Wednesday 9 February 2011

Wales Needs To Catch Up

There's a lot happening across the border on mental health. The (English) Department of Health has launched its No Health Without Mental Health strategy outlining how a new emphasis on early intervention and prevention will help tackle the underlying causes of mental ill-health. Follow the links from the Mental Health Wales story here.

Central to these plans is an additional investment of around £400 million (though some say it's not all new money) to improve access to psychological therapies over the next four years, extending the current programme available to offer personalised support to 3.2 million people across England, making available a choice of psychological therapies such as Cognitive Behavioural Therapy (CBT), Counselling for Depression, and Interpersonal Psychotherapy and (they claim) ensuring access for anyone who needs it.

The new strategy commits the government to expand provision of psychological therapies to children and young people, older people, people with long-term physical health problems, those with medically unexplained symptoms and (fanfare here) those with a serious mental illness. Patients will be able to request a referral via their GP or contact the provider directly for a self-referral consultation.

The government asserts that extending psychological therapies to all those with mental health problems will result in one million people recovering from their condition by 2014 and 75,000 people getting their lives back on track by returning to work, education, training or volunteering. They say it will also create over £700 million of savings to the public sector in healthcare, tax and welfare gains.

Wales needs to get its act together but should start by providing psychological (or "talking") therapies to those in greatest need (and incidentally those who cost most to support) - people with a serious mental illness. Here as in England there is a tendency even among supporters of psychological therapies to see them as appropriate for low-level problems but not to recognise their importance to people with schizophrenia, bipolar disorder, etc, contrary to NICE guidelines which, though conservative and cagey about more in-depth talking therapies, do recognise that they can be both effective for patients and also cost-effective for commissioners (see for example their guidance on schizophrenia here).

Of course if patients with a serious mental illness actually had a choice of therapies they (as NICE admits) would go for "middle-ground" talking therapies - not as superficial as quick-fix CBT but not as deep as traditional, long-term psychoanalysis. I am quite certain they are right.