The Class Divide in Mental Health: How Wealth Shapes Access to Care in the UK

Tez Frost
Oct 19, 2024
8 min read

Updated: Oct 20, 2024

The NHS is one of the cornerstones of the UK's commitment to providing universal healthcare. Founded on 5th July 1948, by the then Labour government[1.], with the simple principle that healthcare should be free at the point of use. It has been a lifeline for millions, offering access to essential medical services regardless of income or background. However, in recent years, the NHS has faced increasing pressure[2.] due to underfunding, staff shortages, and rising demand, resulting in longer waiting times—particularly for referrals and diagnoses of neurological conditions.

This experience can be exasperated further with social inequalities that have long been ingrained in the fabric of society. Those with financial means enjoy better access to education—whether through private schools or tutors, physical health options like personal trainers and gyms, and, as this article focuses on, greater access to mental health resources via private healthcare and counselling.

Quoting from the UK Government website article: Health matters: reducing health inequalities in mental illness[3.].

One in six of adults have had a common mental health disorder, such as anxiety, in the last week, according to survey data. Three quarters of mental health problems are established by the age of 24. Recent data indicates that there are close to 551,000 people in England with more severe mental illness (SMI) such as schizophrenia or bipolar disorder. This is likely to be an underestimate as figures only include those who are diagnosed and recorded on GP registers.

Mental illness is closely associated with many forms of inequalities. Health inequalities are avoidable and unfair differences in health status and determinants between groups of people due to demographic, socioeconomic, geographical and other factors.

These differences can be in relation to prevalence, access to, experience and quality of care and support, as well as opportunities and outcomes. Health inequalities can mean reduced quality of life, poorer health outcomes and early death for many people.

People living with SMI experience some of the worst inequalities, with a life expectancy of up to 20 years less than the general population. This is the same life expectancy that the general population experienced in the 1950s, and evidence suggests that the mortality gap is widening.

The Impact of Time: Waiting for NHS Mental Health Services

In the UK, the government measures waiting times against the 13 weeks target time for the first assessment. In December 2023, there were 172,022 patients with an open referral for suspected autism. Of these, 147,042 (85.5%) had a referral that had been open at least 13 weeks[5.]. To see the full picture the NHS[6.] quote that the whole process from receiving and accepting a referral to final diagnosis can take between 18 and 24 months. The Independent[7.] newspaper cites the NHS in crisis with 190,000 people on the waiting list with some waiting longer than 3 years for an assessment.

A recent study[7.] from Rethink Mental Illness highlights the impact of the longer NHS waiting times for mental health often causing their conditions to worsen. The delays can lead to a significant deterioration in mental health, with some individuals experiencing increased anxiety, depression, or even suicidal thoughts. Many patients find themselves in crisis, requiring emergency medical treatment or interactions with law enforcement due to their distress, which adds further strain to emergency services.

For some, the prolonged wait means they need to take time off work, and in more severe cases, they even lose their jobs, which adds financial stress on top of their health struggles. As a result, many individuals turn to private healthcare, despite the cost-of-living crisis, further emphasising the inequality in accessing mental health care.

Even once they receive treatment, patients often report that the support is insufficient or too brief to be truly effective, leaving them without the continuity of care they need. Overall, long waits for mental health services exacerbate the challenges patients face, with far-reaching consequences for their well-being and broader public services.

Summarising the key statistics from the report[7.]:

Charity calls on next government to ‘fix the mental health system’ as majority of people who attempted to access mental health services within last two years feel they weren’t seen quickly enough, with four in five experiencing a deterioration in their mental health.
One-third of people whose mental health worsened while waiting for treatment took time off work, with some respondents stating they lost their jobs.
Wider impact on public services highlighted, with people needing emergency medical care and coming into contact with police as mental health worsens.
One-third turn to private mental health treatment amid cost-of-living crisis.

The Cost of Private Mental Health Care

small colourful plastic people — Class Divide: shorter waiting times through private healthcare

When considering the cost of seeking a private diagnosis for neurodivergent conditions like ADHD and autism, there are several important factors to account for, as the financial burden can be substantial.

Private Diagnosis: Obtaining a diagnosis for ADHD or autism through private healthcare typically involves initial assessments with specialists such as neurodevelopmental doctors or clinical psychologists. The cost of these assessments can vary widely but often ranges from £800 to £2,000 or more, depending on the complexity of the case and the provider.

Therapy and Counselling: Once diagnosed, regular therapy or counselling is often recommended to help manage the emotional and behavioural challenges associated with neurodivergent conditions. Private therapy sessions can cost anywhere from £50 to £150 per session, depending on the therapist’s qualifications and location. Over time, weekly or bi-weekly sessions can become a significant expense, especially if long-term support is required.

