What is the greatest source of misery in our society – poverty, unemployment or mental illness? As surveys show, the answer is mental illness. Yet under a third of people with these problems are in treatment. If you break a bone, you receive care automatically, but if your spirit is broken, you do not.
Nearly 40% of all illness in this country is mental illness, but most of it is untreated. It is the greatest injustice in our society and every party’s manifesto needs a plan to redress it. The good news is that both depression and chronic anxiety conditions are highly treatable by modern evidence-based psychological therapies such as cognitive behavioural therapy (CBT). Half of the people treated recover fully, and many others improve substantially. After recovery, the chances of relapse are much reduced; many patients say they feel reborn.
The National Institute for Health and Care Excellence (Nice) has recommended that these therapies be made available to all those with depression or anxiety disorders, but at present they are offered to only 13%. That is considerably better than the 1% in 2008, before the government instituted Improving Access to Psychological Therapies; under this programme thousands of therapists have been trained, and new standards for talking therapies have been set. The scheme has done well and the journal Nature has called it “world-beating”. But it needs to double in size during the next parliament and every party should include that commitment in its election manifesto.
Can we afford the cost of it? Well, actually, it would cost us nothing because it would save more than it costs. The gross cost of treatment is only £650 on average, and set against this there are massive savings – on benefits, lost taxes and even physical healthcare.
Because depression and anxiety are also bad for your physical health. Among people with a given physical illness, those who also have a mental illness cost the NHS £2,000 a year more – they go more often to A&E, and have more hospital appointments. The total cost of this to the NHS is £10bn a year. It follows that if we make psychological therapy more readily available, there would be huge savings.
As is well known, many NHS commissioners, when short of money, cut mental healthcare. Last week Sue Bailey, the retiring president of the Royal College of Psychiatrists, called the situation a “car crash”, alluding to the fact that cuts in psychological therapy cause far more problems than they solve.
One-third of all households in Britain includes someone who is mentally ill. It is a daily worry for millions of families, and out of shame it is little discussed. But people know about it all too well, and they will cheer any political party that shows it knows, too.
This letter that I received recently is typical of many others: “Dear Lord Layard, my husband was referred for CBT in April last year. Four months later he had a telephone assessment and was put on a waiting list. Five months after that his mental health really deteriorated. We begged for help because we were frightened of him losing his job and us our home. Three months later that happened.”
What is needed in the manifestos is quite simple. Will every party please undertake to double the psychological therapy available in the NHS by 2020?
This article first appeared in the Guardian on 2 July, 2014.