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Our key primary care role in depression

From Dr Chris Manning Chief executive, Primhe

Once again, depression is in the news. And so it will continue to be, as its prevalence and attendant issues continue to rise – diabetes included.

Whether people continue to consider that this is because of unnecessarily medicalised distress; the more correct attribution of causation of back pain, headaches, general fatigue and polysymptomatic consultations (often with no 'physical' cause found) and attendant labelling on certification, or a true increase, the workload implications are there for all to see.

If frontline professionals are not skilled in dealing with the human condition or abnegate their responsibilities or interest, whether diagnosis is appropriate or not, then the situation will continue to worsen.

Of course, a pilot in Doncaster won't solve all the country's woes (News, 2 November) and neither will CBT, or any other single formulaic intervention for that matter, but it's a start.

And disappointing as it may be to those who have trained in medicine, the simple fact is that unhappy predicaments make people ill in many different ways. So, frontline professionals need to be both prepared and trained to deal with the reality, rather than the Neanderthal version thereof still served up in many medical schools and then perpetrated by dogged and unchallenged old attitudes and silo methods of non-collaborative practice.

Work is not therapeutic for everyone and coherent psychological services need to be offering support and interventions to all those who require them, for example patients with CHD, diabetes, asthma and long-term medical conditions.

Furthermore, we must ensure frontline professionals do not become any further deskilled and are also helped to rediscover their artistry as they deliver the evidence-based science and prevent their patients from becoming just a bag of of bones and associated viscera.

Lord Layard is doing a lot of listening; in my experience of someone at that level with genuine concern and almost unprecedented.

We should all be working together and supporting him in ensuring any new workforces are properly embedded in primary care as much as possible, accessible and used as a result, and that skills are acquired through far closer working with those who have expertise and training in working with whole people and not just their constituent organs below the level of the uvula.

• From Dr Craig Goldsmith Norwich

Last month saw the publication of a further study into the effectiveness of computerised CBT (CCBT), already proven by randomised controlled trial, in a naturalistic setting. Some 219 anxious or depressed patients received Beating the Blues in routine care as a first-line treatment. The study reports significant improvements in Clinical Outcomes in Routine Evaluation-Outcome Measures, Work and Social Adjustment scale and self-reported symptoms. These effects were maintained at six months' follow-up for course completers.

With evidence mounting, it will become increasingly difficult to ignore NICE-recommended therapy which clearly offers a substantial clinical, cost and side-effect profile over the traditional pharmacological approach (Br J Clin Psychol. 2006;45 (4): 499-514).

It just remains for the less progressive PCTs to see the light.

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