Mapping of Mental Health Counselling Services in the City of Edinburgh On behalf of Edinburgh s Strategic Development Group for Mental Health Jan 2008
CONTENTS Page 1. Summary of Findings 3 2. Purpose of Exercise 4 3. Scope of Exercise 5 4. Purpose and Locality of Counselling Services 7 5. Sources of Referral 10 6. Counselling Models Employed 10 7. Nature of People Supported and Their Issues 11 8. Counsellors, Capacity and Length of Support 11 9. Demand and Prioritisation 12 10. Client and Counsellor Fees 12 11. Quality Assurance 13 12. Funding 14 13. How Counselling Services Link into Wider Mental Health Networks 15 2
1. SUMMARY OF FINDINGS There are 17 generic (52% of organisations) and 16 specialist (48% of organisations) mental health counselling services in the City of Edinburgh. There are 19 city-wide (58% of organisations) and 14 sector-based (42% of organisations) counselling services. Some sectors (e.g. North West Edinburgh) are better served than others. NHS staff, particularly GPs, make the most referrals or recommendations (i.e. suggesting a person use counselling) to mental health counselling services. In total, the mapped counselling services employ over 341 counsellors (69% being volunteers) and provide over 1,000 sessions of counselling per week. 13 (41%) of the services provide time-limited counselling. The rest provide open-ended counselling or a combination of both. The majority of services have a waiting list. Few have protocols for prioritising their caseloads. 72% of the services are free. The rest have a wide variety of ways for charging a fee / inviting donations. 20 (62%) of the mapped counselling services are organisational members of a professional counselling body. At the time of the report, 6 organisations (19%) said they had achieved accreditation with a professional counselling body. 5 said they were in the process of doing so. 21 (68%) of the mapped counselling services require their counsellors to be members of a professional counselling body. 5 (17% of organisations) also required their counsellors to be accredited with a professional counselling body. In total, the mapped services received statutory funding of over 933,000 in 2007/08: 488,000 (52.5%) NHS Lothian; 321,000 (34.5%) City of Edinburgh Council; and, 124,000 (13%) Scottish Executive funding. 3
2. PURPOSE OF EXERCISE 2.1 The purpose of mapping mental health counselling services in the City of Edinburgh is to inform their planning and development. 2.2 Lothian Joint Mental Health and Wellbeing Strategy 2.2.1 The Strategic Development Group for Mental Health contributed to the Lothian Joint Mental Health and Wellbeing Strategy. It says: 2.3 Previous surveys psychological therapies [including counselling] should be routinely considered as a treatment option when assessing mental health problems and that there is a need to improve access to therapies across Lothian by ensuring that those involved in their delivery are integrated within wider networks. Key to this approach is the definition of clear pathways which will resolve multiple assessments where this still occurs; reduce long waiting times and ensure greater geographical availability across Lothian s localities to psychotherapeutic help for different psychological conditions. This will ensure that people are receiving access to the range of treatment options at the appropriate time and place in their journey. 1 2.3.1 The University of Edinburgh completed a national survey of voluntary sector counselling in 2003 2 and Edinburgh Voluntary Sector Counselling Services Forum (EVSCSF) regularly pulls together information about its members. 1 Developing and implementing a stepped care model across Lothian: Recommendations for Action (Lothian Psychological Interventions Network, October 2006). 2 Bondi, Fewell, Kirkwood and Arnason (January 2003), Voluntary Sector Counselling in Scotland: an overview (University of Edinburgh). 4
3. SCOPE OF EXERCISE 3.1 For the purposes of this exercise, mental health counselling services were defined as: Meeting the COSCA (Counselling and Psychotherapy in Scotland) definition of a counselling service: An explicit contractual agreement where the practitioner and the client contract to enter into a counselling / psychotherapeutic relationship, offered in privacy and confidence, to work towards living in a more satisfying and resourceful way. Counselling / psychotherapy is the only purpose for which practitioner and client meet. The definition includes work that is both time-limited and long-term, as well as work with individuals, pairs or groups. It may also include counselling which is not face-to-face. 3 Employing counsellors who have previously or are currently completing training to diploma level on a recognised course; or who have successfully completed a course approved by a professional counselling body; Based in and serving the City of Edinburgh; A charitable organisation and / or funded by the public sector; For adults, families or carers; Receiving regular referrals or recommendations (i.e. suggesting that an individual use counselling) from statutory mental health services; and Generic (i.e. supporting anyone with any issue) or specialist (i.e. supporting a particular group of people or dealing with a particular issue). 3.2 The exercise did not include counselling services for: People with physical health problems (e.g. cancer and HIV); Relationship issues; Students; Children; 3 COSCA s Recognition Scheme for Organisations: Information, Guidance and Procedure. 5
