Young people we spoke to had mixed experiences of mental health services, Child and Adolescent Mental Health Services (CAMHS), counselling and practitioners. Many talked about the benefit of finding a safe, confidential space to open up about their feelings to a trained practitioner who understood their situation. However, for some, seeking this support was met with a number of barriers and disappointing experiences. Young people talked about the following topics:
- Accessing services and service provision
- Waiting, assessment and referral at CAMHS
- Finding an inclusive empathic practitioner
- Lack of understanding and discrimination
- Understanding difficulties and developing coping skills
Accessing services and service provision
Seeking and using mental health services can be an important step for many young people in supporting their mental health and can take many different forms. You can read about young people’s experiences of mental health and other forms of support.
Psychological therapies can be accessed through the NHS in the form of talking therapies such as Cognitive Behavioural Therapy (CBT), counselling for depression, or guided self-help. You can find more information about the NHS services on their website.
Counselling can mean different things to different people. It is often used to refer to a broad range of talking therapies with a trained therapist where you can share emotional issues. It can be accessed in many different ways. People told us they accessed counselling through school, college, universities as well as through private therapists. You can find more information about accessing counselling from Mind.
People spoke about different ways they had accessed NHS mental health services and psychological therapies. Some were frustrated about waiting times and access. Michelle said that trying to get NHS treatment to support her mental health ‘was a nightmare’. It ‘took a while’, but she managed to get ‘a year of psychodynamic therapy’ but felt by the time she got this that it didn’t feel as useful as she hoped. She said, ‘it would just be like talk and talk and tell your story from that week and then, “Well thank you very much, see you next week.” Jessica felt that ‘the individuals are very nice [but] the system is kind of broken’.
Summer talks about the mental health support she has accessed from different services.
Henry self-referred to free counselling for 16-25 year olds that which was helpful.
G felt ‘the NHS doesn’t have the funding or the ability to provide long term therapy for many people.’ Bay said not enough sessions were available on the NHS to support their mental health needs so they paid to see a private therapist.
Many young people who were able to access counselling, had to do so privately. Jaz said, ‘all of the mental health support or the therapy I’ve had in my time has been through private means’.
Jay talks about the benefit of group therapy for understanding their difficulties and knowing what to work on.
G reflects on the provision of NHS mental health care in the UK.
Bay said counselling is ‘something that I feel I’ve had to go out of my way to seek privately [as a way] to support my mental health.’ They felt they needed more sessions than were available on the NHS to support their mental health needs. Of the six allocated NHS sessions, Bay said, ‘I might have only just you know been able to talk to them by the sixth session, let alone open up about anything, let alone everything being resolved by that point.’ Bay added that private counselling is something they ‘spend a lot of money on’. They said, ‘I can’t really afford to, but I prioritise it and I put it first’.
Cassie stated, ‘I’m lucky enough to have a private therapist. But even with her, I don’t really talk much about gender dysphoria, it’s more other issues … she’s familiar with it at least and not, you know, dismissive or sort of obstructive about who I am, which is again not taken for granted.’ M said they ‘had to privately get a therapist and that’s been helpful in supporting me with mental health.’
M talks about the process of trying to access free counselling, just kind of getting thrown around’ and gave up.
Other counselling support was found through school and/or through work. Jessica, Tom and Cas all talked about being offered counselling at school which they were able to access if they chose to. Tom said about the school counsellor, “it was like she kind of talked to me like a different way, and she had a different perspective, and I was like actually …that kind of helped.” Bee talked about being offered counselling at their workplace. A, Sally and Rahul had accessed mental health support at college and University.
A few young people we spoke to had reservations about accessing mental health services and counselling because of the stigma attached to mental health and gender identity. Freya described feeling like she had ‘a big long rap sheet of all these doubts and sadness’s and things related to trans stuff [practitioners are] gonna wanna talk about’. In addition, when seeking counselling and mental health support, some young people we spoke to were not certain where to turn. Cas said mental health support for trans people is not ‘advertised enough. You just don’t know where to find the information.’
Charke talks about CAMHS being an underfunded service that does the best they can with what they’ve got.
Henry didn’t access counselling services because of stigma between mental health and trans identity.
