Postcode determines whether patients wait days or months for therapy
Thousands of patients with depression are still waiting more than six months for NHS counselling and other talking therapies, despite the Government’s £170m investment in improving access to treatment, Health Insurance can reveal.
At least 10 primary care trusts (PCTs) in England have waits of more than six months to see a trained counsellor. Patients referred for cognitive behavioural therapy (CBT) – the main talking therapy recommended by the National Institute for Health and Clinical Excellence (NICE) – are waiting for more than six months in at least eight PCTs.
The findings lend weight to the business case for employers to fund access to therapy. Mental ill-health, including anxiety, stress and depression, is the leading cause of long-term absence in the UK and is estimated to cost employers on average £1,035 per employee per year, through sickness absence, staff turnover and reduced productivity.
'Vulnerable to cuts'
The data, collected from 120 PCTs under the Freedom of Information Act, shows that waiting times have increased in some areas since 2009, when Health Insurance conducted a similar investigation. Today, 41% of 85 PCTs have waits of more than three months for counselling, compared to 29% of 90 PCTs in 2009. Patients wait for more than three months for CBT in a quarter (27%) of PCTs, a similar proportion to 2009.
While some authorities offer immediate access to a trained mental health professional, others report waits of more than a year. Patients are waiting up to 54 weeks for counselling in Central and Eastern Cheshire and up to 67 weeks for CBT in the Wirral. Both are available with no wait or in a matter of days in other areas.
Mental health experts expressed concern about the findings.
"We know that there is a postcode lottery in access to talking therapies and always has been," said Phillip Hodson of the British Association of Counselling and Psychotherapy. "Despite the best intentions, mental health services remain a Cinderella service and vulnerable to cuts."
"Waiting times for treatment can make the difference between someone making a swift recovery, to someone having every area of their life fall apart," said Vicki Nash, head of policy and campaigns at mental health charity Mind. "It seems so wrong that the outcome all depends on where in the country you live."
Previous research carried out by Mind found that people waiting for three months or less for therapy were five times more likely to report that the treatment helped them get back to work than those waiting for one or two years.
The survey also shows that the range of talking therapies recommended by the National Institute for Health and Clinical Excellence (NICE) for mild to moderate depression is unavailable in many parts of the country, despite the fact that CBT is not appropriate for everyone diagnosed with the condition and the Government’s commitment to delivering patient choice.
Interpersonal therapy – a treatment designed to address relationship problems – is not provided by 45 PCTs while 61 do not offer behavioural couples therapy. Psychodynamic therapy, which focuses on causes of depression rooted in childhood, is unavailable in 56 PCTs.
Hodson said that the NHS needed "a whole family of therapies" to serve people with depression.
"CBT is very important and useful," he said. "We would not be without it. But it is not some kind of panacea and it is damaging to the confidence and health of patients and therapy itself if someone suggests that it is."
In February the Government announced that it would invest £400m over the next four years to complete the roll-out of the Improving Access to Psychological Therapies (IAPT) programme and ensure that every adult has access to psychological therapies for anxiety disorders and depression. Since the programme was launched in 2008 more than 600,000 people with mild to moderate depression have entered treatment and the Department reports that alternatives to CBT are becoming more widely available. The current standard for IAPT services is 28 days from referral to first treatment session.
Since the economic recession an increasing number of employers have invested in counselling services for staff. The latest data from the Chartered Institute for Personnel and Development shows that access to counselling is now the most widely provided employee benefit, offered by nearly half of private sector employers, compared with just over a third in 2009. Over a third of employers noted an increase in reported mental health problems among employees in 2010, with those that had made or were planning to make redundancies more likely to report an increase.
Dr Seamus Dagens, a consultant occupational health physician at PMI Health Group, a firm which advises employers on health and wellbeing, said that many employers recognised that prompt access to treatment for depression could "dramatically" shorten the course of the illness.
"This in turn facilitates a more timely return to normal every day activities and work,” he said. “In such cases this is obviously advantageous for both employee and employer."
Eugene Farrell, business manager at AXA ICAS, which provides counselling and other talking therapies to organisations, said that employers could secure a four to one return on investment by screening for mental health problems and providing early access to support.
Look out for the full report of the research in the August edition of Health Insurance, out next week.