For years Emma Carter had suffered from crippling anxiety and panic attacks. By 2001 these had become so debilitating that she had to cancel the white wedding she had planned and opt instead for a smaller ceremony in a register office. Emma was later prescribed citalopram but had to stop taking it when she became pregnant, and the problem returned.

Patients who experience mild to moderate depression and anxiety and panic attacks should be offered psychological help first — talking therapies, rather than medication — according to guidelines from the National Institute for Health and Clinical Excellence (NICE). However, as the Downing Street adviser Lord Layard outlined in September, the chronic shortage of therapists means that only one NHS mental health patient in ten receives any form of talking therapy. The result? Unnecessary suffering and huge economic cost — prescriptions for antidepressants cost the NHS £395 million in 2003, making mental health, in Lord Layard’s words, “our biggest social problem”.

Those who do see a therapist have an average wait of five months, a study last year by Norwich Union Healthcare found; in some parts of the country the wait is as long as two years. Majorie Wallace, chief executive of the mental health charity SANE, says that these enormous waiting lists could prove disastrous for some. “During a two-year wait for psychotherapy, a moderate mental health problem could deepen, necessitate time off work, disturb relationships and become much harder to treat,” she says.

After visiting her GP in May, Emma waited three months to have cognitive behavioural therapy (CBT). Dr Steven Harris, who works in Crouch End, North London, is one of a handful of British GPs who have trained in CBT; he offers the therapy on-site and free to his patients. Emma is one of about 200 people to have been helped by his scheme.

“The idea grew out of my frustration at the way we treat mental disorders, which make up one in five cases a GP sees,” says Dr Harris. “Often a GP has no choice but to prescribe drugs, when the overwhelming majority of these patients don’t need them: we know that CBT will be just as, if not more, effective.”

Drugs for mental disorders can have side-effects such as irritability, confusion and appetite disturbance. They are also expensive. Private CBT sessions cost about £90 for 50 minutes. For the past three years Dr Harris has devoted an afternoon a week to his CBT clinic. Any GP in his practice can refer a patient, and he sees each for five half-hour weekly sessions.

But, he says, this has involved “shuffling timetables with the other GPs here, and a little extra work”. Recently, Professor Windy Dryden, of Goldsmiths College, an expert in CBT, has started a weekly group session at the practice.

To assess the scheme’s effectiveness, Dr Harris conducted a study of 60 of his patients over a period of six weeks: each suffered mild to moderate depression or anxiety. Half had CBT, the other half weekly support from their GP; none was on medication. The CBT group fared better according to standard measures of severity, frequency and duration of symptoms. Ninety per cent said that they had improved significantly, and that result was maintained six months later. This compares with SANE figures that showed a 70 per cent improvement for those on medication. Only about one in 20 of Dr Harris’s CBT patients was found to need further CBT when assessed after six months.

The Department of Health acknowledges that waiting times are often too long. “The recognition of CBT and similar therapies by NICE is relatively recent,” says Victoria Maccallum, a DoH spokesman. “It takes time to properly train therapists. We are due to announce plans to improve access shortly.”

The British Association for Counselling and Psychotherapy emphasises the need for proper training: “GPs can’t turn themselves into therapists in a matter of weeks,” says its spokesman, Phillip Hodson. “Our accredited members have 950 hours of training and practice.”

For Emma Carter fast access to CBT has meant a great improvement. “For the first time, I feel I’ve been given the tools to deal with this problem,” she says. She hasn’t experienced a panic attack since her CBT sessions began.

www.sane.org.uk

The name Emma Carter is a pseudonym