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'GMS contract not working well for Northern Ireland'

NICE guidance was hailed as a watershed for psychological treatments, but GPs are still waiting for access ­ Nerys Hairon reports

When in December 2004 NICE recommended psychological therapies first-line for mild and moderate depression it was hailed as a watershed.

Amid a flurry of damaging headlines on SSRIs, it seemed the time had arrived for a fresh approach and for new investment in CBT and counselling.

But while the SSRI headlines keep on coming with more arriving last week, the impetus to provide GPs with new treatment options appears to have dribbled away.

'The consensus is that waiting times for counselling and CBT haven't changed since publication of the NICE guidelines,' said a spokeswoman for the not-for-profit Centre for Mental Health this week.

The centre said patients were still routinely facing waits of three to six months for counselling and three months for CBT, adding: 'Massive investment is needed to meet the demand for these kinds of talking therapies.'

There is growing frustration among mental health charities, GPs and politicians that this 'massive investment' has not been forthcoming.

'Waiting times are very long. Surveys tend to show provision is incredibly patchy,' said the Sainsbury Centre for Mental Health, a charity that supports patients with severe mental health problems.

Some GPs complain they still have no access at all to CBT, nine months after it took its place as one of NICE's favoured treatment options.

Dr Nigel Watson, chief executive of Wessex LMCs and a GP in the New Forest, Hampshire, said: 'Where I work we have got no CBT and counselling. The workload on general practice has increased significantly over the last 10 years.

'If they want us to do something differently there needs to be comprehensive mental health services. In areas like the New Forest we do not have access to any of that.'

Dr David Kessler, a senior research fellow in community-based medicine at the University of Bristol, who has researched the economics of depression treatment, said: 'It's all very well for NICE to make these recommendations. My suspicion is that in the face of unhappiness in the surgery GPs feel they have little else to offer apart from antidepressants. Many would like to offer talking therapies such as CBT but the resources simply are not there.'

The Department of Health admitted it did not collect data centrally on local provision of psychological therapies or their waiting times, but acknowledged there were problems.

'We know waiting times are too long in some areas and we intend to improve the situation through a new programme of work.'

But the department insisted there had been 'very significant increases' in the numbers of staff who could deliver therapies, including clinical psychologists, non-medical psychotherapists and graduate primary care workers.

The Labour peer Lord Layard, professor of economics at the London School of Economics, believes the Government needs to go further. In a recent paper on mental health policy for the Number 10 strategy unit, he called for an extra 10,000 therapists to deliver CBT over the next 10 years.

He told Pulse: 'We need a clear picture of where we are trying to get to. It's time now for people with depression to have a new deal.'

In the meantime, GPs

must make do with the limited existing options, including computerised CBT, which

a NICE final draft appraisal recommended only last week.

Computerised CBT is likely to be available to all GPs who want it within a few months ­ yet some are sceptical it can be an adequate alternative.

Dr Greg Battle, chair of the professional executive committee at Islington PCT and the mental health lead at his practice, said: 'It has not solved anything. I don't know that we feel terribly comfortable referring to a computer rather than a human being.'

In the longer-term, there are hopes practice-based commissioning can address shortfalls in access to depression treatments.

Dr Mike Dixon, chair of the NHS Alliance, said: 'It's for GPs to take on the commissioning role and be planning services locally to make sure patients get what they need.'

Increasing the

options for your

patients with

depression

·Make use of primary care mental health workers, mental health charities and religious groups for CBT and counselling

·Offer stepped-care management programmes covering guided self-help, nutrition and exercise

·Turn to self-help and community groups for help with patient relaxation ­ aromatherapy, acupuncture, reflexology and yoga

·Use practice-based commissioning to increase local provision of CBT and counselling

Source: NHS Alliance, GP experts and Centre for Mental Health

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