Private Mental Health Care or Public Health Service? 12 Questions to Ask Yourself

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by Andrea M. Darcy

The rise of online therapy now means that booking private mental health care is more accessible and affordable than ever.

But the NHS (public health care in the UK) still provides a good service for many people.

What are the main differences you need to know between public and private mental health care?

Private mental health care vs NHS therapy

The main differences between a privately booked therapist and one booked through the national health service (NHS) are around:

• wait times
• types of therapy
• length of therapy
• choice of therapist and therapy
• privacy
• cost.

12 Questions to ask before deciding to book private counselling

Here are good questions to ask yourself before you book private mental health care or call your GP.

1. How fast do I need help?

Private counselling can be very fast. Assuming your preferred therapist is taking clients, you generally will be offered a session within a week or so. 

(Our new site can see you talking to a registered and qualified therapist within 24 hours).

Depending on your area, NHS counselling for things like anxiety and depression can be quite a wait. Some boroughs in London, for example, report waits of up to or even over a year for in-person sessions!

2. How much am I willing to pay for therapy?

By: Victor

The main benefit of going through the NHS is, of course, the free price tag. But if you need help now, then waiting months or even over a year for free therapy can actually end up costing you.

Being depressed or anxious can mean you overspend money to feel better, don’t manage to find new clients for your business, drop out of school after paying tuition, or even lose your job. So in some cases getting help you pay for saves you a lot in the long run. It’s worth thinking through — read our article “How Therapy Can Make You Money“. 

There are also various ways to find therapy to suit your budget. Online therapy is often cheaper, or you can find low cost counselling with a trainee therapist. And do check your work insurance policy to see if any sessions are covered. Read our article on ‘Free and Low Cost Counselling” for more.

3. Do I want a good therapist? 

This one has nothing to do with whether a therapist is private or through the NHS. In fact many therapists work both privately and with NHS clients.

Therapists are people, with all the flaws that can bring. And like with any profession, there are those who are good at their job and those who are not.  You’ll find some truly great therapists within the NHS. As well as some not-so-great ones who are private. Of course if you are seeing a private therapist you don’t like you can just switch, not so with the NHS.

And note that even a good NHS talk therapist might be far more rushed than they would be if you booked them privately. And you might have to go to a location that is very clinical or run down over a nice private office to see them. 

4. How many people do I want to go over my issues with?

With a private mental health care, you go through your mental health history just with your therapist.

With the NHS, you might have to talk through your mental health history with several people. First you discuss things with your GP. Then you receive a call from a mental heath practitioner who takes your entire history over the phone. If you are lucky enough to be offered a therapist, he or she will need to hear the whole story again.

On a good note, you can avoid some of this palaver if your area is covered by the self-assessment services the NHS has been rolling out. Applying can be as easy as filling out a form online. Try putting your post code into the NHS IAPT tool, which will pull up all mental health services in your area, clearly stating which ones can be self-referral.

5. Do I think a self-help course might be enough to help me?

If you feel you are only struggling with mild depression or anxiety  and decide to use the NHS, you might be offered a free online mental health program instead of sessions with a therapist. This means you work through a series of exercises on your own time and tend to have email access to a mental health professional.

These free online mental health tools and self-help courses have been shown to be effective. And they are something you can be offered with little to no wait time. They might be perfect for you, especially if you find the idea of talking to someone intimidating. 

6. How much do I value my privacy?

By: Caoimhín Düytes

All therapists, whether booked privately or through the NHS, respect your privacy.

But sometimes with the NHS you are required to go to an ‘introduction session’ after your phone assessment. This will be held in a public health space such as a room at a local health centre and you’ll be placed with other members of your local community also seeking support. If you like privacy, this can be a huge issue.

Also note that private therapists tend to have discreet offices. If you are seeing an NHS therapist, on the other hand, then you might be sent to a busy local medical centre with many people in the waiting room for different specialists, risking seeing people you know. Or even have to go to appointments in a hospital setting, which for some people can create more anxiety than the very act of attending therapy already does for them.

7. What do I want on my medical record?

Nobody who isn’t a medical professional has the right to access your medical records without your consent, barring if you make an insurance claim. But of course if you go see an NHS talk therapist then any doctor or specialist you see through the NHS will see this in your file.

And if you are given a mental health diagnosis such as borderline personality disorder it will be pinned to the top of your file as an ‘alert’. This has led to people filing complaints for being dealt with in a way that feels biased when visiting other health practitioners. 

If the thought of such an invasion of privacy makes you anxious, then rest assured that if you book therapy privately it does not go on your medical record. The only reason it would would be if you booked with a psychiatrist and decided to go on medication. Most psychiatrists want to confer with your GP about this.

8. Do I want to choose the type of therapy I try?

If you book privately, you can choose any type of therapy you want.

The NHS, on the other hand, will give you the type of therapy they feel best. And they tend to use a limited variety of therapies, veering toward shorter-term, cost effective therapies, like cognitive behavioural therapy (CBT).

9. Do I want to choose the therapist I work with? 

With NHS counselling, you are assigned to a therapist. If it doesn’t go well and you don’t want to work with them, you can raise the case, but good luck getting another one without a battle.

But with private therapy you are in charge. If after several sessions you decide a therapist isn’t for you, then by all means find another one.

10. Do I think I need medication?

A counsellor, psychotherapist, or counselling psychologist in the UK does not have the power to prescribe medication. If you need medication you will be referred to a psychiatrist. Even if you book a private psychiatrist, they usually want to contact your GP and let him or her know you are taking medication.

11. Is the mental health diagnosis I think I need recognised by the NHS?

The NHS does not easily recognise all mental health conditions like, say, America. A key example here is adult ADHD. While treatment on the NHS is now available, getting to it is notoriously difficult. Many GPs are still loathe to recognise adult ADHD as a real problem and might simply refuse to refer you one of the limited ADHD psychiatrists or centres available. If you are one of the lucky ones who gets referred, the waitlists are extremely long, even over two years.

12. How long do I want to be in therapy?

Again, the NHS veers towards shorter-term therapies. like cognitive behavioural therapy (CBT). You are offered a certain amount of therapy and that’s it, even if you want more, unless they decide you really need it.

If you feel you want to be in open-ended therapy that finishes when you decide you are ready, or want to try a long-form therapy, then private mental health care is probably the way forward.

Private therapy versus NHS therapy, is it worth it?

The NHS is a great resource for many people and it is wonderful it exists. But if you can afford it, private therapy does offer far more options and privacy. It can feel less rushed and be in nicer offices. Plus there is no limit on how many sessions you can choose to have.

If you feel the NHS can provide what you need, and you have the courage to speak to your GP, then you can always get yourself on a waitlist and seek a private therapist in the interim. You can then decide when a NHS therapist is offered if you’d rather make the switch. What matters most is that you reach out and get the help you need.

Harley Therapy connects you to a team of highly regarded and experienced therapists in central London or online. For therapy for all budgets and all locations try our therapy booking site. 

Andrea M. Darcy is a health and wellbeing writer as well as mentor, trained in person-centred counselling and coaching. She often writes about trauma, relationships, and ADHD. Find her on Instagram @am_darcy