Waiting, assessment and referral at CAMHS
In England and Wales the NHS provides Child and Adolescent Mental Health Services (CAMHS). More information on how to access mental health services can be found on the NHS website. These services provide assessment, access to mental health specialists and psychological therapies as well as other forms of support. For trans and gender diverse young people CAMHS can play a role in referring to the Gender Identity Development Service (GIDS).
Some young people talked about their experiences of CAMHS and the referral pathway to GIDS. Some found it a useful and positive support while waiting to be seen by GIDS. Declan talked about how he was referred to ‘an LGBT specialist therapist at CAMHS to have some therapy [and] someone to talk to while my referral [to GIDS] was taking place… so that put in place some ongoing support as well and they just took care of my referral.’ Charke said, ‘CAMHS did a good job and it wasn’t necessarily just trans issues it was much more depression, anxiety and all these things but I think they were related to my dysphoria and how I was feeling at the time.’
In contrast, other younger people had experiences of being rejected from CAMHS due to similarly long waiting lists for mental health support and were told to refer directly to GIDS. Reuben had been seen by CAMHS for several years but when he turned 17/18 he ‘was left stranded.’
Jessica talks about her experience with CAMHS feeling like a waiting room.
Jacob talks about being refused support by CAMHS because they didn’t think he was bad enough.
Finding an inclusive, empathic practitioner
Young people shared some of the positive experiences they had with mental health practitioners across a range of services. Young people talked about valuing affirmative* therapists or practitioners who had openness, empathy and understanding.
Loges valued being able to talk to his CAMHS practitioner about anything. He said, ‘I can be open and talk and there’s nothing I can’t say that’s gonna make it weird.’ Patrick said, ‘I’ve had two counsellors who’ve been …incredible and their support was really useful because I just clicked with them and they seemed to get it.’ Sally said, ‘I was seeing a counsellor through my college and that was a really good experience. She was really helpful [and] really affirming.’
A values the mental health staff at university and explains how they have been really supportive.
Finn talks about his counselling experience and the process of healing.
Those we interviewed valued having a private space without judgement to share whatever they needed to. Sophie said her private counsellor has been ‘unbelievably helpful.’ She said they ‘help me cope with transitioning and helped me not get too annoyed. [Counselling is] somewhere I can vent my anger without feeling I’m being judged.’ She said this is ‘very helpful and makes me happier.’
Jacob said he appreciates that his CAMHS practitioner ‘really listened, rather than just telling’. He said it’s been helpful ‘getting everything off my chest in a room where this person isn’t gonna start crying when I tell them and isn’t gonna go and tell my mum and all of that’. Nat relied on private counselling for ‘emotional support… navigating the [trans healthcare] system’. She said this, ‘is more of a downer than anything [being] in that waiting game.’ She said counselling ‘was really helpful in terms of having a space to process what the fuck was going on.’
Bay talks about their experience of private counselling as an absolutely invaluable space.
Bee describes their positive experience of counselling she’s been super supportive.
Finding diverse practitioners
The young people we spoke to valued being able to find practitioners and therapists that belonged to the same diverse communities as them. Erion said he actively tries to find ‘queer friendly therapists’. He said, ‘it has been a nightmare trying to find an inclusive and accessible mental health professional’.
Noelle felt that ‘an LGBT specific counsellor would have had a better perspective…and maybe offered advice and support that was actually relevant to me.’ June said ‘I was quite determined to have a trans therapist and Spectra [free health and well-being service] offers that service’. He said, the therapy was really great, and they helped me work through a lot.’
Max talks about the benefit of having a counsellor who was LGBT and a person of colour.
This was specifically important to trans young people of colour. N talked about how they found a therapist who is a non-binary person of colour. They said, ‘finding them suddenly made [counselling] feel like something that was for me.’ In their experience, ‘most therapists are middle class and white, and straight…it didn’t feel like it was a space for me.’ M said their hopes for therapy were ‘a therapist that was able to deal with trans issues, ideally a therapist of colour… that was either trans themselves or was like trained in like trans issues would have been, would have been ideal.’ However, they commented ‘they are few and far between’.
Some young people described positive experiences even though their counsellor did not specialise in gender identity. Bay says, ‘My counsellor isn’t someone who specialises in gender identity, but it has been a positive experience of, I’ve felt free to explore things without any judgement or anything you know negative from her in that.’
