Mental Health

What do service users/clients say they want?

Lesson 3

There are evidence that complementary and alternative therapies may have something particularly important to offer many mental health service users/ patients. As you saw in the last section, part of the explanation lies in the unsatisfactory or damaging experiences of conventional psychiatric interventions that they have.

Medication remains the most common response to mental distress in mainstream services, and the distressing side effects of many drugs have been well documented.

In recent years’ service users/patients have become more closely involved in discussions about psychiatric treatment. At the same time, nurses, social workers and psychologists have become part of multidisciplinary mental health teams.

This has led to increased pressure for treatments and services with less damaging side effects that do not focus solely on illness but on the holistic context of people's lives in the community, on cultural and religious diversity and on personal preference.

During the 1990s some large-scale surveys and consultation exercises were held with mental health service users/patients. Many expressed dissatisfactions with conventional psychiatric treatments because of the likelihood of damaging effects (Rogers et al., 1993).

In a consultation exercise held by the Department of Health Mental Health Taskforce (1994), service users said they wanted information and access to alternatives to orthodox psychiatric treatments. A large survey (Faulkner and Layzell, 2000) showed that although the majority had not been offered any complementary therapies, those who had received treatments such as acupuncture, massage, aromatherapy, exercise and nutritional therapy mainly found them very helpful.

Only a very small number (1%) had experienced problems with these therapies, while high percentages of service users/patients had found conventional psychiatric treatments such as medication and ECT unhelpful or damaging (17%  for antidepressants, 21% for major tranquillisers and 47%  for ECT).

There are a number of examples from around the UK of services and voluntary sector projects that offer complementary therapies for mental distress - some within health and social services, many others in voluntary sector projects.

One example is the Anam Cara crisis house in north Birmingham, which has used a range of therapies, including aromatherapy and Australian Bush Flower remedies, with people in crisis.

Another is CEDARS (Colchester Eating Disorders All Round Support) project, which offers a range of therapies including meditation, reflexology, aromatherapy and nutritional information to young people with anorexia and bulimia. The Creative Living Centre in Salford resulted from collaboration between Salford NHS Trust and Mind.

It is a day service for people recovering from severe mental health problems, offering complementary therapies, creative arts, support groups and a healing garden.

The Marylebone Health Centre in London is an example of a GP practice which integrates complementary and conventional treatments.

It has found that if GPs have resources such as counselling, massage therapy and education classes to offer, they tend to prescribe much less medication to people experiencing mental distress (Wallcraft, 1998).

Another valuable innovation has been the growing number of mental health events that offer free 'taster' sessions of complementary therapy. The Strategies for Living project at the Mental Health Foundation pioneered this format with its annual Big Alternative Conference, and many other local and national events have followed suit.

For example, a conference about service development may provide sessions which offer a way for mental health workers and service users to find out more about complementary therapies by experiencing the treatments at first hand.

Leeds Social Services has also set up and evaluated an experimental complementary therapy service for mental health service users.

It has found that people have experienced relief from tension and a sense of wellbeing, reporting that they value being treated as a whole person rather than a label, and feel more in control of the treatment and of their illness.

However, there have been complaints from some people that they were offered only a series of 12 treatment sessions and wanted the service to continue.

While dissatisfaction with the treatments available within mainstream services is clearly a key issue for many service users/patients, dissatisfaction with their face-to-face experience of mental health professionals - particularly doctors -is also important. 

In other words, it is not just about what is prescribed, but how consultations are set up and carried out that is problematic:

“Constraints on time and other pressures on the NHS, and the reliance on drug prescribing in conventional medicine, have eroded the time patients spend with doctors and has tended to lead to a forced discussion of 'the problem' rather than also embracing the context in which the problem needs to be considered.

This can lead to the patient feeling that the doctor has not paid him or her much attention or taken time to understand fully what is wrong with them.”

(House of Lords, 2000, para. 3.8)

Although these problems are true of health care generally, they are of significance for mental health service users/survivors. This is because of the central importance of emotions and the potential that interaction with others holds in terms of mediating some of the most painful experiences associated with mental distress. 

These include fear, anxiety and feelings of stigma. The appeal of complementary and alternative therapies for mental health services may therefore not just be confined to the different kinds of treatments they offer but include significant differences in the approach to face-to-face interactions.

The House of Lords Select Committee (2000) report into complementary and alternative approaches has highlighted a number of these differences:

  • Complementary therapists tend to focus on a person's overall sense of wellbeing, their personal experiences, and the social context within which they are living.
  • Consultations are generally much longer than those offered by conventional practitioners, and they frequently take place in relaxed and pleasant environments.
  • As well as being longer, consultations tend to be more detailed and thorough than those in conventional medical settings.
  • Complementary therapists tend to have very good communication skills, including active listening skills, and can create relationships based on openness, warmth and trust. They are also skilled at communicating about health issues in language which is easy to understand.
  • They often specialise in dealing with health problems that are difficult to define and which may not be considered important by conventional medicine 

- particularly if there is no diagnosable 'pathology'.

The House of Lords Select Committee (2000)

The Strategies for Living study (Faulkner and Layzell, 2000) is based on in-depth interviews with 76 mental health service users/patient

Relatively few of them had been offered complementary therapies, but those who had generally appreciated them.

The therapies received included

  1. reflexology,
  2. healing,
  3. relaxation, 
  4. meditation,
  5. yoga,
  6. Tai Chi,
  7. homoeopathy,
  8. herbal remedies,
  9. acupuncture,
  10. aromatherapy
  11. massage. 

Most found these therapies helped them cope with their mental distress by enabling relaxation, concentration, better sleep, peace of mind, more control over their lives, a sense of being cared for, and an opportunity to talk to someone.

Some people were given complementary therapies as part of voluntary sector or user-run drop-ins and day services. 

A few people found difficulties with some therapies


  • My medication stiffens up my muscles, and knots them all up, makes them all knotted and horrible, so the massage part of the aromatherapy treatment is wonderful to say the least. It just, you know, knocks about 20 years off me.
  • I used to go to a mental health users group and it was run by two females and they had lots of things going on - aromatherapy, reflexology - just different things
  • I found the reflexology really wonderful and the massage, and that really helped a lot, you felt so relaxed, it was lovely.


  • people with anxiety and depression are told to relax and listen to relaxation tapes and it is one of the most difficult things to try and make yourself do when you are tensed up.
  • there is not a lot of it going round, that is one problem, and obviously I think it would be great if they had it in doctors' surgeries, so that you could use it as a service on the National Health Service, because it did me a lot of good.
  • The main problems with complementary therapies as far as service users are concerned are that they are not freely accessible for most people and are too expensive if not provided free at a day centre or through the NHS.


They are not freely accessible for most people and are too expensive.

When they are provided, this is often on a short-term basis, which may not secure the best possible outcomes from the treatment.

The average cost per session of most complementary and alternative therapies was £30-35. In most cases the first session was charged at an even higher rate, with subsequent sessions slightly cheaper.

This allowed for the extra time normally taken in the initial session to learn about the person and ask more detailed questions.

These fees may be manageable for some people in paid employment, but they are probably beyond the reach of most people who have low paid work or who are receiving state benefits - certainly if the treatment is going to take place over a long period.

Many complementary and alternative therapists were based on high streets or in residential areas, sometimes in the practitioner's own home. This made them quite accessible for most people.