 10-point submission to the Comprehensive Spending Review calls for more investment in counselling and psychotherapy
We've called on the Government to invest in a trained professional counsellor in every secondary school and college in England as part of our 10-point submission to the Comprehensive Spending Review.
The submission is the latest stage of our campaign for a national commitment to counselling provision for all children in England's secondary schools, to bring the country into line with the other nations of the UK.
Our recommendation makes it clear how counselling can complement existing investment by providing a cost-effective and universal, non-stigmatising early intervention.
It will help those young people who do not meet the threshold for support for CAMHS but need more help than can be offered through the ongoing roll-out of mental health support teams.
Martin Bell, our deputy head of policy and public affairs, said: "Counsellors currently working with children and young people play a critical role in supporting this age group with a wide range of issues that impact on their mental health and well-being.
"It's crucial that school counselling services are supported and funded in England to meet this anticipated increase in demand, and to bring the country in line with the other nations.
"We urge the Government to ensure all children and young people have access to this vital form of mental health support. There was a need for a funded school and college counselling programme before Covid-19, but it is now more important than ever."
Martin added: "We'd like to thank the three thousand BACP members and supporters who've taken part in our campaign by writing to their MPs.
"We're seeing positive indications that MPs are supporting our ask, with more than 40% of the response letters shared with us confirming they'll write to Treasury ministers on behalf of their constituents to support the call for investment in school-based counselling."
Find out more about our schools counselling campaign and how you can get involved.
Our 10-point submission to the Government's Comprehensive Spending Review includes a series of recommendations for investment in counselling and psychotherapy.
It includes a call for a cross-departmental mental health action plan to respond to the coronavirus crisis and funding for bereavement support to ensure consistent access to quality services including support for people who have lost loved ones to Covid-19.
Other asks in the submission include free relationship counselling to lower-income families and support for employers, employees and vulnerable groups through workplace counselling.
We're also calling for the role of counselling and psychotherapy to be enhanced within the NHS workforce and for a VAT exemption to be extended to counselling and psychotherapy services provided by Professional Standards Authority registered and accredited members.
Martin said: "This Comprehensive Spending Review is an important opportunity for the Government to invest in counselling and psychotherapy and the skills of our members to support the mental health of the nation.
"The impact of Covid-19 on people's mental health and expected increased demand for services, can only be met by additional funding and capacity across a range of sectors, including education, bereavement services, relationship support and the NHS.
"We need a clear mental health action plan from the Government, which includes our members as a central part of the response to dealing with the pandemic."
Submission to Comprehensive Spending Review
The British Association for Counselling and Psychotherapy (BACP) is pleased to provide a submission to the Comprehensive Spending Review.
BACP is the leading and largest professional body for counselling and psychotherapy in the UK, with over 52,000 members. Our members are drawn from the various professional disciplines in the field of counselling and psychotherapy, working in a full range of settings including educational settings, private practice, health, through workplace support or within the third sector and across all age-ranges.
Invest in a trained, professional counsellor in every secondary school and college in England to meet the growing mental health crisis facing children and young people.
Develop a Cross-Departmental Mental Health Action Plan to respond to the Covid-19 crisis.
Extend VAT exemption to all individual Professional Standards Authority registered and accredited members and registrants who are qualified psychotherapists and counsellors removing unnecessary barriers to access mental health support.
Fund research into the impact of Covid-19 on care home residents and staff and how evidence-based non-pharmacological interventions, such as counselling and psychotherapy, can improve their mental health and well-being.
Additional funding for bereavement support to ensure consistent access to quality services and for appropriate bereavement services specifically designed to support people who have lost loved ones to Covid-19.
Invest in relationships by providing free relationship counselling to lower-income families enabling more people to benefit from this cost-effective support.
Strengthen the UK's economic recovery from Covid-19 by supporting employers, employees and vulnerable groups through workplace counselling
Increase in NHS Funding Settlement to ensure NHS Long Term Plan can be implemented in light of Covid-19.
Longer Term Funding Settlement for Health Education England.
Enhance the role of counselling and psychotherapy within the NHS workforce.
