GPs must make sure that mental health doesn’t lose out
The RCGP’s promise for more specialist training in mental health is just the beginning, writes Professor Steve Field.
In the UK and other advanced countries mental illness represents nearly a half of all illness among people under 65. What many people fail to realise is that depression is much more debilitating than chronic physical conditions like angina, asthma, arthritis and diabetes. Also, when depression or anxiety disorders co-exist with physical illness, the mental health problems typically add some 50% to the cost of the physical healthcare.
It's been a privilege to work with Richard Layard and colleagues writing a report for the LSE Centre for Economic Performance's Mental Health Policy Group. In the report, we have demonstrated that when patients are treated with depression and anxiety disorders using evidence-based medication or therapy, they have high incremental recovery rates. It's also cost- effective for the NHS - most therapies pay for themselves. The results of IAPT suggest that savings are enough to repay the cost of the treatment while there are also savings in physical healthcare costs as people's mental health improves, and wider societal savings on disability benefits and lost taxes.
But in Britain, despite mental illness representing 23% of the burden of disease, it only receives 13% of NHS spending. Cost-effective treatments exist but are not available to all who need them. More money spent could largely pay for itself.
So, why are we not investing in appropriate treatments? Before the last general election, all of the major political parties supported the IAPT programme but some PCTs have since cut investment in talking therapies.
Not only do we need to continue the investment in mental health to ensure patients wherever they live in the country may receive the appropriate treatments, we must also ensure that patients are diagnosed and referred promptly.
We must ensure that GPs treating physical disease must have the appropriate skills to diagnose mental health problems too. The profession has the central role in mental healtjcare because most patients present initially to their GP, and the GP will also have a key role in the patient's continuing holistic care.
It is important therefore that GPs have appropriate diagnostic skills and knowledge of mental health treatments including talking therapies. This is covered by the RCGP Curriculum but in the past training has been a too short for trainees to gain sufficient experience.
I am thrilled that the RCGP has finally secured a promise to increase the length of GP specialist training. The case for enhanced GP specialist training is straight forward. Since at least a quarter of patient's visits to their GP are explicitly about mental health. Extending training will allow better exposure of trainees to patients with mental health problems over the course of their illness and will also make time available for placements in IAPT or other adult or child mental health services.
The medical case is strongly evidence-based, as is the economic case. The humanitarian case is overwhelming.
So, if you are a GP consulting room, a GP trainer or programme director or a GP commissioner in the CGG, you must stand up and be counted to ensure that mental health becomes a major priority for the reformed NHS.
Prof Steve Field is a GPin Birmingham and former chair of the RCGP