Increasing access to psychological therapy is an important intervention particularly for those who are severely depressed. Access to psychotherapy is only useful when given in primary care and before the patient becomes treatment resistant. It is well documented that CBT is ineffective when a patients' get to the point of needing to be referred to a consultant psychiatrist. That said, there are two other important issues regarding improved access and suceesfull outcomes.

First is that the effective outcome of psychotherapy depends on the quality of the psychotherapist;the one who has the ability to tailor psychotherapy to the needs of each individual patient.

Secondly, improving access due to the increase in the number of available psychotherapists is likely to mean that there is a potential for infinitely expandable demand. The greater the provision made, the more likely it is that the increase in provision will itself create an expanding demand.

Competing interests: None declared