Here are two sneaky ways to try and ensure that you get good treatment for a serious mental health condition — one for private patients in the UK, and one for NHS patients. They involve a very small and short-lived pretence, not exactly a lie…
The problem we want to solve concerns the seriousness of your mental health condition. The word “serious” here means that your life is very significantly disrupted or threatened. For example, perhaps you cannot do many of the things that normal people do, or perhaps you are at risk of harming yourself or other people because of your mental ill-health.
This is a problem because not all therapists can handle serious conditions. Some therapists, particularly (but not exclusively) unregistered therapists, only handle cases where it does not matter much whether therapy succeeds or fails. You do not want a therapist like that. For example, if you have had serious depression for the last ten years, it disrupts your work and family life, and your GP and practice counsellor have not been able to come up with anything that helps, then you do not want a therapist who can only offer lifeskills training.
The solution depends on a non-profit organization called BUPA, which is the leading healthcare insurer in the UK. (If you are a member of BUPA, and if your insurance covers mental health, then you can stop reading now because what follows does not apply to you.)
BUPA has a secret list of CBT therapists. All these therapists receive referrals from psychiatrists, so they can all treat serious conditions. In fact, BUPA members cannot get their CBT treatment paid for at all without a referral from a psychiatrist to a therapist on the list. What you need to do is to get access to that secret list.
The sneaky part
Here’s the sneaky part. BUPA also has a range of insurance policies with different levels of benefit, and various terms and conditions. As a result, BUPA members are often confused about exactly what they are covered for. You can exploit this confusion to get access to the secret list — not full access, but enough, even if you are not a BUPA member.
To exploit the confusion, you pretend that you think you might have BUPA cover. The next day you admit that you do not have BUPA cover after all. No one will question this, because BUPA members are often uncertain about whether they have cover or not.
If you are questioned about your BUPA membership you simply say, “I’m sorry, I don’t have any of the paperwork here right now,” which is completely true.
What to do
Making this work is easy, but not entirely simple because there are several steps.
Start with the UK register of CBT therapists: CBT Register UK
Search for therapists in your area. Ignore the conditions and methodology sections. If you don’t get many choices, remember to search neighbouring counties.
Now telephone the therapists and ask them the following questions. You make up to two telephone calls to each therapist. If the therapist gets all the questions right in the first call, you telephone again after a few hours or the next day, to follow up with a second call.
If a therapist gives a wrong answer, terminate the call and cross that therapist off your list: “OK, thank you. You have been very helpful. Can I call you back when I have decided what to do?”
If a secretary answers, that’s OK. If the secretary cannot answer one of the questions, ask when you could call back to get the answer. You don’t necessarily need to speak to the therapist in person. Offer to call back the next day with an approximate time: “Would you be able to tell me the answer if I call back tomorrow afternoon?”
The first call
Q1. Do you provide CBT for private patients?
Correct answer: “Yes.”
Correct answer: “No, REBT actually” (REBT is as near CBT as makes no difference.)
Wrong answer: “No.”
Wrong answer: “Yes, behaviour therapy.” (BT is not CBT. Don’t let anyone tell you it is.)
Response to a wrong answer: “Oh, I’ve been recommended to have CBT. Thank you anyway.”
Q2. Are you a BUPA provider?
(BUPA is always pronounced as a word, like: BOO-pa)
Correct answer: “Yes”
Wrong answer: “No”
Response to a wrong answer: “Oh, I’m looking for a BUPA provider. Thank you anyway.”
Note that you have not told any lie by asking this.
Q3. Can you tell me your provider number?
Correct answer: “No, you don’t need it. Call the BUPA hotline to confirm that I am on their list.”
Correct answer: “Yes, it’s xxxxxxxx” (An eight-digit number)
Wrong answer: “Oh, BUPA…I made a mistake. Did you want a BUPA provider? I can apply for a number tomorrow…in fact I think it’s in the post…”
Response to a wrong answer: “Oh, I’m looking for a therapist who is already a BUPA provider. Thank you anyway.”
This is really only to confirm the answer to Q2, in case some secretaries bluff.
Q4. Can I refer myself for treatment, or do I have to go through my GP?
