Respect for All: offering counselling and therapy for children, young people and adults across Greater Manchester

Respect for All is run by a registered charity offering counselling and therapy for children, young people and adults across Greater Manchester. Their approach is different because therapy is changed to fit the needs of the person. It recognises that people with a learning disability and autistic people do not fit into the standard Improving Access to Psychological Therapies (IAPT) and the early support offer that is offered to the wider population.

We believe counselling is for everyone and everyone is different.  The smallest of changes can make a huge difference to someone’s life. Our work is guided by the needs of our clients.”

The service provides a strengths-based approach to working with individuals experiencing anxiety, depression, ‘stress of fitting into society,’ loneliness, social isolation, and trauma. It also works with families to develop strategies for supporting family members.

The result of this way of working is that people feel listened to, and individuals feel able to take further steps after they have attended.

Finally, someone understands and sees me.”

This service is run by a registered charity, and it is for children, young people, and adults in all ten boroughs of Greater Manchester including Salford, Trafford, Bury, Wigan, Bolton, City of Manchester, Rochdale, Oldham, Tameside, and Stockport.

It was formed by counsellors with experience of supporting learning disabled and autistic people. The founders all have experience, either through professional work or their families, of supporting learning disabled and autistic people. They had seen how underserved this group was by the IAPT/early intervention offer from community mental health or children and adolescent mental health services, because it is not flexible or bespoke enough to support individuals to achieve their aspirations. Initially they were very much working against the system in providing bespoke early support to people with a learning disability and autistic people.

The COVID-19 pandemic has further highlighted the gap in early support provision, particularly for autistic people, and in recognition of this the Greater Manchester Health and Social Care Partnership has invested in two years of funding, so far, for an initial support service from Respect for All.

It is in the second year of funding and seeking to develop beyond an initial short-term service into something with more depth that works flexibly with individuals and families.

This all-age service makes sure that people have early help and access to the right therapy for them. Therapy is changed to fit the needs of the person. It recognises that people with a learning disability and autistic people do not fit into the standard Improving Access to Psychological Therapies (IAPT) and early support offer that is offered to the wider population.

Although it is a support service providing counselling and play therapy to learning disabled and autistic people and supports their parents, families, and carers, it now can also provide sessions to parents and siblings.

It does not work with individuals who are experiencing a mental health crisis and will ensure that when individuals come to the service in crisis, they are referred to their GP.

Therapists work closely with people to develop their approach, and therapies are adapted and changed to the person’s needs. These changes might mean offering individual therapy sessions for people who find group therapy difficult to cope with. Staff work hard to agree the pace of sessions that suit each individual and use non-verbal approaches such as play therapy to help people where this works better for people.

People using the service are encouraged to choose the right therapeutic approach for them and the length of sessions, to ensure that sensory and processing needs are appropriately met.

The services it provides are:

• Short term telephone / online video counselling support service
• Counselling for individuals (12 – 24 sessions)
• Family / couples counselling
• Pre- and Post-diagnostic support

Respect for All is 'good' because it has a flexible approach to working with individuals and families and they may use a combination of these services. People feel listened to, and individuals feel able to take steps after they have attended.

Respect For All can provide pre-diagnosis and post diagnosis support; and work with individuals at whatever stage they are at. Its focus is on what individuals need to help them take the next steps. It provides a bespoke service for everyone and has a flexible approach to how many sessions and approach taken.

Therapists take time to dig into the issues the individual brings to sessions and there is a good recognition of trauma.

It has, until recently, mainly been a spot purchased service apart from a longer-standing arrangement with Stockport Council/NHS.

Now it is funded through Greater Manchester Health and Social Care Partnership through an annually reviewed contract to provide short term (average of six hours) telephone or online video support for people with a learning disability and autistic people.

Respect for All also has funding via Rochdale Clinical Commissioning Group (CCG) through an annually reviewed contract. Spot purchasing arrangements exist through the individual CCGs of Stockport, Manchester, Salford, Trafford, Bury, Oldham for 12 x one-hour therapy sessions for those referred to the service via a GP and granted CCG funding.

Respect for All supports individuals referred by GPs and self-referrals to secure NHS funding for therapy. Some individuals and families will pay for sessions when their Greater Manchester funded allocation ends or it is not approved by a CCG.

The charity provides additional support to individuals to ensure they can secure NHS funding for their therapy.

• Funding: Historically the service has been spot purchased by seven out of the 10 Greater Manchester boroughs each with different spot purchasing routes. This has led to uneven service across the patch ‘postcode lottery’ for people using the service. Funding therapies is complex, and some commissioners are uncertain about paying for the services – and in some areas there is a confusion about what a post-diagnostic service provides and the need to provide an appropriate therapy for people with learning disabilities and autistic people. To get round this they have worked to secure contracts in some parts of Greater Manchester and secure funding for individuals through individual funding requests.
• Culture: There remain commissioners and clinicians who do not ‘get’ the need for the services provided by Respect for All.  To work around this, Respect for All participates in Greater Manchester’s work to improve the offer to autistic people and has formed good relationships with some GPs/ commissioners.
• Access to referral pathway: There are delays of up to 12 months for CCG and other panels to approve funding, which impedes timely access to help.
• Complexity of getting support: It can be overwhelming for clients and their families. Respect for All helps them by providing a letter to give to their GP or personally guiding families through the process and chasing up funding requests to try to reduce waiting times
• There is a lack of interface with mental health providers and diagnostic services: There is no current capacity in the charity to advertise or raise awareness of this issue.

Looking to the future there are challenges. Respect for All is a small charity with limited capacity. It has 17 self-employed counsellors with family members or people with experience of autism or learning disability. They are looking to expand capacity without compromising quality of service.

A post-diagnostic peer support group is currently being established and the service will look at how this could be expanded/developed. There is also a proposal to establish an advocacy service to run alongside counselling services.

Ideally we would like to offer a suite of services that clients can dip in and out of.”

They are also helping to shape the Greater Manchester offer through working groups. Taking the Greater Manchester Health and Social Care funded service to the next level of development is an aspiration and if they had capacity, they would hope to reach out to services to share their learning and approaches

Finally, Respect for All have noticed an increasing trend of adults diagnosed with Autistic Spectrum Disorder later in life requiring support and also recognised that now more autistic people without a learning disability are seeking their help.