The Surviving Work Survey

Mental Health

If you’re working in mental health its time to talk about money. Whether you’re a psychologist or a counsellor, a trainee or occupational therapist, psychiatric nurse or working in private practice the growing reality is that you’re probably concerned about earning enough to sustain yourself in the current mental health job market.

Why are we doing the Surviving Work Survey?

As this week’s Mental Health Taskforce report highlights, mental health services have been underfunded over a long time, and are failing to respond to the rise in demand for services.

An important report by the British Psychoanalytic Council and the UKCP about the working lives of psychotherapists concludes that with a 77% increase in complex cases and 63% of clients reporting that NHS therapy was too short to do any good. Mental health workers report that the reality of working in mental health and containing increasing levels of distress is becoming unsustainable.

Additionally many of us working in mental health are now working for non-NHS providers. Over the last 5 years there has been a 50 per cent increase in services provided by non-NHS providers with expenditure rising from £6.6 billion to £10 billion. There are an estimated 53,000 private contracts in the NHS with 15,000 within 211 CCGs in community health services and secondary care. An estimated 12.7 per cent of the CCG budget is spent on specialist mental health services – and the primary problems relate to poor contract management and very low penalties for poor delivery. What we do know is that in 2014 half of the private mental health providers commissioned by NHS England to provide specialist care were not fully compliant with NHS standards.

Commissioning Support Units were set up to administer the NHS contracting process and raise any concerns about the governance and monitoring those services provided by private providers. From April 2016, these Units will be privatised. You read that correctly; the administrators in charge of managing third-party contracts will themselves be working for third parties.

The lack of understanding about employment relations in the sector exposes a range of problems faced by mental health workers, including the growth of contract and agency labour, the use of unwaged labour, the insecurity of ‘permanent’ employees in the NHS. Because of the growing insecurity of work in mental health and the fear of blacklisting of individuals who raise their concerns, people are often unwilling to speak up at work.

As a result not much is known about what is happening to wages, working conditions and clinical practice in our sector.

Why Is The Surviving Work Survey Being Conducted?

The aims of this survey are to help us build a map of the trends in working conditions for mental health workers in the UK. Through the Surviving Work Survey and anonymous case studies we want to create a map which measures:

  • trends in wages and earnings in the sector
  • what jobs people are doing in mental health
  • the scale of unwaged and honorary work, principally by trainees
  • growth of private contractors and private employment agencies providing clinical services
  • impact on clinical supervision and professional practice
  • impact on our states of mind and our relationships with each other

As we build a picture of our sector, we will produce infographics and an online map to raise awareness and encourage debate about the future of work in mental health. During 2016 we will produce a series of articles and blogs about what we have found.

Who is conducting the Research?

The research will be jointly carried out by:

• Elizabeth Cotton, Surviving Work & lead researcher
• Leanne Stelmaszczyk, British Psychoanalytic Council
• Clare Gerada, Practitioner Health Programme
• John Grahl, Professor in Economics, Middlesex University

The lead researcher for the project is Elizabeth Cotton. If you would like to contact her anonymously to help build up a picture of what is happening in our sector please feel free to email her directly at


We guarantee that all information submitted will be anonymised and used only for the purposes of this mapping exercise. We guarantee that any information you submit will be held anonymously by Surviving Work and will not be passed on to your employer or any professional body. We will not use your data to try to sell you anything nor will we make any commercial gain from the information you give us. You do not need to submit your name or contact details in the survey. We only ask participants to provide us with a personal email address if they are willing to have a follow up phone interviews to deepen our understanding of the issues faced by mental health workers in the UK.

Take the Surviving Work Survey

Download the Survey leaflet