On Friday 15th July, the ‘National Health Service (Co-funding and CoPayment) Bill’ will be debated in parliament. Put forward by the Conservative MP Christopher Chope, the bill would see an increase to the number of NHS services that could be charged for, as well as the option for those who can afford it to pay to be able to access health treatment more quickly. It’s unlikely it will make it to the floor, never mind be passed, but instead of breathing a sigh of relief, I would argue that in many areas of our health service – especially mental health – this system is already effectively in place.
I’ve been thinking a lot recently about mental health and socioeconomic privilege. It’s no secret that wealthy people are afforded the same privileges in healthcare as they are in many other areas of life, but it is in mental health care specifically that this is felt most deeply by those that are less fortunate.
Poverty is a well-established cause, as well as a consequence, of poor mental health – meaning the greatest need for services is often found amongst those who can’t afford top-up fees or private care. Children and adults living in households in the lowest 20% income bracket in Great Britain are 2-3 times more likely to develop mental health problems than those in the highest income bracket. But with only 1 in 10 mental health trusts seeing children in poverty as a priority group for access to mental health services, and continued government failure to invest in our public health service, we see a recipe for disastrous mental health inequalities, which would only be worsened if this bill were to pass.
Still, with NHS waiting lists running to years long and availability of inpatient beds becoming scarcer by the day, many distressed people are forced to consider paying for mental health treatment privately.
"The prices made me nauseous. But more sickening was the thought that if I could just fork out for it, I could see someone the very next day"
I was recently formally discharged from the mental health team I was under, meaning I no longer have any support. Even this was an extension of the duration of treatment I was ‘supposed’ to get; technically I was meant to be discharged in 2017, but I was in such extreme distress that I was granted a paltry 3 extra follow up sessions over 6 months, thanks only to the intervention of my amazingly proactive GP and a formal complaint to the Trust. This time around, I don’t even feel distressed, I just feel numb. I feel like I’m just waiting in limbo for the next crisis deemed severe enough to warrant help, and in the meantime I’m just trying to make it through each day.
What would it cost to access care that was on my terms, that didn’t end when I was in acute distress and allowed me to get well at my own pace, without feeling as though I was on borrowed time? Thirty minutes after my late evening email to The Priory, I had my answer: £200-400 for an assessment, and £148 per therapy session, or £1060 per night if I needed inpatient treatment.
The prices made me nauseous. But more sickening was the thought that - in stark comparison to the 9 months I spent on the waiting list for treatment with the mental health team, and years of my adolescence being passed from pillar to post, being refused help by charities and primary care services for being too ‘complex’, yet apparently not at risk enough to warrant more intensive support - if I could just fork out for it, I could see someone the very next day, should I want to. I could get any help I needed. What it is to have money.
In this way, the two-tiered system that Mr Chope is proposing for the NHS, whereby people can pay to ‘jump the queue’ for healthcare, already very much exists in mental health, and this is something that I wish was being debated by MPs this Friday.
"For working class people, being hospitalised for your mental health can pretty much ruin you... just trying to put your life back together after a crisis like that can take years and years."
A little while back I did a free peer support skills course, and a member of the group was receiving inpatient treatment for his mental health. “They took anything I could use to hurt myself off me when I went in,” he told us, “which was ridiculous because I didn’t want to kill myself anyway.” I was astonished – he didn’t want to kill himself? And he got an inpatient bed? How?!? There is no way you would be admitted to hospital on the NHS unless you were at immediate risk to yourself or others (and frankly, not always even then). That's when I realised he was clearly receiving private treatment.
By the end of the course he was out of hospital. He messaged us all to say he was getting back to work with a half-day in a friend’s business.
I wouldn’t dream of invalidating someone’s experience of distress, but in that moment, I did resent the massive disparity between his experience of getting over a mental health crisis, and most other people’s.
For working class people, being hospitalised for your mental health can pretty much ruin you: trying to pick up the pieces afterwards, sort out the debt you’ve got into, the unpaid bills, attempting to get back into work and explain gaps in your work history, having to deal with the questions, amending broken relationships, and just trying to put your life back together after a crisis like that is often the hardest part - it can take years and years. A far cry from a quick, precautionary stint in hospital, before taking up a flexible job with an understanding friend.
The whole situation makes me furious. So many people are suffering and don’t get help even when they are in acute crisis, and others are forced to empty their pockets to access care that should be a right. We need a system that does the best for everybody, not just a privileged few. I want to make it clear that the idea of payment for fast track healthcare that Mr Chope is proposing is already very much a reality in mental health – and it is completely unjust.
"The system is sending a dangerous message to distressed people: you are not worthy of help; you cost too much to help"
And yet, where is the outrage? Why does the current mental health system promote the notion that some lives are worth more than others, simply because some people can afford to pay for treatment?
The system is sending a dangerous message to distressed people: you are not worthy of help; you cost too much to help; unless you have money and can pay, you’ll just have to ‘get over it’ on your own. What happened to reducing such stigmatising views? What do we do when the healthcare system itself is perpetuating them?
Mental health care is not a luxury to be granted only to the wealthy; for so many it is literally a lifesaver. So while we’re expressing outrage at the suggestion that rich people should be able to pay to jump NHS queues and get better treatment, let us remember that this hierarchical system is already effectively in place in mental health, and let’s do something about it.