Your questions on therapy on the NHS and the Government’s plans on mental health
News from Â鶹ԭ´´

In recent weeks, we’ve had a Prime Minister demonstrating his interest in mental health and an announcement of plans to expand community mental health services. And the Government’s new mental health strategy is likely to be launched later this year.

We know many of you, understandably, have questions about these announcements – including about therapists’ qualifications and training needed for NHS work and the choice of therapy available on the NHS.

Our policy and public affairs team work with politicians and decision makers across the UK to help them understand how counselling changes lives, to increase access to counselling and psychotherapy for those in need of it, and to advocate for the skills and expertise of all our members and for more paid employment of therapists.

They’ve looked at some of the common themes and queries from our members who’ve commented on recent social media posts, and put together this Q&A to give you more information about therapy on the NHS and the work we’re doing in this area.

Community health services announcement

Do you have any further information about how these community mental health services will be managed, what jobs will be available, whether these will be paid roles, and what types of therapy the services will offer?

We’re still awaiting further information about these services. Service management is likely to vary depending on the area, with some services run directly by the NHS and others as partnerships between the NHS and third-party providers, such as charities and community interest companies (CICs). The services will be designed around local need (as six pilot centres have been) so there’ll be some variation in what’s on offer depending on what’s in demand in the services’ specific area. But we expect there to be a range of interventions available through the centres. There aren’t any details about jobs available yet, but we’d recommend members visit the NHS Jobs website for opportunities in their area.

We’ll be monitoring further developments on the plans for these services, and have offered our support and advice to the Department for Health and local health leaders to ensure the counselling and psychotherapy workforce is part of these services.

My understanding of the new community mental health services was that they’re for people in crisis and needed somewhere to go other than A&E. Counsellors are not trained for complex crisis management, so why would they work in these services?

The services will be designed around local need so there’ll be some variation on what’s offered and the workforce needed to staff them. They’re designed to offer a ‘no wrong door or threshold’ service, which is how the six pilot centres have operated.

Some of the services offered, such as overnight crisis support, would likely be staffed by different professional groups. But we expect that other services on offer in the centres would fit what counsellors and psychotherapists do.

Why are the community mental health services only in England? What’s happening in Scotland, Northern Ireland and Wales?

As healthcare is a devolved matter, the Governments in each country in the UK follow their own plans for community health. They have a key focus on prevention, early intervention and delivering more care closer to home.

• Wales was the first UK nation to make it a legal right for people to access integrated, community-based care for mental health, in 2010.
• Scotland has focussed on community mental health through the development of Health and Social Care Partnerships, Primary Care Improvement Plans, Community Link Workers and multidisciplinary community teams.
• Northern Ireland’s Department of Health published its Neighbourhood Model of Health and Wellbeing in March 2026. This will establish 17 Integrated Neighbourhood Teams, which bring together GPs, community pharmacy, health and social care providers, councils, independent providers and the voluntary and community sector.
We’ve been robustly making the case for inclusion of counselling and psychotherapy into these approaches in each country.

NHS funding

Why isn’t there NHS or Government funding made available for patients to use to see therapists in private practice?

This is a suggestion we often hear from members and we understand why this feels like an obvious solution to people. However, the reality is this is unlikely to happen. This is not only due to the large number of administrative challenges and costs, but primarily due to the difference in how therapists in the NHS and private practitioners work, how they charge and how they report on outcomes.

Some Integrated Care Boards (ICBs) have had to make financial savings over the past few years. Where will they find the money to employ more counsellors? How are you challenging these cuts?

ICBs have been told to make 50% cuts to their ‘running costs’ as part of the merger between NHS England and the Department of Health and Social Care. These cuts are not meant to be applied to frontline services, but we recognise they’ll have had an unavoidable impact on ICBs. There is money allocated for further expansion of NHS Talking Therapies workforce from NHS England – which includes roles for counsellors delivering high intensity therapies.

Our work advocating for counselling and psychotherapy in the NHS involves:
• Working with NHS England on Psychotherapeutic Counselling Core Training Pathway
• Working with NHS England on identify where training places aren’t being commissioned locally within England
• Working with groups of counsellors, services, unions and NHS England to address pay inequity in the NHS faced by some practitioners in NHS Talking Therapies services.
• Engaging with consultations and discussions ahead of the publication of the Long Term Workforce Plan, new mental health strategy for England, and final report of the Independent Review into mental health, ADHD and autism – and responding to them once published.

NHS employment and training

Why does the NHS require Â鶹ԭ´´ accreditation? What are you doing to show that being a registered therapist is enough for NHS work?

We emphasise to employers, such as the NHS, the skills, knowledge and competencies that all our members have. However, they make their own choices about the criteria for their staff. Our ambition is that there are more career opportunities in the NHS for all members. This includes opening up roles for newly qualified and registered members – which are currently limited.
Over the past decade, NHS England documentation and guidance has increasingly demonstrated that counselling and psychotherapy are valued and essential parts of the NHS workforce. This includes new guidance released in August on registration requirements. That’s not to say that the job at a national level is done, but progress has been made.
We continue to engage with NHS commissioners and NHS England on this.

Why can’t the NHS create more funded pathways into therapy training which lead directly to jobs on the NHS?

