How to get mental health help on the NHS

NHS Talking Therapies for anxiety and depression — previously called IAPT — provides evidence-based psychological therapy free on the NHS for adults in England. It covers depression, generalised anxiety, panic, social anxiety, health anxiety, obsessive-compulsive disorder, phobias and post-traumatic stress disorder.

You do not need to see a GP first. Use the NHS service search to find the service covering your area, then refer yourself online or by phone. You will be asked about your symptoms, your history and your risk, and offered an assessment appointment, usually by telephone.

The assessment decides what level of support fits. Services work in steps: guided self-help supported by a practitioner, structured online programmes, group courses, and one-to-one therapy such as cognitive behavioural therapy, counselling for depression, interpersonal therapy or EMDR for trauma. Starting at a lower step is normal and is not a refusal — if it does not work you step up, but only if you tell them it is not working.

Be candid at the assessment. Services triage on what you report, and understating symptoms out of embarrassment or a sense that others need it more results in being offered less help than you need. If you have thoughts of harming yourself, say so plainly — it changes the urgency and the route rather than disqualifying you.

Ask what the wait is for each option at that service and whether a different modality is quicker. Waits vary considerably between the first assessment and the start of treatment, and between group and individual formats. If a group course starts next month and individual therapy is six months away, taking the group place and asking to be reviewed afterwards usually beats waiting.

Talking Therapies is for common mental health problems. It is not the route for psychosis, bipolar disorder, severe eating disorders, personality disorder, dementia or complex needs requiring a multidisciplinary team — those go through the GP to a community mental health team. If you refer yourself and are signposted elsewhere, that is the system working, not a rejection.

You can also get help while you wait. NHS-recommended digital therapy programmes, structured self-help workbooks, and the mental health charities' helplines and peer support are all free and available immediately.

For anything beyond common anxiety and depression, or if you are unsure, the GP is the front door. They can prescribe, refer to community mental health services, arrange sick notes, and coordinate with employers and other services in a way self-referral cannot.

Book a double appointment if the practice allows it. Ten minutes is not enough to cover a mental health history, and running out of time is a common reason people leave with less than they needed.

Prepare what to say. Write down what has changed, when it started, how it affects sleep, appetite, work, relationships and daily functioning, what you have already tried, and what you want from the appointment. Reading from notes is entirely acceptable and often produces a better consultation than trying to describe it under pressure.

Be explicit about risk. If you have thoughts of suicide or self-harm, say so directly. GPs are required to assess this and cannot act on what they are not told. Disclosing does not automatically lead to hospital admission — in the great majority of cases it changes the urgency of a referral and the follow-up arrangements, nothing more.

Ask specific questions: what are you referring me to, what is the expected wait, what should I do if things get worse before then, and who do I contact out of hours. Ask for the referral to be recorded and for a copy of the letter if you want one.

If medication is offered, ask how long it takes to work, what the common side effects are in the first weeks, how long you would be expected to take it and how it is stopped. Antidepressants typically take several weeks to have full effect and can feel worse before better, which is the point at which people stop taking them. Medication and talking therapy are not alternatives — for moderate to severe depression, the evidence supports both together.

If you are not satisfied, ask to see a different GP at the practice. Experience and confidence with mental health vary between clinicians, and asking for someone else is a normal request, not a complaint.

You can bring someone with you. A friend or relative who can describe what they have observed frequently changes the consultation, particularly where you are minimising or struggling to articulate what has been happening.

If life is at immediate risk — someone has taken an overdose, seriously harmed themselves, or is about to — call 999 or go to A&E. A mental health emergency is a medical emergency and A&E departments have liaison psychiatry teams for exactly this.

Short of that, there is now a dedicated route that avoids A&E. In England, call NHS 111 and select the mental health option: it is available 24 hours a day, for all ages, and connects you to local mental health crisis support rather than to general triage. You can call for yourself or on behalf of someone else.

Local crisis resolution and home treatment teams provide intensive support at home as an alternative to admission, and many areas run crisis cafés, safe havens and sanctuaries — non-clinical drop-in spaces staffed in the evenings and at weekends, when services are otherwise closed and when crises actually happen. Ask your GP or the crisis line what exists locally and note it down before you need it.

If you are already under a mental health team, you should have a crisis plan naming who to contact out of hours. If you do not have one, ask for one at your next appointment. A written plan agreed in advance works far better than trying to navigate services during a crisis.

