The unacceptable working conditions of mental health workers means that the UK could be within a decade of genuine therapeutic professions dying out, according to the Surviving Work Survey, carried out by Dr Elizabeth Cotton. The Survey results are published online today, 13th November 2017 at


The website provides a unique insight into the crisis in mental health services and the experiences of people working on the frontline. The survey, conducted by Dr Elizabeth Cotton in 2016, founder of and academic at Middlesex University, reveals mental health workers suffer from a lack of job security, low pay, poor management as well as having to deal with the significant pressure of working in this field of healthcare.

Key results are as follows:
–  21% of therapists are working unwaged as honoraries
–  30% of therapists are self-employed and 91% of self-employed therapists work in multiple settings
–  over half (54%) of respondents are working in multiple jobs
only a quarter (25%) of concerns about patient safety were adequately resolved. This went down to 8% in the case of concerns about working conditions
–  6% of senior clinicians said they were working for free
–  when asked what intervention would improve their working life, 52% respondents said “better management & funding”, a response to the growth in failing       performance management systems


The survey reveals some worrying trends for the future provision of quality mental health services. In addition to the profound downgrading and demoralisation of clinicians, with 60% of therapists over the age of 47 the sector is an ageing profession. If we add the widening jobs gap and lack of promotion for senior professions, the sector will over the next ten years face a crisis of developing experienced and qualified therapists to manage the mental health crisis in the UK.

Commenting on the survey, Dr Cotton said:

“As a nation we might be becoming obsessed with mental health, but the debate about the welfare of the people delivering those services is strikingly absent. Unfortunately therapists are the least likely to talk about their working lives. What emerges from our survey is a very depressing and complex picture. Our findings present a bleak prognosis for earning a living as a therapist in the UK.

“Job insecurity is a major theme with many therapists on precarious contracts, with a rapid rise in self-employment. The results also reveal the growth of unwaged work, widespread across the NHS, IAPT services and the Third Sector. Therapists said they had to work part-time as a primary way to cope with increased distress at work. Respondents also raised concerns about private and third sector contractors and the growth of short term therapy that is being championed by the government within the NHS.

“If trained professional therapists cannot earn a decent living, when the current 21% of psychotherapists who are 57 years or older retire, who will provide services for the one in four of us who experience mental health problems?”


The results of the survey can be accessed at with short infographics, data and quotes as well as an eBook looking at trends in the sector.


The survey results will be launched on the 16th November at the Tavistock and Portman NHS Foundation Trust. A video and podcast of the event will be available at www.thefutureoftherapy shortly after.


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