Getting Mental Health Support in the UK: Self-Referral, Community Mental Health Teams and Where Occupational Therapy Fits

When somebody is struggling with their mental health, the hardest part is often not deciding to get help. It is working out who to ask. The system has several front doors, some you can walk through yourself and some that need a GP, and nobody hands you a map. This guide is that map: the routes in, what a community mental health team is, what happens at a mental health assessment, and where occupational therapy fits.

We are an occupational therapy service, so we will be straight about the limits of that. Occupational therapy is not counselling, it does not diagnose and it does not prescribe. What an OT does is the daily-life half of recovery, and for many people that is the half nobody is looking at. Most of what follows is about NHS routes that cost nothing, because those come first.

The routes in, in plain English

There is no single front door. Which one is right depends on how urgent things are and what sort of difficulty it is.

• Refer yourself for talking therapy. In England, NHS Talking Therapies takes self-referrals for anxiety, depression, stress, phobias, obsessive-compulsive difficulties and PTSD. No GP appointment is needed, and you can find your local service on the NHS website. Scotland, Wales and Northern Ireland have their own arrangements.
• Start with the GP for anything else. The GP is the route to medication, to a fit note, to ruling out a physical cause, and to a referral into adult mental health services where the difficulty is more serious or longer running. Ask for a longer appointment when you book.
• Urgent, but not immediately life-threatening. In England you can call NHS 111 and choose the mental health option to reach a local urgent mental health helpline, day or night. Many areas also publish a direct crisis line, and some run evening crisis cafes or safe havens.
• Somebody to talk to at any hour. Samaritans are free to call on 116 123, any time, from any phone, and you do not have to be suicidal to ring them.
• If life is in danger. Call 999 or go to the emergency department. That includes an overdose, a serious injury, or being unable to keep yourself safe right now.

These are not a queue to work through in order. If things are urgent, go straight to the urgent one.

What a community mental health team is, and how you get referred

A community mental health team, usually shortened to CMHT, is the NHS service for adults whose difficulties are too serious, too complex or too long-running for a GP and talking therapy alone. It is secondary care, reached by referral rather than by walking in. Teams differ by area and many are split into named services for psychosis, mood, older adults or early intervention, but the shape is similar. Who you see depends on what you need.

• Psychiatrist. Diagnosis, medication and the medical side.
• Community psychiatric nurse. Often the person seen most often, for regular contact, monitoring and support.
• Psychologist. Structured psychological therapy and making sense of what is happening.
• Occupational therapist. Daily life: routine, activity, self-care, work, study and getting back out into the world.
• Social worker. Housing, benefits, safeguarding and the legal side.
• Support workers and peer support workers. Practical help, and in the peer workers' case, somebody who has been through it themselves.

Referrals usually come from a GP, though a crisis team, a hospital ward or another service can refer too. Many areas run a single point of access that triages everything, so the first contact may be a phone screening rather than an appointment. Waits vary enormously: a few weeks in one area, several months in another, and a referral can come back with a different service suggested. Ask what the wait is and what to do if things get worse. If they do, say so rather than waiting quietly.

What a mental health assessment actually involves

A mental health assessment is a conversation, not a test. Nobody is trying to catch you out and there is nothing to revise. It usually runs between forty-five minutes and an hour and a half, may be split over more than one appointment, and often starts by phone or video.

Expect questions about your history, what has been happening recently, and how it affects an ordinary day: sleep, eating, work, money, drink and drugs, who is around you. You will be asked about risk, including thoughts of harming yourself. It is asked of everybody, and answering honestly is what gets the right level of support. You will also be asked what you want to be different, the question people are least ready for.

• Write things down beforehand. A short list of what has changed, when it started and what you want help with. Minds go blank in appointments.
• Take somebody with you. They hear what you miss, and can say what they have noticed.
• Describe the worst days, not the average. An assessment on a good afternoon can capture a version of you that is not the whole picture.
• Ask what happens next. Who is responsible, when you will hear, and who to contact in the meantime.

