Accessing Mental Health Care Does Not Mean Receiving the Right Care

On 26 August 2026, the Royal College of Psychiatrists published a position statement addressing the mental health of adults who experienced sexual abuse during childhood.

One of the acknowledgements stood out to me.

Survivors have experienced avoidable harm because they haven’t received the care they needed. Some have struggled to access help at all. Others have received the wrong form of treatment.

The Royal College is now calling for compassionate, holistic, person-centred and trauma-informed care.

I welcome that.

But I also find myself asking: why are we still having to say this in 2026?

Because none of this is new.

The Mental Health Trusts Collaboration Project began in July 2006 and included a specific focus on improving mental health services for adult survivors of child sexual abuse. In 2018, an editorial in the British Journal of Psychiatry was again discussing what mental health services needed to do differently for victims and survivors.

The Royal College’s latest position statement has also been years in the making, with a consultation draft circulating by 2024.

So while I welcome this acknowledgement, survivors should not have had to wait this long for the system to acknowledge something many have already experienced for themselves:

Accessing mental health care does not necessarily mean receiving the right mental health care.

I Know What That Difference Feels Like

This subject is personal to me.

I have experienced sexual abuse at different stages of my life, including rape, and I have accessed therapy because of it.

I was given CBT.

I want to make something very clear here. This isn’t an attack on CBT. CBT can be incredibly helpful and, for some people and some psychological difficulties, it may be exactly the right treatment.

But it wasn’t what I wanted for that particular situation.

I continued with it anyway.

Eventually, towards the end of my allocated sessions, I stopped attending.

My clinical psychologist hadn’t mistreated me. She hadn’t offended me. But I wasn’t getting what I felt I needed emotionally from the therapy.

I had entered that service following one experience of rape.

But I wasn’t entering that therapy room carrying only that rape.

There were other experiences of sexual abuse from different stages of my life. I had a history.

And that is something I think we need to understand when talking about trauma.

A referral may be made because of one incident. A person does not necessarily arrive with only one incident living inside them.

Trauma doesn’t divide itself into convenient chapters because a service needs to focus on one presenting problem.

One experience can connect with another. Something happening later in life can sit alongside things that happened years earlier.

So what happens when a service is treating an incident, but the person sitting in front of them is carrying a history?

When the Sessions End Before the Therapy Does

I’ve experienced this outside of sexual trauma too.

I’ve completed courses of therapy without feeling that I was psychologically ready for therapy to end.

I remember this particularly when I was pregnant with my son.

My allocated sessions came to an end.

Administratively, the therapy was completed.

Emotionally, I wasn’t finished.

There is a difference.

We can record that somebody attended therapy. We can record how many sessions they received. We can record that their treatment ended.

But none of those things, by themselves, answer the question:

Did that person get what they actually needed?

NHS Talking Therapies data itself shows how structured this system can be. In July 2025, people completing treatment received an average of 8.5 sessions.

That doesn’t mean everybody should receive unlimited therapy. Resources aren’t unlimited either.

But trauma isn’t governed by an appointment calendar.

And even NICE guidance recognises that people who have experienced multiple traumas may require additional trauma-focused treatment sessions.

So why does it sometimes feel as though patients have to fit their psychological experiences around the structure of the service rather than the service having enough flexibility to respond to the person?

The Problem Starts Before We Even Enter the Therapy Room

I also saw another side of this while studying Counselling and Integrative Therapy at university.

There were different therapeutic routes available, including CBT and integrative therapy.

And I remember conversations among students about employment.

Some people felt that CBT offered a clearer route into work, particularly if they wanted to work within the NHS, even when another therapeutic approach appealed to them more.

At the time, that was simply something I observed among people studying alongside me.

I wouldn’t take conversations at one university and claim they represent the motivations of every counselling student in Britain.

But years later, the workforce figures make the question even more interesting.

In the 2023 NHS Talking Therapies workforce census there were 3,645 high-intensity CBT therapists, compared with 1,331 therapists and counsellors across the other recognised high-intensity modalities combined.

Among trainees there were 1,146 high-intensity CBT trainees compared with 229 trainees across the other recognised modalities.

That is a substantial difference.

So perhaps therapeutic choice begins long before a patient walks into a therapy room.

It begins with what we train people to deliver.

It continues with which qualifications lead most easily into recognised roles.

It is shaped by what services commission and who they employ.

And eventually those decisions determine what is actually available when somebody asks for help.

The guidelines may recognise different therapeutic approaches.

The workforce is much less evenly distributed.

Free Mental Health Care Doesn’t Necessarily Mean Choice

People sometimes say that if a particular therapist or therapeutic approach isn’t working, you should find another one.

That assumes you can afford to.

Private therapy can be expensive.

You don’t need to be living in poverty for weekly private therapy to become financially difficult. Somebody can have a reasonable income and still have rent or a mortgage, childcare, food, energy bills, transport and everything else that comes with everyday life.

For many people, NHS treatment isn’t one choice among ten.

It’s the treatment they can afford.

