Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. II: Cost effectiveness
I would like to know more about "usual GP care". Only a few months
ago I had a letter from a service user with depression (I will not call
her a patient, since she was not even afforded the luxury of a
diagnosis)whose GP had said "you will just have to face the fact that you
are never going to be one of life's little sunbeams". Perhaps she would
have been better off with a chihuahua?
Whilst this study does look beyond cost to user and staff choice and
availability (roll on the 1000 new "Psychoangels" announced in the NHS
Plan?, I cannot see it as particularly powerful or ground-breaking. I
thought we already knew that CBT and counselling were equally efficacious
and what about the person offering the intervention - their motivation and
belief in the therapy, for example?
Isn't one of the problems with applying RCT 'mentality' to complex
human systems that it is simply like trying to sieve flour though a
container whose holes are too big really to do justice to the subject?
Surely, longitudinal tracking naturalistic studies would yield far more of
the quality information we need.
We need to know what works, not what doesn't. On the basis of this
study, if commissioning services, I would maintain my waiting lists and
allow 'time' to deal with those whose condition is going to resolve
spontaneously anyway. I believe there is a high DNA rate for many
psychology services that are not practice-based?
Perhaps we should tease all those psychologists out of their 'sets'
and get them seeing some patients in primary care settings, get away from
all this 'boxed-in thinking and concentrate on issues such as fitness for
purpose, rather than traditional job titles?
Rapid Response:
Usual GP care
Dear Editor
I would like to know more about "usual GP care". Only a few months
ago I had a letter from a service user with depression (I will not call
her a patient, since she was not even afforded the luxury of a
diagnosis)whose GP had said "you will just have to face the fact that you
are never going to be one of life's little sunbeams". Perhaps she would
have been better off with a chihuahua?
Whilst this study does look beyond cost to user and staff choice and
availability (roll on the 1000 new "Psychoangels" announced in the NHS
Plan?, I cannot see it as particularly powerful or ground-breaking. I
thought we already knew that CBT and counselling were equally efficacious
and what about the person offering the intervention - their motivation and
belief in the therapy, for example?
Isn't one of the problems with applying RCT 'mentality' to complex
human systems that it is simply like trying to sieve flour though a
container whose holes are too big really to do justice to the subject?
Surely, longitudinal tracking naturalistic studies would yield far more of
the quality information we need.
We need to know what works, not what doesn't. On the basis of this
study, if commissioning services, I would maintain my waiting lists and
allow 'time' to deal with those whose condition is going to resolve
spontaneously anyway. I believe there is a high DNA rate for many
psychology services that are not practice-based?
Perhaps we should tease all those psychologists out of their 'sets'
and get them seeing some patients in primary care settings, get away from
all this 'boxed-in thinking and concentrate on issues such as fitness for
purpose, rather than traditional job titles?
Dr Chris Manning
Co-Chair PriMHE
www.primhe.org
Competing interests: No competing interests