David Richards: CBT: three letters that spell hope for the forgotten majority


In 2005, Labour made a manifesto commitment to increase the amount of psychological treatments available to patients with anxiety and depression. This week that promise came good, with Alan Johnson announcing a £170m investment in talking therapies.

This is truly excellent news. The money is targeted at the "forgotten majority" – people with depression and anxiety. These people outnumber those with very florid mental health problems such as schizophrenia by a factor of more than 30 to one. We all know at least one person with depression or anxiety and there is a good chance we may suffer ourselves. World Mental Health Day 2007 will go down as the day the UK woke up to its responsibilities for the mental well-being of us all.

These people are not the "worried well", to use that utterly demeaning term. If you are depressed you cannot function as normal. You cannot sleep, cannot eat, cannot work. Such disorders cost the UK 2 per cent of its gross domestic product. Jobs are lost, families break up and people die through suicide.

The worst obscenity of the past has been that these mental health disorders are eminently treatable. Talking therapies, particularly cognitive behavioural therapy or CBT, are as effective as drug treatments. Countless clinical trials of CBT have shown that 50 to 60 per cent of patients can make a complete recovery and go on to lead lives enriched with renewed confidence.

Why have we waited so long to make good the CBT gap? The answer was that successive governments doubted whether the results of clinical trials could be delivered in everyday NHS environments. Labour had to fund a multi-million pound programme of "demonstration sites" to examine the feasibility of getting CBT to all who need it. These sites – in Doncaster and Newham – have repaid that investment handsomely.

Volume has been the driver. Governments like big numbers. To get the volume, these sites have adapted the clinical methods used in research. In Doncaster particularly, case managers have been recruited from within their own communities and trained to deliver CBT.

These new workers – "Community Support Officers for Talking Therapies" – have been able to treat more than 4,000 patients a year, four times more than was possible using traditional methods. The big fear – that quality would be sacrificed for volume – has not materialised.

A combination of focused training, smart information technology and expert supervision has shown that the majority of patients can make a full recovery from their disabling disorders using CBT. It was these facts that persuaded Mr Johnson to deliver Labour's manifesto promise.

The jubilation expressed by the Department of Health, patient advocacy groups and professionals has been tempered by the realisation that there is now a huge job to be done. At the moment there simply is not the infrastructure to support the huge planned expansion.

The headline figure – £170m – will come on-stream in 2010/11. Next year, in preparation for this massive growth, the NHS and universities will be asked to gear up to the task of training another 3,400 therapists. By 2009 the programme will begin to treat large volumes of patients.

For the first time, you, me, your friends and anyone else struggling with common emotional distress will get more than a kindly GP consultation and drug treatment. It cannot come too soon.

David Richards is Professor of Mental Health at the University of York. He leads a research programme and campaigns to improve access to mental health care

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