1) Invest in a National school and college- based counselling programme
School-based counselling is a proven intervention for children and young people experiencing psychological distress but is not currently universally accessible in all secondary schools and FE colleges within England. Schools struggle to pay for in-house counselling provision and third sector providers often work within limited geographical areas or have funding restrictions resulting in inconsistent provision. School counselling provision can change on an annual basis and is not currently sustainable for many schools.
We know that pre-lockdown, one in eight young people were struggling with diagnosable mental health issues (Mental Health Foundation), we anticipate these numbers are now higher. In order to effectively support the mental health of our nation's children and young people, now is a critical time for the Government to financially commit to a sustainable school and college counselling programme that will complement other departmental mental health and well-being strategies for this age group and form part of the post-Covid recovery plan.
BACP have a number of fully costed school-based counselling options which would ensure universal access to counselling as well as meeting the need of targeted and more vulnerable groups that have struggled disproportionally during lockdown. We have shared costings with the Department for Education and organisations including Young Minds, who are also committed to a funded school counselling programme for England.
We have a highly trained and qualified children and young people's counselling workforce with capacity to deliver against this ask. Our counsellors and psychotherapists work within a core competence framework ensuring the highest of professional standards.
School-based counselling in the UK is based on a non-directive humanistic approach to counselling and focuses on individual goals for therapy set between the counsellor and young person. Research from four pilot randomised controlled trials has indicated that school-based counselling, as typically delivered in secondary schools, brings about significant reductions in psychological distress (Cooper, 2013, School Based Counselling in UK Secondary Schools, a Critical Review); it is valued by pupils and school staff and is seen as being able to bring about improvements in well-being and educational attainment.
A BACP commissioned trial by the London School of Economics and the Metanoia Institute into the cost-effectiveness of school counselling (ALIGN Trial, 2017) looked at two groups of students, one who received school counselling compared to another placed on a waiting list. The study, which covered 64 students across three schools, highlighted the cost effectiveness of counselling compared with CAMHS and pastoral care.
The study showed that by the end of the trial the costs for those children who remained on the waiting list were higher than those who received counselling, taking into account the need for GP appointments, access to pastoral care and other support within the school, as well as access to community services and emergency services.
Costs of delivering school-based counselling in England
The delivery of school-based counselling varies from direct employment by the school to the commissioning of counselling services employing a number of counsellors and working across many schools. The costs associated with these delivery methods vary greatly, mostly due to the management costs associated with outsourcing.
Following a data collection exercise around school-based counselling services, BACP has developed the following cost estimates of delivering school counselling nationally in all England's state-funded secondary schools and academies. A separate calculation, based on the figures below, would also apply to counselling in FE Colleges, special schools and alternative education settings:
Based on our data, a typical secondary school might employ a counsellor for two days per week at a cost of approximately £14,500 per annum with a counsellor undertaking approximately 332 counselling sessions per academic year. School counsellors may also deliver additional counselling outside the school term.
We estimate that the cost to deliver a single session of school counselling is between £34 and £47. Therefore, the total cost of a child accessing an average of five counselling sessions would be between £171 and £233; the figure of £229 is provided as an average cost of six counselling sessions in a school as outlined by the Children's Commissioner's Report (2017) where it is compared to £2,338 the average cost of a referral to a community CAMHs service.
Upscaling the cost of delivering school-based counselling to all state funded secondary schools and academies in England, based on the need identified above, we estimate a national programme would cost between £76 and £104 million per annum.
An alternative figure, if we consider the amount of young people in secondary schools (estimated at 3.41 million) with a prevalence of need based on the Welsh data of 10 per cent of students accessing services, alongside the number of counsellors needed to meet demand over a school year period our estimate would be upwards of £118m per annum, which may be a more realistic sum.
Why we believe school-based counselling is a cost-effective solution
Whilst a figure of up to £118m to introduce a counsellor for all 11-16-year olds in state funded secondary schools is a significant outlay, especially at a time of economic difficulty, BACP believes that school counselling is a cost-effective early intervention. A properly nationally funded school counselling programme will keep many children away from costly and overstretched CAMHs services and crisis care and potentially have a positive impact on social care. This is before considering the costs of untreated mental illness if left to continue into adulthood.
