Monday, 18 June 2012

Why the worried well trump real mental illness


"The "scandalous" scale of the NHS's neglect of mental illness has been described in a report which suggests only a quarter of those who need treatment are getting it.The report claims that millions of pounds are being wasted by not addressing the real cause of many people's health problems. Nearly half of all the ill-health suffered by people of working age has a psychological root and is profoundly disabling, says the report from a team of economists, psychologists, doctors and NHS managers, published by the London School of Economics. 
Talking therapies such as cognitive behaviour therapy relieves anxiety and depression in 40% of those treated, says the Mental Heath Policy Group led by Lord Layard. But despite government funding to train more therapists, availability is patchy with some NHS commissioners not spending the money as intended, and services for children being cut in some areas. "It is a real scandal that we have 6 million people with depression or crippling anxiety conditions and 700,000 children with problem behaviours, anxiety or depression," says the report. "Yet three quarters of each group get no treatment."
"IAPT has created a revolution in mental health by establishing a national competency framework for therapists, by training them to a high standard and by carefully monitoring their outcomes. Many readers will be amazed to hear that 10 years ago only 11% of British psychiatrists regularly administered any objective measure of mood when treating depression. Now all IAPT workers do so and the results, which are available on the NHS Information Centre website, are in line with the assumptions of the economic case. Latest figures show that 44% of people who have some form of treatment in IAPT recover. Many more (around 65%) show worthwhile improvements. In addition, the number of people who have moved off sick pay and benefits exceeds expectation. 
...The same story emerges with service budgets. IAPT is expected to offer treatment to a modest 15% of people with depression and anxiety by 2014. On average services currently provide for around two thirds of that. However, instead of expanding, there are signs that cash-strapped commissioners are cutting back. For example, one well-performing London IAPT service recently had its budget cut by 30%. Such cuts make no economic or humanitarian sense. As evidence-based psychological treatments save the NHS more than they cost, we should be doing more, not less, in tight economic times."
Well bollocks to that. IAPT (Improving Access to Psychological Therapy) provides a few sessions of crappy telephone or group based therapy 'inspired' by CBT and delivered by minimally trained therapists to people with mild symptoms of life stresses who barely meet criteria if at all) for mental illness.
Meanwhile people with significant mental illness are excluded by their services and sent to secondary psychiatric care where the same old waiting lists for CBT and other therapies exist as they did before IAPT was invented. All because they're too 'risky' or 'complicated' to be dealt with by IAPT (read that as 'actually mentally ill'). Of course 40% of people get better, most would have got better anyway!
Patients hate it, clinicians think it is a joke. So inevitably more and more money will be diverted in its direction, probably at the expense of people who know what they're doing.
The report itself is a magnificent example of eliding different definitions of depression and other mental illness -pretending that those in community prevalence estimates of depression are the same as those in morbidity studies of depression are the same as those on incapacity benefit for 'mental health problems' are the same people as those in clinical trials of depression in order to make breathtakingly speculative claims about how CBT can save the economy millions.
Yes, fund mental health better, no, don't piss millions more away treating mild unhappiness at the expense of real illness.


John said...

Of course 40% of people get better, most would have got better anyway!

Exactly. Talk therapy can make matters worse. Encouraging depressives to stop talking and start doing is much more beneficial. In true depression though it can take some time for that to be possible. That's why the drugs can be so beneficial. See

Anonymous said...

Part of the problem is that when IAPT are recruiting they prefer to recruit graduates that have been on their PWP training who have little or no experience and are paid a pittance whilst training, rather than employing people that are skilled and experienced in enabling people to help themselves through the delivery of interventions, and are more skilled, just because they haven't been on a PWP training course and don't want a pay cut to do so.

Additionally, they appear to cherry pick the clients that are the easiest to help and bounce clients with more complex problems such as dual diagnosis to other services first. They also appear to think that phone intervention or cd rome are a good way of engaging people.