There are two routes into practice in the NHS.

• The psychotherapeutic counselling core training pathway is a three-year fully-funded, salaried training route for new entrants to the profession. Running since 2022, this was the first fully-funded core training route for therapists into the NHS workforce and takes a new cohort of about 60 trainees every three years. We want to ensure this is a success for students, service users and services and make the case for why these routes should be expanded.
• The paid-to-train route into NHS Talking Therapies for existing practitioners supports existing trained practitioners who are either accredited or near completion of their accreditation to take up a band 6 role in an NHS Talking Therapies service as a Trainee High Intensity Therapist. The NHS funds top up training and once completed the therapist works in the service as a Band 7 qualified high intensity practitioner.

We want to see more routes into the NHS created. Once the new long term workforce plan (which will set the workforce plan for the next 10 years), the new mental health strategy for England and the Independent Review into Mental Health, ADHD and Autism are published we should have a clearer idea of the roadmap for NHS mental health workforce over the next decade and will adjust our advocacy work accordingly.

How does Â鶹ԭ´´ respond to concerns that some counsellors may not have sufficient specialist mental health training for particular NHS roles?

It’s not uncommon for practitioners to need to undertake additional training to meet the exact criteria of different roles. We argue the NHS needs to take better account of the core skills that counsellors and psychotherapists possess and that could be used to much greater effect across the NHS. Where this requires additional top up training specific to the role or service, then this should be made available.

NHS therapy and client choice

Why does the NHS not offer a greater variety of types of therapy, as well as CBT?

Greater choice of psychological therapies is crucial. Research is clear - where service users have a meaningful choice of interventions and they’re involved in the co-design of their care, then outcomes are better.

The NHS does make non-CBT interventions available, but these are usually commissioned in line with NICE guidelines and the interventions recommended within them. CBT is recommended by the guidelines for more issues than other interventions and so CBT features more frequently in services.

We need more research data that demonstrates the effectiveness of non-CBT interventions and approaches. This isn’t just about more Randomised Control Trials, it’s also about services and individual practitioners contributing to routine outcome data collection. The more evidence we have that shows the effectiveness of different types of therapy – the stronger the arguments become for persuading the NHS and other services, to spend money on commissioning those interventions.

We’ve had success in recent years in securing a positive update to the Depression in Adults clinical guideline and we’re hoping a review to the anxiety guideline will see a similar change.

How’s Â鶹ԭ´´ promoting the value of the therapeutic relationship alongside outcome-focused treatment models?

Research shows that a big part of successful therapy is down to the therapeutic relationship. This is why choice is so important - choice of intervention, choice of therapist, choice of how and where and when you receive your therapy. We continue to advocate for choice at every opportunity.

NHS counsellors’ pay and working conditions

What’s Â鶹ԭ´´ doing about the pay disparity for counsellors employed in different NHS trusts?

We’ve supported NHS therapists in their campaign against pay inequity. Some counsellors and psychotherapists working for NHS Talking Therapies for Anxiety and Depression services are paid less than other psychological therapists working in the same services – even though they’re seeing people from the same waiting lists who have the same complexity of issues. They’re classed as being at Agenda for Change pay band 6 – which refers to being ‘in training’ – rather than at band 7 – which properly recognises their training and expertise.

We’ve worked with Â鶹ԭ´´ members in about 40 NHS Talking therapy services in England, producing a resource pack and helping to make the case to NHS Trusts and care boards on why pay equity is needed. About 20 services have now brought pay in line, worth around £10,000 per full-time role each year. Visit our pay equality support resources page.

Do Â鶹ԭ´´ members want to work in the NHS?

Member survey data shows that around 66% of members who responded would like to undertake some work in the NHS, either as their full-time role or for part of their work.

Third sector

What’s Â鶹ԭ´´ doing to ensure charities are more sustainably funded so they can afford to pay therapists and to address the significant pay disparity between counsellors employed through charities and those employed directly by the NHS?

From our workforce mapping survey, we know that one-third of members deliver all or part of their practise in the third sector. Community-based services are vital in the provision of mental health support and are increasingly relied upon by the NHS, often through referral and signposting but without funding.

Our 2024 report Bridging the gaps highlighted the challenges for third sector counselling organisations which are facing growing referrals from NHS sources but without funding to meet this increase in clients. It included a series of recommendations, including increased funding and simplified commissioning. The report was shared with MPs, policymakers, NHS contacts and other organisations. And we’ve seen some of these calls reflected in party manifestos at the last General Election and in a report by the Health and Social Care committee.

But we need greater action on this. Shortly we’ll be releasing a follow-up based on evidence from our members – and launching a campaign to publicise the report’s recommendations. Our survey completed by 119 services in summer 2026 found that 33% don’t have funds to maintain current levels of provision and that 86% are operating beyond capacity. Alongside our members, and with the support of an expert reference group of third sector service leads, we’re calling on policymakers in the four nations of the UK to recognise the vital role of the sector, increase multi-year funding that supports stability and workforce planning, and to invest to release the known unused capacity available in the third sector workforce.

If you’d like to contact our policy team directly about your experience of any of these issues – please email them on publicaffairs@bacp.co.uk.