On Monday morning I did two things to start my day. First of all, I scanned my face on the Santander app to check my current account. Second of all, I emailed my therapist to let him know that I would be cancelling our appointments, and would hopefully be able to resume them in October, subject to how much my energy bill was.
I recently tried to become a person who can prioritise – and more importantly, who can afford – private therapy, and then quickly realised I was not a person who could do that.
When I spoke to friends who had attempted the same, I realised I wasn’t alone. Like me, they’d completely abandoned any kind of Tony Soprano fantasy of regular check-ins with someone they could pay to listen to their problems. Others hadn’t cancelled totally, but had found workarounds, like paying for Zoom therapy instead with professionals based so far out of London that their rates were cheaper than what they would have paid face to face.
A recent article for The Guardian by one psychologist argued passionately that personalising our mental health struggles was nothing more than a collective lie meant to distract us from the political, societal roots of our distress. “Doesn’t it make sense that so many of us are suffering?” asks Sanah Ashan. “Of course it does: we are living in a traumatising and uncertain world.”
Ashan argues for fewer therapists, for less individualism, for more of a focus on structural change that would actually make our lives better. There are of course counter arguments to this; that attributing all of our personal problems to the structural and political is over-simplistic. An article in Gawker challenged the idea that our individual inability to cope can be totally blamed on capitalism, arguing that acknowledgement of our collective failure to cope is too easy if we blame it on society; that this “avoids the personalisation of pain”.
Yet it’s true that money worries, and worries about the state of the world in general, are something that weigh heavy on us, a weight that many of us choose to express in mental health settings. Until we can’t afford to do so.
When it comes to our finances the link is pretty damning: one in five people with mental health problems are in problem debt, while in one survey, 86 per cent of those surveyed who had experienced mental health issues said that their financial situation had made their mental health problems worse. If you can’t afford therapy, this becomes a vicious cycle.
“I would say 70 per cent of people who are in therapy are in therapy not because of their upbringing,” explains American author John Hodgman, “not because of their mean sister or obsessions, but because of anxiety brought about by lack of financial security.”
But therapy’s ability to deal with those worries and financial insecurities is limited. Cognitive behavioural therapy (CBT) can teach us emotional control and to reframe our problems, but all the “mental toolkits” in the world can’t protect us from a winter so bleak it’s already led to breakfast TV hosts auctioning off energy bills as prizes.
“Therapy and medication are pointless when the problem is situational,” one recent tweet reads. “You can’t therapy your way out of not being able to afford the bills. Sure, you might be at the brink of becoming homeless but at least you can identify that black and white thinking pattern!”
This kind of argument, motivated by nihilism, by annoyance, is becoming more prevalent on social media. “I need therapy but I can’t afford it because I lost my job and then I get anxious thinking about it and how I need it and I can’t afford it and that spirals me to need therapy even more and it is just this ongoing vicious cycle and life sucks,” says one person.
“Yes medication and therapy has its place,” acknowledges another, “but not without acknowledging systemic, structural inequalities. If our new government wants to prevent a worsening mental health crisis, it needs to address the cost of living crisis.”
Luckily, you don’t have to decide which side of the argument you come down on if you can’t afford to therapise yourself anyway. And increasingly, as Britain spirals into a winter defined by a cost of living crisis, we can’t. With energy bills set to reach nearly £5,000 from January, yeeting yourself off the waiting lists and trying to pay for private therapy increasingly seems an extravagance and luxury.
The timing couldn’t be worse either: the isolating effects of lockdown and the overhang of grief and trauma from the pandemic, research has illustrated, has only led to an increase in people seeking therapy. The British Association for Counselling and Psychotherapy (BACP) says demand is higher for therapy now than ever before: in 2021 they observed a 58 per cent increase in monthly enquiries to therapists listed in its directory, compared with 2019, with 33 per cent of people saying they had consulted a counsellor or psychotherapist, according to a BACP survey with YouGov, up from 21 per cent in 2010.
“The cost of living crisis can only exacerbate the situation,” says Julie Bass, the chief executive of health and social care enterprise Turning Point UK.
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Of course, private health care is a privilege, even if it’s a privilege motivated by need, even if it’s a situation created by austerity, even if it’s a privilege nobody should in theory have to access. Twelve years of continuous Tory rule has decimated the NHS, in particular mental health services, making it more and more difficult to access care as cutbacks reduce services and waiting lists spiral out of control.
Before my albeit brief experience with private therapy, I waited 18 months on waiting lists for NHS counselling, being passed from anonymous case-worker to case-worker before eventually ending up with, when the pandemic hit, 12 weekly sessions of CBT administered over Zoom in my living room. And my experience is still better than most.
There are plenty of horror stories about people who have died while on waiting lists for treatment; in 2021, the NHS received 4.3 million referrals for anxiety and depression alone. It’s not a huge ideological leap to imagine that those numbers will continue to increase with the cost of living crisis, and that the shelled-out NHS will continue to struggle to cope with the pressure.
When almost five million people (discounting those who haven’t been referred, which would undoubtedly send the figures into greater millions) are dealing with the same problem, we have to at least acknowledge that it’s a collective issue, and one we should deal with collectively. Individual therapy can only do so much, and increasingly, we can’t even access it to do the bare minimum.
Even mental health professionals themselves are now looking to the cost of living crisis as a contributing factor for patients. At what point does the onus move off us, as individuals trying to improve our mental health, and off the mental health professionals individually trying to help us, and move back to the politicians at the heart of many of the issues that are sending us in droves to therapy in the first place?
There are times I look at the world and feel nihilistically certain that nothing can get better. Is it a therapist’s job to convince me, convince any of us otherwise? Realistically, can they? Or is that just paying for the privilege of someone to metaphorically stroke my hair and soothe my anxieties while the world burns around us and I save money for my electricity bill by showering at the gym?
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