The Postcode Lottery of Psychological Therapies



If you think disparity is just between Physical Health and Mental Health think again, there is disparity even within various streams of Mental Health budgets. Yes it’s not just one big pot of NHS funding, it’s broken down into smaller pots of money held and managed by various Clinical Commissioning groups (CCG’s) throughout the UK.

The CCG’s have control of various pots of funding, they might have contracts with a local NHS trust, or a contract to an external provider for specialist services and then there is the rather isolated pot of funds for Secure Forensic Services. Each pot will no doubt be managed independently of one another and the pot holder is known to be very protective of their little pot of funding.

This means if they are faced with a client with complex needs such as Dissociative Identity Disorder they may feel it’s not within the parameters of their budget to fund a service. Instead they may choose to do nothing, ignore the clients needs and tell the NHS trust locally to try and sort this patient out within regular services. Or they might choose to pass the buck and ask their colleagues in Specialist services to think about funding a specialist psychological therapy geared towards such clients and that is deemed beneficial. Specialist services may choose to accept this client or try and either pass them back or ask if the client needs a forensic service to offer said treatment and if so pass the buck to the Forensic services budget holder.

Sound complicated, well it is and what’s more it’s not cost effective never mind client focused, if you think this doesn’t happen think again as sadly it does. What we have here is a postcode lottery that exists within the NHS and it is a nightmare. We also have self absorbed individuals who protect their budget at all cost and do not look at the bigger picture.

Let me explain this is detail. In Cheshire there are numerous CCG’s some spend more on Mental Health than others, some commission long term psychological therapy for those with Complex Dissociative Disorders or complex trauma. Yet the harsh reality is some CCG’s are so blinkered they don’t and that creates a very un-level playing field within which people have to navigate getting the healthcare they need.



The sad fact is those CCG’s which don’t offer specialist psychological services are actually wasting more money than they save, research of one such specialist psychological intervention program in Cheshire shows that the cost saving per client per annum was £20,000. (The role of Clinical Psychology, British Psychological Society 2014).

Research clearly shows that by training and equipping a psychologist within the NHS to treat those with Dissociative Identity Disorder the cost saving per client is huge. The quality of life improvement is priceless and yet it doesn’t happen everywhere, it doesn’t even happen in the same county across different CCG boundaries. This is ludicrous it’s a waste of valuable NHS resources and it’s hellishly frustrating for the clients stuck within this postcode lottery.

I happen to live in Cheshire, just the wrong part it transpires and as such if I needed to access NHS services here I’d be treated according to Cheshire and Wirral Partnership NHS foundation trust ‘within a wider treatment model rather than as standalone cases’ as happens in the east of the county. This care would be using a regular time limited CBT type therapy, with long waiting times and limited success. A year of CBT if I’m lucky won’t even scratch the surface of my needs and the cost of in-patient care or crisis support that would be inevitable will be far higher than the cost of long term psychological therapy.

Despite everyone knowing it saves more money to offer specialist long term therapy it doesn’t happen and why, well after attending the AGM of the foundation trust this week I was told that my CCG West Cheshire won’t fund the care, care that is clearly needed by people with D.I.D, saves valuable NHS funds and gives people back their lives. I was also made aware that certain CCG’s spend less in percentage terms of their pot of funds on Mental Health than others, how can this be right or fair?

Over the coming weeks and months I will be asking questions of the local CCG, the health secretary and others because whilst I may by default be accessing a great service; purely due to having being sectioned under the Mental Health Act in the past, many others won’t be. Instead like many people I meet throughout the UK and Overseas they will either be struggling to fund their own psychological therapy, receiving inadequate care or none at all.

It’s time we stopped the disparity, it’s time we stopped this unacceptable treatment of those who have already suffered enough. If I had a broken leg I would not be told to wait a year for a cast, if I had a brain tumour I wouldn’t be told I couldn’t see a specialist and instead had to make to do with a student nurse. So why should those clients requiring long term psychological input be treated like third grade citizens, we shouldn’t. I’m willing to fight, are you?



Research papers : National Mental Health: Well Being and Psychological therapies – the role of clinical psychology 2014  British Psychological Society

How investing in therapeutic services provides a clinical cost saving in the long term 1 September 2011 By Mike Lloyd HSJ Health services Journal

Copyright DID Dispatches 2014



6 thoughts on “The Postcode Lottery of Psychological Therapies

  1. I tried to get treatment on the NHS and it was such a horrible experience. It makes me teary just thinking back on it. I was bounced around from pillar to post, and even when I ended up in the Trauma Service, no one knew what to do with me or could work with me for the length of time that is required for those with dissociative disorders. I have a wonderful therapist now but that’s because I spent a lot of time, energy and effort researching local therapists, who have good understanding and experience, and could work with me without completely crippling me financially. I consider myself lucky to have the therapist I do and she has been incredibly kind by reducing her rates for me. Still, it’s wrong that there isn’t consistent NHS treatment across the country for people with DID and other dissociative disorders. It’s wrong that there is huge ignorance, lack of training and even fear amongst those who work for the NHS when DID has been a recognised condition for years. So painfully often in the last few years and ongoing there have been stories of abuse scandals hitting the media. Early childhood trauma is considered to be the main cause for someone developing DID and it (abuse) is evidently significantly more common than people would like to think. So, wouldn’t it make sense, therefore, to consider then that maybe, possibly, there are many more people in this country, who are struggling with DID, than are known about? Really, the NHS is doing a great disservice to those of us with DID by not using common sense. Haven’t we already suffered enough?

    • Hi Hannah I couldn’t agree more, I think it’s so wrong people with D.I.D are failed by the health system. Like you say, we have all suffered enough and we deserve far better treatment. My hope is one day it will happen until then we keep fighting. C x

      • I think that the more people are failed and not able to gain access to services the more this will result in people in crisis, and in some cases attempting suicide. It would be useful if research was available to demonstrate the link between lack of services and support with levels of suicide, the disparity in suicide rates may well reflect those areas with better or worse MH provision.

  2. i would like to support your attempts to get psychological therapies consistently available and also to promote better recognition, treatment and understanding of all forms of dissociation across the uk. I have DID but had a 40 year misdiagnosis and incorrect treatment which has robbed me of so much despite being a qualified nurse, midwife and councellor,My son has just been taken away by the police back to hospital ( where he has spent 15 of the last 18 years and I believe he also has a mis- diagnosis, but we have been unable to access psychological treatment for him either. The waste of money and life is staggering. We are both victims of very early and prolonged abuse which my father perpetrated on at least 6 children , one of whom took her own life at the age of 11.
    After a year in hospital my CMH services discharged me a year ago, without any follow up or support, to live alone for the first time for 35 years, ( despite the fact I have a serious physical disability) and tryin to get help has been a renewed trauma.I am trying to start a scheme here ( a community garden ) but the lack of any support AT ALL has put me in terrible situations. Good luck and best wishes with your efforts and recovery

    • Thanks Christine for your support. I’m so sorry you and your son have been failed by mental health services. I hope your community garden scheme is successful. I hope you are able to get the help and support you need for yourself and your son. Take care C x

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