The children of Wales and Northern Ireland are already benefitting from national school-based counselling programmes; the Scottish Government have committed 60 million pounds to a similar programme for secondary school children. BACP believe that children and young people in England should receive the same access within their schools, ensuring universal access across the four nations.
2) Develop a Cross Departmental Mental Health Action Plan to respond to the Covid-19 crisis
We call on Government to lead on the development of a clear and fully funded action plan to deliver a comprehensive mental health response to the Covid-19 crisis. This needs to build on existing provision for mental health support in response to the unprecedented mental health challenges and demand as a result of the pandemic and lockdown measures.
Within this, appropriate resource must be earmarked for counselling and psychotherapy, particularly to provide urgent therapeutic support for bereavement, to those who have experienced domestic abuse, to vulnerable children and older people, to support relationships and to those in financial difficulties. This should be informed by evidence to ensure resource can be targeted at those communities and people most affected by the pandemic.
Numerous experts have begun to highlight the unfolding mental health crisis resulting from Covid-19 and the physical distancing measures so necessary to manage the spread of the pandemic, which have clearly exacerbated poor mental health outcomes.
Analysis by the Office for National Statistics indicates that the crisis is negatively impacting on the mental well-being of the population, with 49.6% of respondents reporting "high" levels of anxiety (ONS, Coronavirus and anxiety, Great Britain: 3 April 2020 to 10 May 2020, 15 June 2020). A recent report by the Institute for Fiscal Studies found that mental health in the UK worsened substantially as a result of the Covid-19 pandemic – by 8.1% on average and by much more for young adults and for women which are groups that already had poorer levels of mental health before Covid-19 (IFS, The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK, 10 June 2020). As a result of the crisis the Samaritans reported receiving 7,000 calls a day more from people struggling to cope. There has also been a further negative impact on those already suffering with mental ill health. The Mental Health Foundation has reported that almost 80 percent of people living with mental illness have reported that their mental health has got worse (MHF, A new social contract: letter to Prime Minister 26 June 2020).
Demographic analysis has also shown the virus has had a greater impact on poorer people and families and BAME communities, and these groups will require targeted psychological support in the coming months and years. This has had particularly distressing consequences for bereaved people, many of whom have been unable to say goodbye to loved ones or attend funerals and this will lead to an increase in complex grief reactions in the coming months. There has also been a big spike in domestic abuse – with Refuge reporting a 700% increase in calls to its helpline in a single day and a 25% increase overall (Refuge, PR: 25% increase in calls to National Domestic Abuse Helpline since lockdown measures began, 9 Apr 2020) – creating an urgent need to scale up provision of specialist support for those affected.
The fear, uncertainty and loss of routine brought on by the crisis is also having a profound impact on children and their development. A survey of young people by Young Minds in July found that 80% of respondents agreed that the coronavirus pandemic had made their mental health worse (Young Minds, COVID-19 summer 2020 survey,10 Jul 2020). 41% said it had made their mental health "much worse", up from 32% in the previous survey in March. This was often related to increased feelings of anxiety, isolation, a loss of coping mechanisms or a loss of motivation. Among more than 1,000 respondents who were accessing mental health support in the three months leading up the crisis (including from the NHS, school and university counsellors, private providers, charities and helplines), 31% said they were no longer able to access support but still needed it. Of those who had not been accessing support immediately before the crisis, 40% said that they had not looked for support but were struggling with their mental health (Young Minds, COVID-19 summer 2020 survey,10 Jul 2020).
The Department of Education summary report of school attendance in England over the lockdown period showed that children from poorer families, who are more likely to have existing mental health challenges, were particularly vulnerable to the negative consequences of school closures and social distancing restrictions (Department for Education, Attendance in education and early years settings during the coronavirus outbreak: 23 March to 11 June 2020, 23 June 2020). As we are now seeing a strengthening of Covid-19 regulations to see off a potential second wave, we expect this group will remain particularly vulnerable and will require additional mental health support.
