Now is the time for talking

Doncaster and Newham may be about to prove that cognitive behavioural therapy could help people with mental health problems back to work. Simeon Brody reports

“The end of the Prozac nation” was how the government proclaimed the launch of its 3.7m talking therapy pilot project earlier this month (news, page 9, 18 May).

The phrase may seem somewhat hyperbolic for what will be two limited demonstration sites, but charities hope the pilots could pave the way for a fundamental change in the way services are delivered.

The two sites, Newham, east London, and Doncaster, will test the theory that using psychological therapies to help people with common mental health problems, such as depression and anxiety, get back to work or remain in work will have a significant economic benefit.

The Department of Health hopes that, over the next 18 months, the pilots will provide hard evidence of the cost-effectiveness of providing cognitive behavioural therapy. It will be particularly keen to see how many people it removes from long-term incapacity benefit.

If the sites prove successful, the department will bid for more funding with a view to rolling out a five- to 10-year scheme across England.

“We need hard facts and figures, which is what this programme is going to deliver,” a DH spokesperson says. “If it works, it’s got the potential to save the economy billions.”

The therapy will only be available to people of working age but she emphasises it will extend beyond those on incapacity benefit.

The National Institute for Health and Clinical Excellence has long advocated using psychological therapies and mental health charities have reacted positively to the initiative.

Rethink, Mind and the Sainsbury Centre for Mental Health all hope the pilots will be the first step towards making talking therapy available to everyone who needs it.

Mental Health Foundation chief executive Andrew McCulloch also supports the pilots but questions the government’s aims in setting them up. If the target is to help people with anxiety or depression access CBT more quickly, he says it is likely to succeed. But it is less likely to succeed if the aim is to get people on long-term incapacity benefit back to work as they will need more support.

“The distinction between people who are off sick long-term and need multiple support to get back to work and people having a single episode of a common mental disorder has not been made,” he says.

“We are treating two different client groups here. Some people may be too frightened to go out of their front door to go to the treatment centre in the first place.”

A spokesperson for mental health charity Together is even more sceptical, suggesting that talking therapies should be made more widely available across the country now.

“What further research into their usefulness do we need? Surely what we want is what the Nice guidelines say – that they are available to people today, to help them today.”

The further research planned by the government will measure the impact on the wider economy. But that may prompt some to ask in what other areas of health would the best treatment need to be justified by how much money it saves?