Psychiatrist Appointments for Medication: For individuals needing medication to manage conditions like ADHD, ongoing appointments with a psychiatrist are necessary to monitor the effectiveness of the treatment and make any adjustments. These appointments, depending on the frequency, can cost between £100 and £300 per session, with more regular check-ups required initially.

Prescription Costs: Once a medication plan is in place, the cost of the prescription itself must be considered. If medication is prescribed privately, patients will need to pay for each prescription. In the UK, a private prescription fee can range from £25 to £50 per month, depending on the medication.

Monthly Medication Costs: Finally, the ongoing cost of the medication itself is a key consideration. Medications for ADHD, such as stimulants, can vary in price but may cost anywhere from £100 to £200 or more per month. The cost will depend on the type of medication prescribed.

Overall, the financial commitment of pursuing private care for neurodivergent conditions involves both initial diagnosis and ongoing treatment costs, which can add up quickly. For many, weighing these expenses against the benefits. It is also highly recommended to involve your GP if you go down this route as not all NHS services will officially recognise the results.

It's important to mention the controversy surrounding private diagnoses. A 2023 BBC Panorama investigation followed Rory Carson, who received three ADHD diagnoses from private clinics, despite a leading NHS consultant concluding he did not have ADHD. In one case, the assessment lasted just 45 minutes and resulted in both an ADHD diagnosis and a prescription for stimulants. This example highlights the need to exercise caution when seeking private healthcare. Thorough research is essential—something often associated with autistic traits—before deciding on a provider.

In my own experience, I used the private company Psychiatry UK, which, at the time, was funded through the NHS "Right to Choose" scheme. They conducted a series of online consultations, questionnaires, and interviews with my family members. It took several months from the initial screening to receive my autism diagnosis.

My wife followed a similar process for her autism diagnosis, but opted to pay privately for her ADHD assessment. She used a psychiatrist recommended from a Bupa-provided list and followed a process similar to what I experienced with Psychiatry UK. After completing titration to find the right medication, the psychiatrist set up a shared-care agreement with her GP (local doctor). This allowed the NHS to cover the medication costs, provided my wife continued to see the private psychiatrist for follow-up appointments every six months.

"There's no doubt that many people who go private will have ADHD. But my investigation shows how some clinics hand out unreliable diagnoses - and that can put vulnerable patients at risk." - Rory Carson, BBC Panorama.

two men sat down talking with round coffee table — ADHD: Private clinics exposed by BBC undercover investigation. Rory Carson. BBC Panorama[8.]

The Societal Impacts of Private Diagnosis and the Way Forward

The societal impacts can run deep for those in lower socioeconomic brackets who may already be struggling, creating a further burden. Contrast this with individuals from higher-income households who can readily access services, medication, and follow-up care without worrying about costs. This class divide redefines mental health care as a luxury.

With the NHS founded on socialist principles, the government-funded safety net wears thin with free-market capitalism filling the gap in reduced resources, perhaps it is time to re-address the balance. Several options lay on the table for future discussion:

Increase NHS Funding for Mental Health: Greater funding and prioritisation of mental health services within the NHS, reducing waiting times and providing more accessible, comprehensive care for all.
Introduce Subsidised Private Care Options: Government subsidies or insurance options for private mental health services, allowing those from lower-income households to access care without bearing the full financial burden.
Community-Based Support: The development of community mental health initiatives that provide free or low-cost counselling and therapy to those in need.
Digital Solutions: Increased use of digital services to help reduce the strain on NHS services and provide quicker access to care.

Exploring digital solution in more detail, a 2023 report[9.] from the NHS Confederation entitled: " Maximising the potential of digital in mental health" lays down a potential roadmap to reduce the class divide in accessing mental health care by overcoming key barriers traditionally faced by lower-income individuals:

Improved Accessibility: Digital mental health platforms can provide access to care for people in remote areas or those who can't afford frequent in-person visits. Tools like telemedicine, online counselling, and self-help apps make services more widely available, regardless of geographical or financial constraints.
Lower Costs: Digital interventions often come at a lower cost than in-person therapy or private treatment, making them more affordable. Services like guided meditation apps or online therapy sessions can be more financially accessible, providing support at a reduced rate or even for free.
Early Intervention: Digital tools can monitor mental health indicators and offer early interventions before conditions worsen, preventing more serious, costly treatments. This reduces the likelihood that only wealthier individuals, who can afford private care, receive timely interventions.
Reduced Stigma: By allowing individuals to access care privately from their own homes, digital tools can make mental health support less stigmatized and more appealing to those who might feel embarrassed or judged when seeking help in person.

Conclusion

In conclusion, the growing divide in mental health care access highlights the urgent need for change. Longer NHS wait times push many toward costly private care, deepening inequalities and the need for the government to redirect its funding policy. However, the promising area of digital solutions offer a promising path forward—boosting accessibility, reducing costs, and delivering early intervention. By embracing technology, increasing funding, and providing subsidised care, we can bridge the gap and create a more equitable mental health system for all.