The wider economic impact of the crisis has taken its toll on the mental health across the country, with increased job insecurity and levels of personal debt on the rise. In the early days of the lockdown we saw many small businesses close and significant job losses, with 1.8 million new claims made to Universal Credit in the early months of lockdown (BBC News Report quoting Rt Hon Therese Coffey MP, Coronavirus: Nearly two million claim universal credit, 4 May 2020). It is estimated that half a million UK firms are at risk of collapse, according to insolvency experts Begbies Traynor (Financial Times, How Covid-19 is escalating problem debt, 30 April 2020) and many workers have taken pay cuts, worked reduced hours or taken a sabbatical to help firms limit the numbers they will have to lay off. This uncertainty is another contributing factor to a potential mental health crisis.
The role of counselling and psychotherapy in supporting the nation to heal
Counsellors and psychotherapists have played a vital role on the frontline of this epidemic supporting vulnerable people, sometimes on a voluntary basis, including medical staff and other key workers who are struggling with their own mental health. Our recent member survey indicated that 87.7% of people have said they've been able to continue to provide a level of counselling and psychotherapy since the Government restrictions came into place (BACP, Preliminary results of our member survey, 6 May 2020). We also know that Covid-19 has been a big driver for new clients seeking support. A quarter of our members (25%) reported that the impact of Covid-19 on an individual's mental health is a key reason why people are now seeking counselling. The following related issues were highlighted:
Social isolation (78.3% of respondents reported this)
Concerns about important people in their lives becoming ill (e.g. partner, children, parents, grandparents, friends) (72.9%)
Distress over watching the news (63.2%)
Financial problems surrounding income in their household during the crisis (60.4%)
Concerns about becoming ill themselves (59.2%)
We have also saw a fall in clients seeking support, 74.7% of members reported a decrease in the number of clients they work with. Many providers, private practitioners and charities also saw funding cuts and sessions drop as social isolating measures came into force, reducing their ability to refer clients. As a result, the numbers of clients being referred for support has fallen dramatically with 78.2% reporting a decrease in new referrals compared to usual circumstances (BACP, Preliminary results of our member survey, 6 May 2020).
As the impact of the pandemic grows, we know that demand for therapeutic support will further increase and we wish to offer our full support to Government in putting a long-term plan in place to ensure this need is met in collaboration with professional organisations and other mental health services providers.
3) Remove VAT on counselling and psychotherapy
Adding VAT to mental health services contradicts legislation on parity of esteem between physical and mental health and it highlights a significant and unfair anomaly between the treatment of health services provided, for example, by doctors, dentists, dieticians, opticians, and the ones offered by many mental health professionals.
According to an HMRC brief issued in 2009 when psychologists' services became VAT exempt, 'medical care' is defined as any 'service principally aimed at the benefit of the patient and at the protection, maintenance or restoration of health of the person concerned', including mental health. Despite this, counselling and psychotherapy services, all provided for 'the protection, maintenance or restoration of health of the person concerned' remain subject to VAT. HMRC's definition of medical care therefore should also include services such as counselling and psychotherapy.
Registered and accredited individual and group practice psychotherapists and counsellors are required to register for VAT when their income from the provision of mental health services exceeds, or is likely to exceed, £85,000 in a 12-month period. Clients are typically not VAT registered and therefore cannot reclaim VAT on fees, and while therapists are entitled to claim a deduction for expenses incurred on any practice expenses (electricity, phone, rent etc), this 'input VAT' will not usually be significant.
This requirement acts as a barrier to the expansion of private affordable counselling and psychotherapy at a time when Government is promoting the expansion of the provision of mental health services and as highlighted earlier, will be needed to meet the expected demand post-pandemic. Counsellors and psychotherapists are also recognised in the NHS Long Term Plan as part of the 12 distinct psychological professions delivering NHS commissioned healthcare alongside psychologists and other mental health practitioners.
Another significant anomaly is the disparity of treatment within the mental health care professions. Whilst psychologists, art therapists and dance therapists who the Government chooses to regulate by statute, offer VAT exempt services, counsellors and psychotherapists cannot. All our trainees receive the same minimum standards of professional training and once qualified they all provide the same level of highly professional and ethical psychotherapeutic services within their own professional sphere and working to their level of competence.
Most countries around the world have looked at introducing VAT reductions during the Coronavirus pandemic crisis. VAT reduction is one of the measures available to facilitate economic renewal, consumer confidence and access to essential services as part of a wider package of recovery interventions.