Where occupational therapy fits in mental health

Mental health is one of the largest areas of occupational therapy practice in the UK, and an OT is a core member of most community mental health teams. Occupation here does not mean a job. It means everything that fills a day and gives it shape, and when those things fall away mental health gets worse, so rebuilding them deliberately is treatment rather than a nice extra.

• Routine and structure. What an ordinary day looks like now, and a realistic shape to build back towards, starting far smaller than most people expect.
• Sleep and energy. Sleep routines, daytime activity and pacing, because a collapsed sleep pattern undoes most other progress.
• Self-care and the home. Washing, eating, laundry and a house that has got on top of somebody, broken into steps that are achievable this week.
• Getting out again. Graded practice at leaving the house, the bus, the shop, in an order and at a pace you agree.
• Work and study. Return-to-work planning, adjustments and pacing. Our guide to vocational rehabilitation covers that in detail.

Mental health occupational therapy is recovery-focused: the goals are yours, written in your words, and progress is measured by what you are doing again rather than by a score. It sits alongside medication and psychological therapy and replaces neither. Our page on occupational therapy for mental health sets out what a home visit covers.

Going private, and roughly what it costs

Private care buys time, not a different diagnosis. Rough figures, so you know what you are looking at:

• Private psychiatrist. A first assessment commonly runs around £300 to £600, with shorter follow-ups after. Check with your GP before assuming the NHS will take over prescribing anything recommended: shared care arrangements vary by area and this is a common and expensive surprise.
• Private therapist or counsellor. Typically £50 to £120 a session, higher in London. Check the person is registered with a recognised professional body.
• Independent occupational therapist. For the daily-life side: routine, activity, the home, getting back to work. That is where a service like ours fits.

Private is the wrong answer in two situations. If somebody is in crisis, the urgent NHS routes above are faster and free. And if money is tight, NHS Talking Therapies costs nothing and takes self-referrals, so it is worth trying first.

If you are the family member trying to help

Two things are worth knowing. Staff may not be able to tell you anything without consent, but they can always listen, so pass on what you have seen; a note handed in before an appointment is often more use than anything said during it. And your own health counts. Carers UK has free advice, Mind and Rethink Mental Illness both publish information written for families, and if you are providing regular support you can ask the council for an assessment in your own right. Our guide to the carers assessment explains what that involves.

Frequently asked questions

Can I refer myself to mental health services?

In England, yes, for talking therapy: NHS Talking Therapies takes self-referrals for anxiety, depression, phobias, PTSD and similar difficulties with no GP appointment needed. Self-referral into a community mental health team is not usually possible, so for more serious or longer-term difficulties the GP is the route.

What does a community mental health team do?

It supports adults with more serious or longer-term difficulties in the community rather than in hospital: medication reviews with a psychiatrist, regular contact with a community psychiatric nurse, psychological therapy, occupational therapy to rebuild daily life and work, and social work help with housing or benefits. Access is by referral, usually from a GP.

What happens in a mental health assessment?

A conversation, usually forty-five minutes to an hour and a half, about your history, what has been happening lately, how it affects your day and what you want to change. You will be asked about risk, including thoughts of harming yourself, because everybody is. Nothing needs preparing beyond a short written list, and you can bring somebody with you.

How does occupational therapy help with mental health?

By working on the daily life that mental health difficulties dismantle: a routine that has collapsed, sleep, self-care, a home that has got on top of you, confidence leaving the house, and getting back to work or study. An occupational therapist builds a graded plan towards the things you want to be doing again, alongside any medication or therapy. It is not counselling and does not replace it.

Next steps

If nothing has started yet, the two cheapest moves are a self-referral to NHS Talking Therapies and a GP appointment, in whichever order suits. If therapy or medication is already in place and the problem is that ordinary life has not restarted, that is the occupational therapy half, and it can be done at home. Find your local occupational therapist via our areas we cover page, or see our prices for current guide pricing.