Wednesday, June 21, 2006

Welcome report on the effectiveness of therapy in treating depression

I recently noticed that a GP of my acquantaince was down to give a talk on depression to a local church group. When I saw her next I asked her if she was a specialist in depression. Her reply was telling:

"I am a GP. Every GP is a specialist in depression".

...i.e. the problem is one which GPs face with grim frequency. The figures bear this out. One person in six could be diagnosed at some time with chronic anxiety or depression. One million people are on incapacity benefit because of mental illness - more than the number unemployed.

That bears repeating. More than the number unemployed.

However, a report from a team led by Professor Richard Layard says that most GPs can only offer medication and perhaps a little counselling.

Perhaps that is why, as reported in the Observer in 2004, traces of Prozac have been found in our drinking water.

My GP acquaintance bore this out. Therapy is a treatment not readily available on the NHS. The Layard report recommends that the government massively increases the number of therapists. It demonstrates that this would be easily cost-effective when you consider the savings on drugs and days off work etc etc.

Depression is generally misunderstood. The Observer leader put it very well yesterday: There is a "widespread failure to distinguish between depression as a dangerous illness and the more commonplace use of the word to describe a sombre mood that is unpleasant, but not pathological." Depression can often mean that the patient physically can't move. They just cannot raise a leg to get out of bed. Compare that with examples of people often saying they are "depressed" because they have lost their car keys or whatever!

Therapy also has a bit of a bad name. It is often seen as something which involves deep searching questions about your childhood, sexual relations etc etc. As Professor Layard points out in the Observer, Cognitive behavioural therapy is very successful. To the patient, it is a gentle and healing process of going through what has happened and piecing together ways of moving forward. There are not normally questions such as "did your mother beat you?".

So, in summary, depression is a serious illness which is extremely prevalent. People can't just "snap out of it". The NHS is issuing so much Prozac that it's in the water supply. However, therapy is often the best, most cost-effective way of treating it, but the NHS is not providing that course of treatment to most of the people who need it. The Layard report confirms what many of us have known for a long time, but it is nonetheless very welcome.


  1. There is a severe shortage of therapists.
    If you are lucky you can find a charity who provide therapy services (often in conjunction with GPs) although many are more focused on particular groups (often the young).
    Mental health is one of the areas where the NHS is failing most dramatically, waiting lists for therapy are months or years long, you can be made to feel that you should stay with a therapist you don't like when you finally get one (else you risk another long time on waiting lists) and the relationship between therapist and patient is very personal, some therapists can do more harm than good for some patients but be wonderful for others.

    Many of those on incapacity benefit due to mental illness would rather not be, but the treatment is so slow in getting there (beyond drug therapies, which have a place, but are often more like a plaster cast providing support whilst the illness is dealt with through other means) that they have no choice, and end up on incapacity benefit permanently (then people like Blunkett seek to demonise them for being on benefits for so long).

    It is criminal that mental illness is often ignored until it reaches crisis point and drastic action needs to be taken. Part of that is societal, mental illness is still a stigma and people don't want to admit they are ill, but part is institutional, largely I feel due to the way the NHS functions and NICE having to make impossible decisions on where funding should go.

    (as you may have gathered, I feel very strongly about this, having had family, friends and myself been through different parts of the system).

  2. Tristan - I agree wholeheartedly with every word of what you say. Thank you for expressing it so strongly. Hopefully the Layard will do some good.