Any additional cost, particularly during these challenging times, represents a significant barrier to vulnerable people being able to access vital mental health support when they need it and anything that provides or makes it easier for people to access mental health support in this time of crisis should be facilitated and encouraged.
BACP believe that the removal of VAT on counselling and psychotherapy services is long overdue and would remove a needless barrier to people accessing care. Anything that provides or makes it easier for people to access mental health support should be facilitated and encouraged. In view of the highlighted anomalies and expected increase in demand for mental health support in the aftermath of Covid-19, we urge the Government to extend VAT exemption to all individual PSA registered and accredited members and registrants who are qualified psychotherapists and counsellors.
We believe the cost to the Treasury to introduce this exemption would be small. However, it would result in significant benefits in helping the nation recover from the crisis.
4) Investment for research into mental health of care home residents and staff
The Covid-19 pandemic has had the greatest impact on care homes, directly impacting residents, with the frail elderly at greatest risk and 30% of all Covid-19 deaths in England occurring in care homes. The outbreak has also had devastating impact on people working in social care. When adjusted for age and sex, figures published in May 2020 showed that social care workers had twice the rate of death due to Covid-19 compared to the general population.
Prior to the pandemic, The Royal College of Psychiatrists and the British Geriatrics Society have highlighted the prevalence of depression in care homes (British Geriatrics Society and the Royal College of Psychiatrists 2018. Collaborative approaches to treatment Depression among older people living in care homes). Although many people live well within care homes, it is estimated that 60% of those living in residential care have poor mental health (Age Concern and the Mental Health Foundation (2006). Promoting mental health and well-being in later life: A first report from the UK Inquiry into Mental Health and Well-Being in Later Life) and 40% suffer from depression (The Royal College of General Practitioners, 2011). According to the Department of Health, depression in care homes is particularly under-diagnosed and it has been estimated that the prevalence of depression among care home residents could be as high as 44% (Teresi J. et al., 2001)).
Depression has been reported to impact on the well-being of care home residents (Khader, F, 2011) and is associated with loneliness (van Beek, Frijters, Wagner et al, 2011) failure to thrive (Kumeliauskas, L. et al 2013) and suicidality (Kjølseth, Ekeberg, 2012; Cuijpers, van Straten & Smit, 2006).
The prevalence of antidepressant prescribing in care homes has been reported to be nearly four times greater than for older people living in the community (Harris, Carey, Shah, Dewilde & Cook, 2012). However, antidepressants have been found to be ineffective for people with dementia (Dudas R, et al. 2018). Approximately two-thirds of care home residents have some form of dementia, therefore there is a need to find alternative interventions to support care home residents who are experiencing depression.
Additionally, a recent report has highlighted the impact care work has on the mental health of care teams and the potential value of providing time and space for care teams to speak and reflect on the impact of the work they do (Scottish Care, 2017). Care teams sometimes face long working hours, varied quality training programmes, poor pay, and demanding emotional requirements such as supporting people at the end of their lives. The UK Parliament's Communities and Local Government Committee's Social Care Report in 2017 found that on top of the physical and emotional demands of the job, almost three quarters of care staff are paid below the national minimum wage, with 49 per cent employed on zero-hours contracts (compared to 3 per cent of the workforce nationally).
Health and social care staff face a multitude of acute mental stressors due to their work and these have been greatly magnified during the current crisis. Evidence from previous pandemics suggests that health and social care workers have an increased risk of adverse mental health outcomes, including post-traumatic stress disorder and depression. Half of 1000 health care workers surveyed across the UK by IPPR/YouGov in April reported that their mental health had deteriorated since the start of the COVID-19 pandemic. The youngest workers (18–34 years) were hardest hit, with 71% reporting a worsening in their mental health.
It is vital that, as the pandemic continues to be most acutely felt in care homes, that efforts to protect health and well-being include a thorough focus on the mental, as well as physical, health of residents and staff.
The Government must ensure that mental health and well-being is included in measures of the impact of Covid-19 in care settings, and lead the way in responding to the mental health impact of the pandemic by funding research that uncovers the hidden and devastating impact of Covid-19 on care home residents and staff and how evidence-based non-pharmacological interventions, such as counselling and psychotherapy, can improve the mental health and well-being of both.
