People affected by mental health problems – a leading cause of long-term absence from work – can face waits of over six months for treatment on the NHS. This is the key finding of a Health Insurance investigation, in which we used the Freedom of Information Act to gather data from primary care trusts (PCTs).
Of the 90 PCTs who supplied data (of a total of 152 PCTs in England), 12 reported waits of over six months for counselling for patients suffering from mild to moderate depression. One reported a wait of over a year and almost a third (29) listed a wait of over three months.
Over a quarter (25) of the 85 PCTs who responded to a question about waiting times for cognitive behavioural therapy (CBT) reported that patients waited over three months, with one listing a waiting time of three years.
The survey highlights a huge variation in waiting times, with over a quarter (26) of PCTs guaranteeing a first counselling appointment in under six weeks and some offering it in a matter of days. Waiting times for CBT range from three years to just three days.
Despite a key recommendation from a report published in 2008 by mental health charity Mind, a fifth of PCTs (30) said that they did not hold information about waiting times for talking therapies.
Research has shown that waiting for psychological therapy can reduce the likelihood that people will attend and cause them to use medication for longer.
Six million people in England are affected by depression and anxiety but only a quarter are in treatment.
We asked England’s 152 primary care trusts – the organisations which hold NHS budgets at a local level – the following questions under the Freedom of Information Act. A total of 90 responded. We asked:
1. What is the waiting time for outpatient counselling therapy for treatment of mild to moderate depression?
2. What is the waiting time for CBT therapy for treatment of mild to moderate depression?
3. What is the waiting time for access to a psychologist for treatment of mild to moderate depression?
PAUL FARMER, chief executive of Mind, said: “Waiting times for talking therapies are extremely inconsistent and it is disappointing to see that in some parts of the country, people are still waiting months and months for urgent treatments. The first phase of the Improving Access to Psychological Therapies programme aimed to give better access to psychological therapies in half the country by 2011.
“This data shows the importance of being able to offer a universally acceptable level of access to this vital treatment. It's particularly concerning that a fifth of PCTs surveyed didn't even record how long patients were waiting. If mental health services are to achieve equal footing with physical health services, it's vital that trusts start taking note of what position their patients are in, and working towards reducing waiting times for therapies across the board.”
A DEPARTMENT OF HEALTH spokesperson said: “Talking therapy services are being rolled out across the country, but it will take more time for some areas to feel the benefits. We are now halfway through a three year rollout programme. By 2010/11, we plan to have trained 3,600 more therapists who will help to provide access to psychological therapies for 900,000 more people.
“Good progress is being made and by autumn 2009, 115 talking therapy services were up and running, with at least service in 75% of PCTs. This means the NHS is rolling out the programme faster than originally planned. More than 100,000 people have benefited from IAPT services in the first year of the programme.”
THE MENTAL HEALTH NETWORK, which represents providers of mental health services in the NHS, has criticised the government for failing to treat mental and physical illness equally in excluding the former from new legislation guaranteeing access to treatment within 18 weeks.
DR MIKE O’DONNELL, chief medical officer at disability insurer Unum, said: “We know that with any illness the longer you are off sick the harder it is to go back to work. If you are off sick for more than six months the chances of going back to work are very slim indeed. If we are notified quickly if someone has as problem and we feel there is a possibility that the problem could be helped by CBT or something else we can arrange for treatment. This could be in a matter of days through our employee assistance programme LifeWorks. If we identify a need through our rehabilitation service for income protection claimants, it would be two or three weeks maximum.”
EUGENE FARRELL, business manager at employee support provider AXA ICAS, said: “I would very much support the quickest access possible. These therapies have good outcomes. We know that the length of time people may wait before they present can be highly variable. They don’t just wake up and decide they are depressed and could have symptoms for up to a year. By this time their performance at work has already started to slip and go downhill.”
New guidelines from the National Institute of Health and Clinical Excellence (NICE) recommend that people who suffer from mild to moderate depression receive individual self-help based on the principles of cognitive behavioural therapy (CBT), computerised CBT or a structured group physical activity programme. Guidelines in place at the time of the Health Insurance investigation recommended counselling in addition to CBT and the mental health charity MIND has urged the NHS not to withdraw funding for this form of treatment.
NICE guidelines endorse a “stepped care” model as the best system for ensuring access to treatment for people suffering from depression. The principle is that patients receive the least restrictive and least costly intervention that will be effective for their condition, beginning with low-intensity interventions such as group CBT through to referral to a psychiatrist and eventually, inpatient care. This is the model that has been adopted by the Department of Health’s Improving Access to Psychological Therapies programme.
DR DOUG WRIGHT, head of clinical governance at Aviva UK Health, believes that the PMI sector should develop a similar model. “In any situation where you have a desire to control your spend the only thing that makes sense is to have stepped analysis and phased intervention. That is how our Back Up service for musculoskeletal claims works. You can see how a similar process around psychological ill health works in the same sort of way. It is not built yet but it very much on the agenda.
"Certainly as we have gone through 2009 and all the economic pressures, employers have become aware of stress and the psychological ill-health caused by those sorts of pressures more than before. But the need to actively put things in place is not being very well met by the market. The initial reaction is that an EAP may be suitable but that depends on the exact construction. A pure helpline may not be enough to take people as far as they need to go, which is where a staged response comes in.”
Many PCT respondents to our survey cited the Improving Access to Psychological Therapies (IAPT) programme as the key to delivering improvements in the NHS. This initiative was launched in 2006 in a bid to tackle the fact that only a quarter of the six million people in the UK suffering from depression and anxiety disorders were in treatment.
By 2010/11 £173m will have been invested in training 3,600 new therapists. The goal is to ensure that 900,000 more people access treatment, with half of them moving to recovery and 25,000 fewer on sick pay and benefits by 2010/11.
During the first year 2,400 people moved off sick pay. Only 400 therapists are fully trained so far, according to a report in The Observer (04/10/09).
IAPT is being rolled out gradually across PCTs. There are currently 35 sites with 80 more due to join the programme shortly.
Cognitive behavioural therapy (CBT) is a way of talking about how you think about yourself, the world and other people and how what you do affects your thoughts and feelings. It can help can help you to change how you think (“cognitive”) and what you do (“behaviour)”. These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
Source: Royal College of Psychiatrists