Leading article: At last, some signs of sanity


Patricia Hewitt's intentions are admirable, and she deserves congratulations for her plans to shift the emphasis of NHS treatment for depression from drugs to talking. There will, of course, be those who have their doubts about psychotherapy, some of which are legitimate. There are some kinds of mental illness that are not treatable by dialogue, and there are some forms of therapy that do more harm than good. Seroxat, for example, is a drug that allows many people to lead fulfilling lives, and those people are unlikely to be helped by any kind of analysis. Equally, it is plausible that, in some cases, ill-directed therapy can reinforce introversion, or worse.

That said, however, there is something plainly unhealthy about a nation in which one million people take Prozac and nine out of 10 GPs say that they prescribe anti-depressants when what their patients really need is someone to talk to. Professor Richard Layard, who has done more than anyone to make the study of happiness a serious academic discipline, also deserves warm applause for his role in persuading the Secretary of State for Health to change direction. He built his powerful case on three linked arguments: that the shift would be better for individuals; better for the country as a whole; and because it would be more socially just.

That psychotherapy is usually better for people than anti-depressant drugs has been confirmed by Nice, the National Institute for Clinical Excellence, the official body that tries to rule on the efficacy of contending treatments. But it can also be shown that effective treatment, especially for depression, is in our common interest. More than one-third of new claims for incapacity benefit are made on account of depression or anxiety, at a deadweight annual cost to the nation of billions of pounds. Finally, the use of therapy is heavily class-biased in favour of those who can afford it. Even the limited time that GPs give to each of their patients is class-biased, with the most deprived getting only three-quarters as much time, in an average consultation, as the least deprived.

For all these reasons, The Independent on Sunday has been campaigning for better provision for the mentally ill, and against a public policy towards mental illness that is driven by fear of the most dangerous psychopaths. Our congratulations for Ms Hewitt and Professor Layard must be tempered, however, by our scepticism that this welcome change in rhetoric will be backed up by a real shift in resources, especially at a time when the more visible parts of the NHS are suffering from such emotive financial pressures. Ministers talk, worryingly, of mobilising existing resources and levering in the voluntary sector; they should be judged by whether they are prepared to put our money where their mouths are.

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