Safia says their counsellor who is a cis white woman has been willing to listen, take on board and understand their lived experience’ which has been really positive.
Begam shares their experience with a psychiatrist she was ever so niceempathy goes a long way.
You can find more information on how to access LGBT affirmative therapy at Pinktherapy.com.
Lack of understanding and discrimination
Young people also shared negative experiences that they wanted mental health practitioners and counsellors to learn from. Many gave examples of a lack of understanding, inappropriate assumptions and questions, as well as homophobia and transphobia. Begam had a consultation where their mental health practitioner’s religious beliefs negatively impacted the advice they gave saying, ‘your parents they’re never going to understand. They’re not gonna, you’re just wasting your time.’ Cas warned about the dangers of religious beliefs influencing conversion therapy practices. He said ‘[The UK is] still a very strong religious country. Although some people who are religious are fine with it, there is that controversy surrounding the fact that conversion therapy is still legal in the UK.’ ** Rosa said, ‘I had a counsellor at school that did not help whatsoever for various reasons including a bit of implied homophobia and generally quite intrusive questioning which basically made me just completely shut down and barely talk to the counsellor in any other session.’
Noelle says traditional therapy isn’t really well equipped to deal with gender dysphoria.
Safia read notes made by a psychiatrist on them and found examples of misgendering and disregarding their experiences.
The young people talked about a lack of understanding leading to inappropriate ideas and questions about transition. Alistair said in his experience counsellors were very fixated on transitioning as a topic of discussion. He said, ‘they ask questions like “why do you want to be a man?” I found that really unhelpful.’ Declan said, ‘I’ve had a lot of mental health practitioners say that all my problems are because I’m trans… because being trans is so stressful’. He replied, “It’s not that stressful compared to these other things that are making me stressed.”
Bailey talks about CAMHS practitioners making unhelpful assumptions about his gender identity because of his autism.
Theo talks about his experience of having his identity dismissed by a psychiatrist [it] was very insensitive.
Ezio says it’s stressful having to explain gender identity in counselling, every timeI had to explain what non-binary was.
Misgendering was also a prevalent experience with mental health practitioners. Rosa said that, ‘despite her [counsellor] asking what my preferred name and pronouns were, after I came out, she noted them down and then did not use them at all for the rest of the session’. She felt this behaviour, ‘set the tone for [her experiences of] gender specific healthcare’.
Ari spoke about reading a report from the adult mental health team and ‘in the first sentence it said, ‘Please note that [Ari] is non-binary and prefers to be referred by they/them pronouns …then they misgendered me through the rest of the report.’ PJ said, ‘when I first came out as trans [his counsellor] didn’t really get it’. He said, ‘she was a lovely woman but she continued to misname me throughout the whole session so that wasn’t great.’
Declan talks about the difficulties he’s had with family therapy and miscommunication between therapists and family members.
Beth says I never felt like I could fully open up about queerness in general because the people that I saw never represented me.
Understanding difficulties and developing coping skills
Upon reflecting on their experiences of mental health services, CAMHS and talking therapies, a few of our young people were able to share how it helped them to understand their difficulties and find ways of coping. Alistair said counselling has been ‘a saving grace’ and ‘it’s just really helped me make sense of everything’. Begam said their ‘current mental health [is] emotionally stable but not fully there’. They ‘can function to an extent, do part time work… sleep well, eat well… function day by day’.
When it came to coping, Freya said, ‘I mean I’m here and alive, that unfortunately is a lot more than many trans people in the world.’ The young people were also able to identify actions and changes they made that positively impacted their mental health. Sophie ‘was a lot happier and [her] mental health was better’ after changing jobs. Patrick says one of the key supporting factors with his mental health ‘has been increased independence since coming to Uni [and] being able to do my own thing’.
Finn says I am much happier with where I am. But I’m acknowledging the fact that I still have a long way to go.
* “Gender affirmative therapy (GAT) is any form of counselling or psychotherapy which seeks to help people to come to a consensual, comfortable, and self-accepting place with their gender.” (Barker, 2019).
Barker, M. (2019). What Gender Affirmative Therapy is and is not. Rewriting the rules. Accessed at: https://www.rewriting-the-rules.com/gender/what-gender-affirmative-therapy-is-and-is-not/
**Please see the Stonewall website (in resources page) for more information on the dangers and signs of conversion therapy’.