New Initiative for Mental Health Equality: The National Counselling Society launches an initiative to reduce mental health inequalities, waiting lists, and inappropriate therapies

The National Counselling Society is proud to announce the launch of its new initiative: Direct Access to Counselling. This initiative aims to reduce the long waiting lists and high costs associated with the current system of mental health care by allowing patients to choose their own therapist and modality through the Accredited Register programme, a programme set up by the Department of Health in 2012 and administered by the Professional Standards Authority (who also oversee statutory registers).

The campaign message is simple: allow NHS patients to be referred directly to a counsellor or psychotherapist on an Accredited Register through systems that already exist within the NHS.

The current NHS Talking Therapies service alone is evidently not able to provide the support patients need, with 33.7% of patients finishing a course of treatment having shown no reliable improvement[1]. NHS Talking Therapies data shows that 89.1% of patients access their service within 6 weeks of referral, however the data is misleading: they are referencing the initial assessment, which is an approximately 30 minute call with a therapist that allows the patient to outline their issues. It is not a therapy session. The data shows that accessing therapy itself, and the gaps between the first and second sessions of therapy, can in fact be much longer, with 112,026 people looking at delays of over 18 weeks as of November 2022[2].

The recent report on Progress in improving mental health services in England by the National Audit Office on the 9th of February 2023 provides further evidence of the issues.

With over 60,000 qualified and experienced counsellors and psychotherapists on Accredited Registers in the UK, 82% of which have availability within two weeks[3], allowing NHS referrals directly to the Accredited Register programme empowers patients to take an active role in their mental health care, giving them access to timely mental health support that will actually work for them.

Research has shown that offering patients more choice and control in their therapy can lead to better treatment outcomes[4][5]. For example, patients who are involved in shared decision-making with their therapist have been found to have better treatment adherence and improved outcomes in depression treatment. Similarly, giving patients more autonomy and control over their treatment plan has been found to lead to better outcomes in anxiety treatment[6][7][8].

The short-term view of cost-effectiveness leading to limited funding for appropriate therapies doesn’t take into account the costs to the NHS that derive from untreated or poorly treated mental health issues such as an increased risk of cardiovascular disease, digestive issues, or certain types of cancer[9][10]; nor does it take into account the societal impact, for example in terms of employment and education opportunities, especially affecting those with low social capital[11][12].

There would be significantly less pressure on the NHS Talking Therapies department to recruit and train Psychological Wellbeing Practitioners – further removing the financial burden on the NHS, as counsellors and psychotherapists on Accredited Registers have paid for their own training.

By removing the current limitations imposed by the inability to recruit and retain staff, postcode (many intensive NHS Talking Therapies services are limited to certain locations) and financial status (when you can’t get what you need through NHS Talking Therapies you’ll look for a private therapist if you can afford it), this initiative ensures that high-quality, timely, and appropriate mental health support is available to all.

Early intervention is crucial in reducing long-term costs to both the NHS and society as a whole. By addressing mental health concerns before they escalate, individuals are able to maintain their well-being and lead productive lives, reducing the risk of future complications such as decreased productivity and increased healthcare costs. Providing access to appropriate support and resources through Accredited Registers can help prevent the development of chronic mental health conditions, reducing the need for costly ongoing treatment and support.

The Direct Access to Counselling campaign is a cost-effective solution that can yield long-term benefits for both individuals and society as a whole. By offering a choice of practitioner and modality through the NHS ecosystem (via Social Prescribing or Personal Health Budgets), this initiative removes mental health inequalities and ensures that high-quality mental health care is available to all.

The ask to Government is simple: Expand access to high quality mental health services to all by allowing referrals directly to counsellors and psychotherapist on Accredited Registers.

The National Counselling Society is looking for support with this campaign, to ensure that policy-makers understand the mental health crisis that is currently unfolding and still being created in the UK today, and that there is a workforce 60,000-strong that are able to support our nation’s mental health needs.

Meg Moss, Head of Policy & Public Affairs at the National Counselling Society said, “It is clear from all of the data that we’re seeing at the moment that mental health care in the UK just isn’t working: the growing need for crisis services, the ever-expanding waiting lists, and the huge costs to the NHS to recruit and train for very specific roles which experience high levels of attrition are all signs that something really isn’t working. Why are we continuing to invest in low-level, low-intensity roles that can only work in very specific ways, when we can be calling upon a workforce that is already trained, experienced, and subject to a very stringent code of ethical practice? It is vital that the Government recognise this workforce, and put into place a system whereby counsellors and psychotherapists can be called upon to do exactly what they’ve been trained to do for everyone in the UK – not just those that can afford to pay privately.”


Jyles Robillard-Day, CEO at the National Counselling Society said, “There is a missing middle that is being completely overlooked by the system as it stands today. People are looking to the NHS for support with their mental health, and are being offered six sessions of CBT or Guided Self-Help or some other low-intensity support, and they don’t even have a choice about who they work with. The support these people need sits somewhere between the low-intensity options and crisis-level support, but without timely and appropriate help they could very well be the people in crisis of tomorrow.

How can we expect someone to bare their soul to a person they don’t connect with? We should be offering people a choice of practitioner, so that they can find someone that they feel able to be vulnerable with in order for that therapeutic process to really work. What is being offered at the moment can inadvertently disempower patients and reduce the opportunity for real connection when this is the time that they need some genuine human contact the most. The Government needs to urgently consider how to tackle these issues, and I hope they seriously consider the solution the National Counselling Society are proposing”


[1]https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services/november-2022-final-including-a-report-on-the-iapt-employment-advisers-pilot
[2]https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services/november-2022-final-including-a-report-on-the-iapt-employment-advisers-pilot
[3] National Counselling Society Members Survey February 2023
[4]Examining the Relationship between Choice, Therapeutic Alliance and Outcomes in Mental Health Services
[5]Factors Influencing Successful Psychotherapy Outcomes
[6]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/
[7]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592639/
[8]https://oxfordre.com/psychology/display/10.1093/acrefore/9780190236557.001.0001/acrefore-9780190236557-e-79;jsessionid=0410569C53C9EBCA3DBD123260DD7EB3
[9]https://www.sciencedirect.com/science/article/abs/pii/S0140673607612380
[10]https://www.nejm.org/doi/full/10.1056/NEJM197912063012302
[11]https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3083
[12]https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244x-13-144