3.3 It also did not include: Private organisations with no public funding; Addictions counselling services who are non members of EVSCSF; and Psychotherapy services. 3.4 In total, 33 counselling services were mapped. Detailed information about each service can be found in a database which was created for this exercise. If the service takes external referrals, the basic information from this database has been shared with Edspace. 6
4. PURPOSE AND LOCALITY OF COUNSELLING SERVICES 17 (52%) of the mapped counselling services are generic and 16 (48%) are specialist. 19 (58%) of the mapped counselling services are city-wide and 14 (42%) work in particular sectors of the city. CITY-WIDE SERVICES The city is served by: Five generic counselling services: Edinburgh Counselling Ministries (formerly Crossline); CrossReach Counselling: Lothian; Pastoral Foundation Counselling Service; Scottish Institute of Human Relationships; Wellspring (Scotland) Ltd. Three addictions counselling services who are members of EVSCF: Edinburgh & Lothian Council on Alcohol (ELCA), LIBRA and Simpson House Counselling Service (CrossReach). Two loss and bereavement counselling services: Cruse Bereavement Care Scotland (Edinburgh Branch) and Stillbirth and Neonatal Death Society (SANDS) Lothian. A counselling services for people who have been sexually abused as a child: Health In Mind Counselling Service. A counselling service for women who have experienced or are at risk of domestic abuse: Edinburgh Women s Aid. A counselling service for women and their families with perinatal mental health problems: Post Natal Depression Counselling Service (CrossReach). A counselling service for black and minority ethnic women, including asylum seekers, refugees and new migrants: Saheliya. A counselling service for disabled people, their carers and family members: Lothian Centre for Integrated Living Peer Counselling Service. A counselling service for people with mental health problems: The Stafford Centre (NSF Scotland). 7
Continued A counselling service for carers: Vocal Carers Counselling Service. A counselling service for gay and bisexual men: Gay Men s Health. A counselling service for women who are lesbian, bisexual and transgender: Connect-Ed. SECTOR-BASED SERVICES 4 The North West Sector is served by: A generic counselling service for people who are referred by their local GP: North West Edinburgh Local Health Partnership Counselling Service. A generic counselling service for people living in North Edinburgh (Muirhouse, Drylaw, West Pilton, West Granton, Royston and Wardieburn): Pilton Community Health Project Counselling Service. Generic counselling services for patients of the Cramond, Eyre and Ratho Medical Practices / Surgeries. A generic counselling service for people living in Saughtonhall, Roseburn and surrounding areas: Health All Round Counselling Service. The North East Sector is served by: A generic counselling service extending to Newhaven and Portobello: North East Edinburgh Counselling Service. A counselling service for women with mental health problems: Link Up Women s Support Centre. The South East Sector is served by: A generic counselling service for the Greater Craigmillar area (Bingham, Magdalene, Craigmillar and Niddrie): Be Well Community Health Project Counselling Service. A counselling service for women living in Greater Craigmillar: Craigmillar Women s Counselling Service. 4 The Sectors refer to the Local Health Partnership (NHS Lothian) and Health and Social Care Department Practice Team (City of Edinburgh Council) boundaries. 8
Continued The South Central Sector is served by: A generic counselling service for people living in Gorgie, Dalry and surrounding areas: Health All Round Counselling Service. A generic counselling service for patients of Lauriston Medical Practice. The South West Sector is served by: A generic counselling service for people referred by local health professionals: South West Edinburgh Primary Care Counselling Service. A generic counselling service for people living in Longstone, Broomhouse, Sighthill, Parkhead and Wester Hailes (former West Edinburgh Community Planning Partnership area): Wester Hailes Health Agency Counselling Service. A generic counselling service for people living in Stenhouse and the surrounding areas: Health All Round Counselling Service. A generic counselling service for patients of Wester Hailes Medical Practice. 9
5. SOURCES OF REFERRAL A number of the mapped counselling services only accept selfreferrals. They may instead record how people are recommended to the service. GPs make by far the most referrals / recommendations to mental health counselling services in the city. Where recorded, about 60% of the total referrals / recommendations for counselling came from NHS staff. Approximately 6% came from CEC staff. The GP funded counselling services only accept internal referrals. 6. COUNSELLING MODELS EMPLOYED Person Centred is the most common counselling model employed by the mapped services (75% of organisations). Integrative (44% of organisations) and Psychoanalytical and Psychodynamic Counselling (38% of organisations) are also widely used. Transpersonal (19% of organisations), Core Process (12%) Transactional Analysis (12%), Transpersonal (12%) and Gestalt Counselling (12%) are less widely used. Two Christian run organisations also employ Aphesis Counselling for a small number of their clients. It is only used if the client is a Christian and actively seeking this form of counselling. 10
