Imagine if a new drug had been recommended for breast cancer by the National Institute for Health and Clinical Excellence (NICE), yet was available to hardly any sufferers. The vast majority were told that they would have to wait more than a year for it, others that they couldn’t have it at all. There would be uproar, wouldn’t there? Petitions to Downing Street, letters to The Times, questions to the Prime Minister, legal action, the works.
Yet that is exactly what has happened with treatment for depression and anxiety. More than three years after NICE guidelines were issued saying that the best treatment for these conditions was cognitive behavioural therapy (CBT) — a cheap, fast and effective way to help people to feel better about themselves — patients are still being denied it all over the country. Instead they are being pumped full of antidepressants at a cost of more than £300 million a year and goodness knows how many sideeffects. Or they are not being treated at all.
It is a national scandal, and the Government can’t even claim that it can’t afford the treatment. Lord Layard, the eminent economist and author of Happiness: Lessons from a New Science, has calculated that the cost per person of 16 hour-long CBT sessions — £750 — is exactly the amount that the Government would save in just one month if the depressed person managed to come off incapacity benefit. It’s what they call a no-brainer.
One in six of us suffers from depression, and it is no respecter of class or wealth. Forty per cent of people coming on to incapacity benefit do so because of mental illness, and these problems use up a third of GPs’ time. Doctors would love to be able to refer their patients to talking therapy — particularly CBT, as it is so effective — but end up prescribing antidepressants instead because the waiting lists for therapy are so long. Eight out of ten GPs admit that they are overprescribing antidepressants and three quarters say they are handing out more of the drugs than they were five years ago.
Scientific research suggests that CBT is just as effective as drugs in the short term in dealing with mild to moderate depression and anxiety. And it is more effective in the long term at preventing relapses, because it helps people to change their negative thinking patterns. It is also cheap because unlike, say, psychoanalysis, it doesn’t require years of work: 16 sessions are usually enough. And you don’t end up pumping your body full of brain-scrambling chemicals.
Good CBT therapists have to be well trained but they don’t all have to be clinical psychologists. Richard Layard estimates that half could be existing nurses or social workers or newly qualified psychology graduates (of whom there are loads these days, as the degree is immensely popular). The training takes two years, but much of it involves working on the job under supervision.
There are now more people on incapacity benefit because of mental illness than there are unemployed people claiming jobseeker’s allowance. As Layard says: “If unemployment was once the most prominent source of misery, it has been replaced by mental illness.” Yet the NHS spends a minuscule amount on it.
Only one in four of those who suffer from depression or chronic anxiety is receiving any treatment. Many have been depressed or anxious for years. At least half of them could be cured quickly for a one-off cost of just £750. Yet the 16 per cent of the population who are depressed or anxious attract only 2 per cent of NHS expenditure.
This is crazy, because the cost to society of all this misery is huge — and not just in emotional terms. Layard is a fine economist as well as a proselytiser for CBT, and he has calculated that the total economic cost of depression and anxiety is some £12 billion a year, or 1 per cent of national income. This is because depressed and anxious people either lose their jobs or can’t find jobs, or have to take time off from work.
The depressed person bears some of that cost, but of the £12 billion the taxpayer stumps up £7 billion in benefit payouts and lost tax receipts. Compare that with the cost of setting up and running a proper therapy service: just £600 million a year, according to Layard. And the NHS would claw back some of that money as its drugs bill fell and fewer people visited their GP or were referred to hospital.
This is the time of the cycle when endless good causes find themselves hammering at the Treasury’s door, demanding more money in the Comprehensive Spending Review. This column is an unashamed part of that lobbying effort. But, unlike many other competitors for the same pot of money, Layard’s solution has the advantage that it more than pays for itself. Just a small injection of cash now will generate much bigger savings and revenue very quickly.
This argument is the best way to attract the Chancellor’s attention. He sees almost everything in terms of economics. But the rest of us would also relish a return to happiness for the many friends and relatives we know who are sunk in misery. It has to be worth it, many times over.
Monster munch
I know that Schadenfreude is an unattractive trait. And I know that one or two of you castigated me during the summer for laughing at monkeys in Longleat Safari Park ripping the trim off a gleaming 4x4 and eating it.
But didn’t you feel just a glimmer of delight at the news that sales of these hulking, polluting, show-offy, unnecessary, pedestrian-killing monsters were plummeting and that their second-hand value was collapsing? I know I did.
Spooks in spades
The Sunday papers were crammed with theories as to who had poisoned Alexander Litvinenko, the former Russian spy, and how and why they had done it. This was rather a relief, as I didn’t have much time on Sunday and knew that I could just skip these endless pages with impunity.
You see, nobody writing the stories knows the answer. Possibly none of us ever will. For now, at least, it is all speculation and therefore pretty much worthless.
You can wake me up when it’s over — if it ever is — and then I’ll pay attention. Meanwhile, I think we Londoners have a duty to visit the poor, benighted Itsu sushi bar where the poisoning might or might not have happened, when it finally reopens. If you had to design a strategy for keeping customers away, you couldn’t do better than this one, could you? In fact, maybe the murderer had a grudge against the bar-owner, too. Now there’s a thought for another speculative piece . . .