5) Invest in Bereavement support
Bereavement is the experience of having lost someone close who has died. Grief is the biopsychosocial response to bereavement and can include a range of feelings such as anger, denial, relief, guilt and sadness. Everyone will experience grief in their lifetime. For some people the acute pain of grief will continue and stay for a long period, for others it will fade, allowing the bereaved person to accept their loss.
The Covid-19 pandemic has brought into sharp focus the importance of a structured range of bereavement and anticipatory grief support incorporating community, organisational and specialist responses.
Quality bereavement support includes access to suitable immediate advice and assistance, peer support, group support and online support as well as also structured support such as 1-2-1 counselling and psychotherapy or group therapy.
People and organisations have different needs in dealing with bereavement including:
psychoeducation for employers, organisations and individuals
skilled support from peers/trained and experienced supporters in paid and voluntary roles
counselling and psychotherapy (1-2-1 or in a group)
This range of support can be made available through a three-tiered community response model which recognises and responds to all who are bereaved:
Tier 1 delivers supportive responses from existing community networks such as places of worship, neighbourhoods, clubs and societies and offers help and support including peer support and signposting to other services. This should be available for all bereaved people.
Tier 2 combines the community responses with professional support such as a bereavement support organisation. This will be accessed by some bereaved people.
Tier 3 provides specialist psychological 1 to 1 or group support which may include counselling or psychotherapy. This will be required by a smaller proportion of bereaved people.
Accessible national and local psychosocial services are required to enable access to a community response to bereavement:
it is recommended that information is readily available online for bereaved people and community providers of care and support
referral to community support providers should be open and readily available, with choice offered to the bereaved persons
support must take account of practical as well as emotional needs and promote self-determination and control for the bereaved person
a small proportion of bereaved people will have long term problems that require ongoing support. Bereavement support services must be responsive to this longer-term need and include availability of structured 1 to 1 or group support, counselling or psychotherapy, and referral to mental health services for people requiring specialist intervention.
BACP believes that there needs to be investment into bereavement support to remove inconsistent provision and to ensure that quality support is not dependent on where a bereaved person lives.
BACP also supports the Covid-19 Bereaved Families for Justice's call for funding for a national tiered system of appropriate bereavement services specifically designed to support people who have lost loved ones to Covid-19. This system would join together the underutilised resource of counsellors and psychotherapists in private practice, the NHS and GP referral processes, and third sector organisations.
6) Invest in Relationships
Research shows that adults in poor quality and distressed relationships are much more likely to suffer from depression, anxiety and other mental health problems, and from poor physical health. There is also clear evidence that poor-quality parental relationships and inter-parental conflict in particular have a negative impact on children's mental health and long-term life chances across many areas. This is highlighted in the Government's flagship programme focusing on reducing parental conflict, though work in this area remains patchy and does not cover all Local Authorities in England.
Evidence suggests that families on low incomes or experiencing financial pressure may be at particular risk of experiencing relationship difficulties. Financial hardship is a key factor leading to relationship problems (Markman H et al, 2004), predicting lower relationship satisfaction and quality (Grable J et al, 2007), higher psychological distress (Dakin J et al, 2008), and increased risk of relationship breakdown (Archuleta K et al, 2011).
Studies have found relationship counselling improves relationship satisfaction (Lundblad A et al, 2006), and couple therapy results in significant change in relationship satisfaction (Doss B, 2012).
The Government-backed evaluation of UK relationship support found counselling and relationship education resulted in statistically significant positive changes in individuals' relationship quality, well-being and communication, according to validated scientific measures of these. The evaluation modelled the cost effectiveness, finding that for every £1 invested the state could see £11.40 of savings.
The cost of relationship counselling – which is not widely commissioned – can be a significant barrier to access for those on lower incomes. At present, the relationship support sector's ability to provide free or subsidised support rests largely on the resource it is able to draw in from clients' fees. The fact that the majority of clients pay a fee for counselling means that the actual and/or perceived cost of services can be a significant barrier to access for those on low incomes, and especially those in debt (Doubell L et al, 2017).
