Analysis And Comment Health policy

The case for psychological treatment centres

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7548.1030 (Published 27 April 2006) Cite this as: BMJ 2006;332:1030
  1. Richard Layard (r.layard@lse.ac.uk), emeritus professor1
  1. 1 Centre for Economic Performance, London School of Economics, London WC2A 2AE
  • Accepted 30 March 2006

The government is committed to improved access to psychological therapy. How big an expansion is necessary to meet the NICE guidelines on depression and anxiety, and how should it be organised?

If you have schizophrenia or bipolar depression in Britain, you will generally get specialist help from the NHS.1 But only about 1% of the British population have these terrible conditions. Many more (some 15% of us) have unipolar depression or anxiety disorders, yet if you have one of these, often crippling, conditions you are unlikely to get any specialist help at all. You can see your general practitioner, but he or she is unlikely to prescribe any treatment other than drugs.

Risk of relapse after recovery from depression

This pattern of prescribing is completely at variance with the guidelines from the National Institute for Health and Clinical Excellence (NICE) on treating depression and anxiety disorders.2 3 4 These guidelines recommend that cognitive behaviour therapy should be available as an option for all but the mildest or most recent forms of depression and anxiety. The guidelines also recommend other forms of psychological therapy for selected conditions. The guidelines are, of course, based on hundreds of randomised clinical trials. These show clearly that cognitive behaviour therapy is as effective as drugs for treating depression and anxiety in the short term, and tends to have more durable effects.2 3 4 5 6 Moreover, psychological help is what thousands or even millions of patients want.7

At present it is simply impossible for general practitioners to implement the NICE guidelines because the therapists are not available. Thus mentally ill people are denied specialist help, whereas it would automatically be supplied for equally disabling cases of physical illness. If the NICE guidelines were implemented many more people would receive help, and …

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