So if somebody waits for NHS therapy and eventually discovers that the therapeutic approach available isn’t right for them, what exactly are their options?

Take what is available?

Pay privately?

Go back onto another pathway?

Start again?

Or stop asking for help?

Sometimes the Therapeutic Match Isn’t Right Either

There was another difficulty in the therapy I received following rape.

There was a communication barrier between my psychologist and me.

English wasn’t her first language and sometimes I struggled to understand exactly what she was asking me.

That isn’t a criticism of her. She was a qualified professional doing her job.

But therapy relies enormously on communication.

When you’re already trying to explain sexual violence, trauma, shame, anger, self-blame and experiences that may be incredibly difficult to put into words, struggling to understand a question can add another layer of frustration.

Sometimes nobody has necessarily done anything wrong.

The therapeutic match simply isn’t right.

But again, how much choice does somebody using a stretched public service really have?

When Someone Stops Therapy, Do We Ask Why?

I stopped attending before that particular course of therapy completely finished.

On paper, that can look very simple.

Treatment offered.

Treatment started.

Patient stopped attending.

But that doesn’t tell you why.

I didn’t stop because I no longer wanted help.

I stopped because the help I was receiving wasn’t giving me what I felt I needed.

Those are not the same thing.

When somebody disengages from therapy, particularly somebody with a history of trauma, I think we should be curious about what happened before simply deciding that they didn’t engage with treatment.

Did they feel understood?

Was the therapeutic approach right?

Was enough time available?

Did they feel safe?

Were they actually ready for the treatment to end?

Was something about the service itself making it difficult for them to continue?

Sometimes a person still wants help.

They just don’t want the help they’re currently receiving.

How Many Times Are Survivors Expected to Ask for Help?

This is also why I don’t think we can separate mental health treatment from everything else survivors experience.

The Royal College says survivors of non-recent child sexual abuse take an average of 16 to 24 years to disclose what happened to them.

Think about what we can then ask of somebody after sexual violence.

First they survive it.

Then perhaps they tell somebody.

Perhaps they report it.

Perhaps they wait while it is investigated.

Perhaps nobody is ever charged.

The latest Home Office figures show that of rape offences recorded in England and Wales in the year ending March 2026, 3.4% had received a charge or summons outcome by the time those figures were published. That figure will increase as outstanding investigations conclude, so it shouldn’t be mistaken for the final proportion that will ever result in a charge.

But it demonstrates how long and uncertain that process can be.

Then perhaps that survivor asks another institution for help.

Mental health services.

They may wait again.

As of 31 December 2025, there were 118,988 open NHS Talking Therapies referrals in England where the person had not yet attended a first appointment.

And then imagine finally reaching therapy only to discover that the treatment being offered doesn’t feel right for what you’re carrying.

How many times are survivors expected to ask institutions to help them?

How many times are they expected to tell their story?

And how many experiences of not feeling heard does it take before somebody stops believing that speaking will make any difference?

Access Cannot Be the Finish Line

We absolutely need better access to mental health care.

We need shorter waiting times.

We need more professionals.

We need properly funded services.

And personally, I would like to see more places where people can actually walk in and speak to somebody when they need support instead of every route beginning with another referral, another assessment or another waiting list.

But access cannot be where the conversation ends.

Putting somebody in front of a mental health professional isn’t enough.

Giving somebody an evidence-based therapy isn’t automatically enough.

Completing a predetermined number of sessions isn’t automatically enough.

The question has to be whether the person received appropriate care for what they were actually experiencing.

The Royal College of Psychiatrists has acknowledged that services are not getting this right often enough.

That acknowledgement matters.

But survivors have been telling us this for years.

The evidence has been sitting in front of us for years.

Mental health professionals themselves have been discussing the problem for years.

So perhaps the most important thing now isn’t another acknowledgement.

It’s what actually changes because of it.

Because a person shouldn’t have to repeatedly return to therapy just to eventually find the care they needed the first time.

And a survivor shouldn’t have to keep proving that what happened to them deserves to be heard.

Accessing mental health care is not the same as receiving the right care.

In 2026, we should know the difference.

References & Further Reading

Royal College of Psychiatrists (2026), Addressing the impact of non-recent child sexual abuse on the mental health of adults, Position Statement PS04/26.

Royal College of Psychiatrists (2026), Mental health services must change to better support survivors of non-recent child sexual abuse.

Ingrassia, A. (2018), The Independent Inquiry into Child Sexual Abuse in the UK: reflecting on the mental health needs of victims and survivors, British Journal of Psychiatry, 213(4), 571–573.

McNeish, D. & Scott, S., Mental Health Trusts Collaboration Project: Evaluation Findings.

NHS England, NHS Talking Therapies Workforce Census 2023.

NHS England Digital (2025–26), NHS Talking Therapies Monthly Statistics.

National Institute for Health and Care Excellence (NICE), Post-traumatic stress disorder: NG116.

Home Office (2026), Crime outcomes in England and Wales 2025 to 2026.