Correct answer: “You need a referral from your GP to a BUPA psychiatrist, then a second referral from the psychiatrist to me.”
Wrong answer: “Yes, you can refer yourself.”
Wrong answer: “Your GP can refer you.”
Response to any answer, right or wrong: “OK, I need to talk to my GP first. Thank you anyway.”
The purpose of this question is to give you an excuse to terminate the call. The reason for terminating the call is that you need to back out of your BUPA pretence.
At the end of this first call, you have established whether the therapist is a BUPA provider. You know that BUPA providers get referrals from psychiatrists, so you know that this therapist can work with serious conditions.
The second call
In the second call you back out of your BUPA pretence, and you actually make an appointment, if you can afford the price.
Your serious condition means that you should budget for up to twenty sessions. At a typical price of £100 a session, that’s £2000. But prices vary from around half that to around twice that. Also, some mental health conditions are not so serious as they first appear, so you might not really have to pay for as many as twenty sessions.
Additionally, condensed treatment can sometimes be beneficial. For example, a therapist might agree to condense the treatment into just ten sessions to bring the cost down even if you ideally should have twenty.
Anyway, as a rough guide, divide your budget by 20 to get your maximum session price. For example if you can afford £3000, call that £150 per session.
Here are the questions for the second call:
“I called earlier about CBT. I’m having to pay for this myself. Can I have an assessment first, and then think about whether to proceed with treatment?”
Correct answer: “Yes.”
Wrong answer: “No, you have to agree to treatment.”
The reason for this question is to ensure that you can back out of the whole thing if it turns out you don’t like the therapist. There is more information about this in the previous article here.
If someone challenges you about BUPA, just dismiss it: “Oh, it turns out I’m not covered for mental health.” (Which is, of course, completely true.) This is such a common occurrence that no one will question it.
“How much will an assessment cost?”
Correct answer: a figure of around £100 — which means anything from about half that, £50, to about twice that, £200. It’s up to you how much you are prepared to pay. However, less than £50 or more than £200 should make you suspicious.
If you can afford twenty sessions at that price, skip Q7. If you can’t afford it, then…
“If I can’t afford the complete course of treatment, would there be any benefit in having a limited number of sessions?”
Correct answer: “Yes, you can discuss that in your first session.”
Wrong answer: “No, you must have the full course of treatment.”
And then, if you feel comfortable about it, go ahead and make an appointment for assessment. You might want to ask other questions of your own in this second call — it’s up to you.
How does this help if you are an NHS patient? It doesn’t help in the same way.
One of the problems in the NHS is that you might be stuck in primary care, where perhaps no one is good at understanding serious conditions. You can’t get referred to secondary care (where the experts are) until you have been properly assessed. And you can’t be properly assesed until after you have been referred to secondary care. Deadlock.
The trick is that you are allowed to jump out of NHS care and back again. You are even allowed to mix NHS and private treatment. For example, you can have NHS drugs together with private CBT. In this case the trick is to pay for a private assessment, then follow up with NHS treatment.
Although this kind of thing has been controversial in relation to “top-up” treatments where very expensive drugs are used, there has really never been any problem with joint NHS and private care in mental health. NHS and private practitioners will almost always be happy to work together to help you recover.
This means you can break the NHS primary care / secondary care deadlock by getting a private assessment. It will cost you up to around £200 (perhaps plus travel, perhaps plus time off work). Follow the sneaky procedure described above, so that you get a CBT therapist who is familiar with serious conditions.
Explain that you cannot afford private treatment, only the assessment. Ask the CBT therapist to contact your GP with the results and to send you a copy. You do not need a full written report, which would cost a lot more, just a brief indication of what is wrong with you and what has to be done to treat it.
Most GPs will take notice of an assessment by a respected CBT therapist. If your GP is an exception to this, change your GP immediately.
As a bonus, some private CBT therapists also do NHS work or know individual NHS therapists personally. You might get a good recommendation. You might even get a direct referral. In rare cases, the therapist might arrange a transfer to his own NHS department for NHS treatment. However, these bonuses are not things you are entitled to expect. The plan here is simply to provide your GP with good clear information about your condition and how serious it is, giving your NHS treatment a sense of purpose and direction.