7. NATURE OF PEOPLE SUPPORTED AND THEIR ISSUES 70% of people using the mapped counselling services in their last recorded year were women. Only 30% were men. Excluding Saheliya, 5.4% of people were from a black or minority ethnic background. The counselling services deal with wide spectrum of issues, from depression to debt. 8. COUNSELLORS, CAPACITY AND LENGTH OF SUPPORT In total, the mapped counselling services employ over 340 counsellors. 31% are paid and 69% are volunteers. This adds up to approximately 50 fte counsellors. Many of the volunteers are in the process of training to become qualified counsellors. In total, the services provide over 1,000 counselling sessions per week. In total, the services supported over 4,500 people in their last recorded year. 13 (41%) of the services provide time-limited counselling (usually between 6 and 12 sessions). 23 (72%) provide open-ended counselling. 4 (12%) both. Time-limited counselling is more likely to be employed when there are limited funds and / or long waiting lists. 11
9. DEMAND AND PRIORITISATION Many of the mapped counselling services said they had waiting lists. These ranged from a few days to 52 weeks. Unless there is a perceived crisis, most services work on a first come first served basis. A few services are targeted at people living in areas of high health inequalities. One organisation had a written protocol prioritising their caseload (e.g. people who were isolated / living alone). 10. CLIENT AND COUNSELLOR FEES 23 (72%) of the mapped counselling services are free. The rest charge a fee or actively invite donations. There is a wide variety of ways in which this is applied. Some services invite voluntary contributions (this ensures those who cannot pay are not turned away), some work to a sliding scale (for example, level of income), others have a set fee. Over 30% of the services employ freelance counsellors. Rates of pay range from 11-35 per hour ( 20-25 being the average). 12
11. QUALITY ASSURANCE 20 (62%) of the mapped counselling services are organisational members of COSCA (Counselling and Psychotherapy in Scotland) or the British Association for Counselling & Psychotherapy (BACP). 6 services (19%) had achieved accreditation with a professional counselling body at the time of this report. 5 said they were in the process of doing so. 21 services (68%) require their counsellors to be members of a professional counselling body. 5 of the services (17%) also require their counsellors to be accredited with a professional counselling body. The level of record keeping varies widely between services, from no formal records being kept to the use of CORE (Clinical Outcomes for Routine Evaluation 5 ). All the mapped services have a confidentiality policy and complaints procedure. The majority (90%) of services have a method for evaluating the effectiveness of their counselling. These range from simple feedback forms to the use of CORE. 70% of services carry out Disclosure Scotland checks on staff. 5 The CORE System (Clinical Outcomes for Routine Evaluation) has been designed in the UK for use in psychotherapy, counselling and other psychological therapies. Through CORE-PC software, counselling services can measure their effectiveness and overall quality (e.g. outcomes). 13
12. FUNDING In total, the mapped counselling services received funding of over 1,696,000 in 2007/08: 933,000 (55%) statutory funding; 465,000 (27%) charitable grants; and, 298,000 (18%) donations, fees and legacies. Of the statutory funding: 488,000 (52.5%) was from NHS Lothian; 321,000 (34.5%) from City of Edinburgh Council; and, 124,000 (13%) from the Scottish Executive. 690,000 (74%) of the statutory funding was for city-wide counselling services and 243,000 (26%) for sector-based services. 12.1 Summary of sector-based statutory funding North West Sector North East Sector NHS Lothian 70,000 NHS Lothian 6,500 CEC 44,222 CEC 65,525 Total 114,222 Total 72,025 % of total sectorbased funding 47% South East Sector South Central Sector 6 % of total sectorbased funding 30% NHS Lothian 13,250 NHS Lothian - CEC 8,000 CEC 2,667 Total 21,250 Total 2,667 % of total sectorbased funding 9% % of total sectorbased funding 1% South West Sector 7 Total sector-based funding: NHS Lothian 30,000 NHS Lothian 119,750 CEC 2.667 CEC 123,081 Total 32,667 Total 242,831 % of total sectorbased funding 13% 6 Figures do not include the funding for Lauriston Medical Practice Counselling Service. 7 Figures do not include the funding for South West Edinburgh Primary Care Counselling Service and Wester Hailes Medical Practice Counselling Service. 14
13. HOW COUNSELLING SERVICES LINK INTO WIDER MENTAL HEALTH NETWORKS 13.1 The mapped voluntary sector counselling providers receive regular referrals from NHS primary care and other mental health services. Some counsellors also attend multi-agency meetings and feel well regarded. However, the majority of services have no formal links with NHS primary care and other mental health services. Two organisations said: Links could be improved, particularly working more in partnership with psychiatric services ; and Our biggest challenge is being integrated into other mental health services. 13.2 Example of integrated working 13.2.1 The South West Edinburgh LHP counselling service forms part of the local Primary Care Mental Health Team. Alongside the local voluntary sector counselling services, they form part of the South West Edinburgh Stepped Care Group, a multi-agency network of mental health services in primary care. It co-ordinates the local treatment of people with mental health problems in need of primary care.. 15