66% of Relate counsellors identified the limited availability of free relationship support as a barrier that inhibits more referrals/signposting between relationship support and debt advice.
Excellent support is out there, but too few families on lower incomes are currently able to access it. BACP would like to see Government investment to provide free relationship counselling to lower-income families.
7) Strengthen the UK's economic recovery from COVID-19 by supporting employers, employees and vulnerable groups
The Covid-19 outbreak has resulted in one of the largest ever shocks to the UK economy and public finances. The UK economy in May 2020 was approximately a quarter smaller than in February 2020 and the Office for Budget Responsibility (OBR) assesses that the country is on track to record the largest annual fall in GDP in 300 years.
On 11 May the Government published 'Our plan to rebuild': the UK Government's Covid-19 recovery strategy. The Government's aim at the centre of that plan is to return to life as close to normal as possible, for as many people across the UK as possible, as fast and fairly as possible; in a way that avoids a new epidemic, minimises lives lost and maximises health, economic and social outcomes.
To date, the Covid-19 response has required more than £30 billions of additional health spending and £4.7 billion of extra local government funding (A Plan for Jobs, July 2020) and it is clear that the Government will need to bring forward a sizeable financial settlement to meet its manifesto commitment, while supporting the nation to recover from the first phase of the pandemic.
We already know that the first wave of Covid-19 is set to leave a broad and lasting legacy on our health and well-being, with data from the ONS (2020) showing that the prevalence of mental health problems, including depression and anxiety have increased alongside services facing increased demand.
These increases in demand are only now starting to emerge; how long they last, and their severity remain unknowns. What is more, they are set against a context of severe staffing shortages across the NHS and social care that could well impede the system's recovery from Covid-19.
While some degree of worry is understandably widespread, more severe mental ill health is being experienced by some groups. IFS analysis of longitudinal data from the Understanding Society study (2020) found that, taking account of pre-pandemic trajectories, mental health has worsened substantially (by 8.1% on average) as a result of the pandemic. Groups have not been equally impacted; young adults and women – groups with worse mental health pre-pandemic – have been hit hardest.
The UCL Covid-19 social study of 90,000 UK adults has monitored mental health symptoms throughout lockdown, finding levels of anxiety and depression fell in early June as lockdown measures began to lift. But these remained highest among young people, those with lower household income, people with a diagnosed mental illness, people living with children, and people living in urban areas.
Even before Covid-19, projections suggest that, as a percentage of the total number of instances of poor health at work, mental health problems will soon surpass other work-related illnesses. Survey data (2019) from the Chartered Institute of Personnel and Development (CIPD) indicates a significant increase in the number of reported instances of mental ill health over the year 2018-19, in both large (more than 250 employees) and small organisations (less than 250 employees).
Pre-Covid estimates from Deloitte UK (2020) put the cost to employers of poor mental health among employees at £42bn – £45bn each year; made up of absence costs of around £7bn, presenteeism costs between £27bn and £29bn and turnover costs of around £9bn.
By investing in appropriate interventions, including workplace counselling, employers can significantly reduce the costs of disruption to their business and the wider economy. Research has consistently shown the benefit of offering counselling to employees, with increased productivity, morale and resilience reported by many employers.
Research has shown that workplace counselling can halve sickness absence in organisations (McCleod, 2010) and that have accessible services, provided as part of an EAP programme or otherwise, return to work sooner, are more resilient, productive and less likely to become long-term sick.
Earlier this year the Chancellor announced changes to the way welfare counselling provided by employers is taxed, to extend the scope of non-taxable counselling services to include related medical treatment when provided to an employee as part of an employer's welfare counselling services.
We welcomed this move and urge the Government to go further in supporting both the physical and mental health of UK workers, such that they can play a vital role in strengthening the UK's economic recovery from Covid-19.
To support this aim we would urge the Government to:
Provide a funding programme for LEP's to support firms facing closure and redundancies, including help in accessing mental health support and employment opportunities – to reduce the negative impacts of long-term unemployment and mental ill health.
Provide a dedicated SME Mental Health Grant, for investment in mental health interventions, including non-clinical support and workplace counselling – to boost job retention, build resilience and support SME growth.
