More threads by David Baxter PhD

David Baxter PhD

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Good news about therapy (UK)
by Richard Layard, The Observer
Sunday October 14, 2007

The government's commitment finally to provide enough counsellors is a landmark moment in mental health care

A decision was taken last week that will transform the lives of millions of people. State-of-the-art psychological therapy will become available to anyone suffering from depression or crippling anxiety disorders. At last, people with mental-health problems will be offered the best possible care, just as they would expect if they had a physical illness.

The government's commitment last week is simple and unequivocal. It will implement the National Institute for Clinical Excellence (Nice) guidelines for depression and anxiety disorders, which say that everyone who needs it should have access to psychological therapy.

This will be a huge change. At present, the guidelines are simply not implemented, due to a shortage of therapists. But in response to a public campaign in which The Observer played an important part, the government has recognised the need for a new approach.

On Wednesday, Alan Johnson announced that 'we will build a groundbreaking psychological therapy service in Britain', with money to match. This will mean a substantial team of therapists in every area, capable of providing sustained, state-of-the-art, one-to-one therapy that can transform lives. It will also provide brief therapy where that will suffice. The teams will eventually be big enough to handle without delay everyone who refers themselves or is referred by their GP.

To build this service will take a few years. It is a real challenge, because so many people are in need. Six million people suffer from diagnosable depression or crippling anxiety disorders, such as agoraphobia or panic attacks. As a recent article in the Lancet shows, these conditions are not only intensely distressing, but more debilitating than many chronic physical illnesses, such as angina, asthma, arthritis or diabetes.

But while more than 90 per cent of cases of these physical illnesses get treated, only a quarter of those with depression or anxiety get any treatment at all. What most patients want is therapy rather than drugs and GPs are desperate because it is not available.

Therapy is as effective as drugs in the short run and more effective in preventing relapse. The best-studied therapy is cognitive behavioural therapy (CBT), which trains a person how to challenge negative thoughts and feelings and how to develop positive thinking and action. It has been tested in hundreds of scientifically designed clinical trials that show that after fewer than 16 sessions, more than half the people treated will have recovered.

For example, Sarah was raped at university in 1998 at the age of 21. She was haunted by memories of the rape and became so anxious and depressed that she left university. Two bouts of counselling made no difference. In 2003, after five wasted years of anxiety and depression, she had 15 sessions of CBT. By the last session, she was no longer haunted by the memories and felt back to her old self. She has remained well and survived a highly stressful experience by using the tools she had learned through CBT.

Some people who are cured of depression relapse later on, but relapse is much less common for people treated with CBT than with drugs, unless the drugs are taken indefinitely. For anxiety disorders, most cures are permanent. CBT is not the only therapy that works. Nice also recommends other therapies for particular problems and they will doubtless recommend more as the evidence accumulates.

So how do we know this is for real? For one thing, the money is there to develop the service as fast as it is possible to train the extra therapists. Second, the NHS's operational priorities include psychological therapy in the 13 'indicators' by which it will judge its overall performance. So all eyes will be on what is happening, both nationally and locally.

The greatest challenge is to train the new therapists, since, by 2011, the service will be employing some 3,500. Most of the training will need to be in CBT, since this is the therapy in which there is the greatest shortage. Some of the trainees will be clinical psychologists, but the majority will be drawn from other mental-health professions, for example, nurses, social workers and counsellors taking a one-year training in CBT. We hope this new profession of 'psychological therapist' will attract many of the most talented and idealistic people who want to devote their lives to the relief of misery.

It will take up to six years to get to where we need to be, but the government is now committed to getting there. That is the significance of last week and a major tribute to the vision of Alan Johnson.

No longer will we have the intolerable anomaly that while almost every physical wound gets treated, the wounded minds of millions of people go without treatment. That is a real revolution.

Professor Richard Layard is director of the Well-Being Programme in LSE's Centre for Economic Performance. He was co-author of the LSE Depression Report, published in The Observer in September 2006.
I will believe it when I see it and when Im actually part of it! They are always making promises here to provide this or that in the mental health sector but it never happens, or its very limited or you have to fit certain critera to get it.
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