The charity helplines run alongside the NHS and are free and confidential. Samaritans is available 24 hours a day on 116 123 for anyone in distress, and text services and specialist lines exist for young people, veterans, men, and people bereaved by suicide. They do not replace clinical care but they are open when nothing else is.

If you are supporting someone else, you can call 111 or a crisis line on their behalf, and you can attend A&E with them. Confidentiality limits what services can tell you about an adult who has not consented, but nothing prevents you from giving them information — telling a team what you have observed is always permissible and frequently important.

In Scotland, Wales and Northern Ireland the crisis arrangements differ. Scotland has NHS 24 on 111 for urgent care when the GP is closed, alongside local crisis teams. Wales has NHS 111 Wales, which includes a mental health option in participating areas. Northern Ireland has its own crisis and lifeline arrangements through the health and social care trusts. Find the number for your nation now and save it.

Health is devolved, so the services and their names differ. NHS Talking Therapies is an England programme and does not exist under that name elsewhere.

In Scotland, the usual route is through the GP to local psychological therapies services or a community mental health team, with waiting times published by NHS boards. NHS inform hosts free guided self-help programmes and self-help guides covering anxiety, depression, sleep and stress that can be started immediately without any referral, and computerised CBT is available in most board areas. Some boards accept self-referral for certain services, so it is worth checking your own board rather than assuming. NHS 24 on 111 covers urgent care out of hours, and the Scottish Government publishes the mental health strategy and service standards.

In Wales, primary care mental health support services provide assessment and short-term intervention, accessed through the GP or in some health boards by self-referral, with onward referral to secondary services where needed. NHS 111 Wales provides advice and, in participating areas, a mental health option. Welsh Government sets policy and the Mental Health (Wales) Measure gives specific rights around care and treatment planning and reassessment for people discharged from secondary services.

In Northern Ireland, mental health services are delivered through the health and social care trusts, with the GP as the usual referral route and separate arrangements for crisis support. nidirect sets out the services, the professionals involved and what to do in a crisis, and is the correct reference point rather than the NHS website, which describes England.

The legal framework differs too. England and Wales operate under the Mental Health Act 1983, Scotland under the Mental Health (Care and Treatment) (Scotland) Act 2003 with its distinctive tribunal system and named person role, and Northern Ireland under the Mental Health (Northern Ireland) Order 1986. The safeguards, the terminology and the review bodies are not the same.

Practically, if you move between nations, expect to re-enter the system rather than transfer within it. Referrals do not automatically follow you across a border, and registering with a new GP and asking for the previous records to be requested is the fastest way to restart care.

A referral being declined is not the end of the process. Ask specifically why — the usual reasons are that the service is not the right one for the presentation, that thresholds were not met, or that information was missing — and ask what would need to be different. Missing information is the most common and the easiest to fix.

Ask for the decision in writing and ask what else is available locally: a different NHS service, a voluntary sector service commissioned by the NHS, a social prescribing link worker, or a specialist charity. Many areas commission counselling through the voluntary sector that does not appear on NHS lists.

If you disagree with the decision or the care you received, use the NHS complaints process. Complain to the provider first, then to the Parliamentary and Health Service Ombudsman in England, the Scottish Public Services Ombudsman, the Public Services Ombudsman for Wales or the Northern Ireland Public Services Ombudsman. Free independent advocacy exists to help with NHS complaints in every nation.

Waiting time standards exist for some services and not others, and they vary by nation. Ask what standard applies to your referral and what the current local performance is — you are entitled to know, and it informs whether to wait or seek an alternative.

If someone is detained under mental health legislation, rights attach immediately. In England and Wales under the Mental Health Act 1983 a detained patient must be told their rights, has a right to an Independent Mental Health Advocate, has a right to apply to the First-tier Tribunal for discharge, and has a nearest relative with defined powers including, in some circumstances, the ability to request discharge. Detention has specified durations and renewal procedures, and treatment without consent is regulated with second-opinion safeguards.

Scotland's 2003 Act uses a named person rather than a nearest relative, and applications go to the Mental Health Tribunal for Scotland. Northern Ireland's 1986 Order has its own review tribunal. In every nation, advocacy is free and independent, and asking for an advocate is one of the most useful things a detained person or their family can do early.

After discharge there are duties to plan aftercare, and in England and Wales aftercare under section 117 for people detained under certain sections is provided free of charge — a right that is frequently not explained and that covers services people are sometimes wrongly asked to pay for. Ask explicitly whether section 117 applies.