Extend the highly successful TechForce programme, focusing on providing digital health interventions for groups at greater disadvantage due to Covid-19, including women and BAME workers and to support the digital economy, achieve efficiencies and harness innovation in healthcare.
8) Increase in NHS Funding Settlement to ensure the NHS Long Term Plan can be implemented in light of Covid-19
The NHS Long Term Plan sets out a range of ambitious targets for improving health services over the lifetime of the plan and this has been backed by a commitment to increase NHS revenue by £34bn by 2023/24.
Mental health has been earmarked as an area for particular attention within the Long Term Plan and services are due to receive an increase in their budgets of £2.3bn a year by 2023/24.
However, prior to the outbreak of Covid-19 both the King's Fund and Health Foundation had written extensively about how the funding settlement outlined for the NHS to deliver the Long Term Plan was insufficient to both maintain quality and meet increases in demand for services.
Reports from the Health Foundation (Health Foundation, 2019: https://www.health.org.uk/news-and-comment/news/nhs-plan-jeopardised-by-unfinished-business-on-funding-and-rising-demand) found that the budget settlement for the NHS would equate to an increase of around 3.3% a year over the 5 years, which both fell short of the 3.7% historic average for the NHS and the forecasted 4.1% annual increase required to maintain quality alongside increasing demand for services.
As a result of the Coronavirus pandemic and subsequent periods of lockdown and societal upheaval there have been many concerns expressed about how these events will have a longer-term impact on the public's mental health. Recent reports from the Office for National Statistics have shown that during lockdown the prevalence of depression and anxiety has increased and that some mental health services are already seeing an increase in demand for their services (ONS, 2020)
It is a fair prediction that alongside pre-Covid increases in demand for mental health services there will continue to be a Covid-19 related increase in demand for the foreseeable future. Therefore, without an increase in the funding settlement for the NHS to ensure that the system can both cope with a previously unforeseen increase in demand for services as well as continue to deliver the ambitions within the Long Term Plan, the principles of increasing access to quality mental health services could be lost and inequalities facing people with mental health problems continued.
9) Longer Term Funding Settlement for Health Education England
The NHS Long Term Plan funding settlement only includes the delivery of services and doesn't cover the costs of recruiting and training the workforce expansion needed to deliver the services – that is set separately through Health Education England's budget.
Up until now the budget for Health Education England to deliver the workforce expansion required has been set on an annual basis as opposed to being set on a multi-year basis in line with the NHS Long Term Plan funding settlement. The impact of this is that it is increasingly difficult for there to be certainty year-on-year around what numbers of training places, particularly within the psychological professions including counselling and psychotherapy, are likely to be funded and as a result training institutions are unable to plan beyond the next 12 months. Ultimately this is having an impact on the effective and efficient recruitment of practitioners into the NHS workforce.
We would urge the Government to consider setting HEE's budget for the expansion of the mental health workforce to achieve the NHS Long Term Plan on a multi-year basis aligned to the budget settlement the NHS has received to deliver the Long Term Plan.
10) Enhance the role of counselling and psychotherapy within the NHS workforce
As the leading professional body for counselling and psychotherapy in the UK we know that counsellors and psychotherapists as practitioners are frequently undervalued and an underused workforce. Our membership of over 52,000 practitioners frequently report that they have capacity to take on additional work, and we know that their skills and expertise as mental health practitioners makes them a valuable ally in meeting the mental health needs of the country. Needs which are already increasing further as a consequence of the current pandemic.
Data is already showing an increase in demand for mental health services as a result of Covid-19 and at a time where workforce expansion is often given as a leading barrier to NHS mental health services being able expand quickly enough to meet the demands for help from the public, failing to fully capitalise on the skills of a highly trained workforce is wrong.
We would urge the Government to both:
Invest in a recruitment drive campaign for counselling and psychotherapy – addressing the barriers faced by counsellors and psychotherapists in becoming a much greater part of the NHS workforce skills mix.
To provide a psychological support service for NHS staff and other key workers, and to look to the counselling and psychotherapy workforce as a way of quickly bringing additional capacity and skills into the mental health workforce to meet this need.
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