NHS failing to act on talking therapies clinical guidance, says new report
Posted Monday 30 October 2006
Mental Health Foundation, Mind, Rethink, The Sainsbury Centre for Mental Health, Young Minds
The NHS is failing millions of people by ignoring clinical guidelines on psychological therapies, a group of charities warn in a report published today.
We Need to Talk argues that evidence-based talking therapies such as cognitive behavioural therapy are as important for the nation's health as any cancer drug or surgical procedure. Evidence shows that they can help millions of people in the UK who experience common and severe mental health problems.
Yet for three years the NHS has failed to act on recommendations from the National Institute for Health and Clinical Excellence (NICE) to offer psychological therapies to people with depression, anxiety and schizophrenia, due to a lack of investment.
Waiting times of six to 18 months force many people to suffer unnecessarily or give up waiting on the NHS and go private - if they can afford it. Many GPs admit giving prescribing antidepressant medications because they can't access talking therapies for their patients. Even acute psychiatric wards frequently do not offer their patients psychological therapies.
The impact of that failure is massive - mental ill health costs over £77 billion in England alone and causes suffering to people of all ages. At least one million adults are out of work with mental health problems and countless children miss out on schooling and fail to achieve their full potential because their mental distress is not treated properly. And many people with long-term physical illnesses develop mental health problems, which go untreated.
We Need to Talk calls on the Government to provide psychological therapy through the NHS in line with NICE guidance. It also says that the NHS should introduce waiting time measures for access to mental health treatments.
Barry Davies, 44, from Cheshire, who has been diagnosed with Bipolar Disorder said: "I found out about CBT about ten years ago. It was really useful and helped me in so many ways. It's like a learnt behaviour and you don't forget the techniques - a bit like riding a bike. You might wobble a bit if you haven't done it for a while but you will always be able to do it. Years ago I had automatic negative thoughts but nowadays its automatic positive thoughts. CBT has more or less reversed the equation."
Chief Executive of the Mental Health Foundation, Andrew McCulloch, said: "There is strong evidence that many talking therapies can effectively treat a range of mental health problems. We must not deny people who need therapy from having access to it, and medication should not be relied upon just because there is no alternative."
Chief Executive of Mind, Paul Farmer, said: "The NHS would never be allowed to fail to provide a drug or operation that was mandated in NICE guidance, yet that is exactly what is happening with talking therapies. This is a fundamental inequality that should not be allowed to continue."
Director of Public Affairs at Rethink, Paul Corry, said: "People with severe mental health problems can benefit hugely from talking therapies. Offering proven psychological therapies is essential to make patient choice a reality in the NHS."
Chief Executive of The Sainsbury Centre for Mental Health, Angela Greatley, said: "Poor access to psychological therapies can prevent people in work from keeping their jobs. Just eight sessions of CBT can make all the difference for some people with depression. The cost of not offering this support far outweighs the investment needed to make all the difference."
Chief Executive of Young Minds, Barbara Herts, said: "Children and young people suffer high rates of mental distress. This can disrupt their family lives and damage their education. We must intervene early to get children and young people the right help when they need it."
Report facts and figures:
- In 2002/3, spending on mental health by the NHS and local social services in England was estimated to be £7.9billion, equivalent to 11.8 per cent of public spending on health services.
- Over half (55 per cent) of GPs believe that talking treatments are the most effective way to treat mild or moderate depression, yet 78 per cent have prescribed an antidepressant while believing an alternative would have been preferable.
- In 2005, 27.7 million antidepressant prescriptions were written in England, at a cost of £338 million to the NHS. Eight out of ten GPs admit that they are over-prescribing anti-depressants and three quarters say they are handing out more of the drugs than they did five years ago.
- Black people are less likely to be offered talking treatments, and more likely to be given medication and coercive treatments. Refugees and asylum seekers often find it difficult to access therapies, especially in languages other than English.
- Despite the extremely high prevalence of mental health problems amongst people in prison, there is little access to psychological therapies.
- A Healthcare Commission survey of over 8,000 people in secondary - hospital based - mental health services in England in 2005 found that just 39 per cent had received some kind of talking treatment (compared to 57 per cent who would have liked to do so).
- A study of acute inpatient services in 2004 found that just one ward in five regularly offers CBT to patients.
- Poor mental health affects physical health, can lead to an earlier death - up to ten years earlier - and is a major cause of suicide.
- People with depression, anxiety or severe mental illness are more likely to be unemployed or economically inactive than the wider population. Less than 25 per cent of people with long-term mental illness have a job, compared to 75 per cent of the general working age population.
- The NHS should implement NICE guidance as a matter of urgency.
- The Government's 2007 Comprehensive Spending Review should provide for improved access to talking therapies.
- The NHS should introduce waiting time measures for access to mental health treatments.
- The Department of Health should make a realistic assessment of the workforce and training implications of delivering psychological therapies.
- The Department of Health and regulatory bodies should ensure substantive measures for public protection from malpractice.
- The Department of Health should investigate the current bias in research priorities and address it by supporting more research into psychological therapies.