Special report on depression - an introduction
Dr John Hague introduces our special report by painting a picture of what current service delivery is like and what changes are on the way
These are exciting times for everyone involved in caring for those suffering with common mental health problems. Every one of the GPs who reads this special report spends at least a third of their time working with these patients.
Less than two weeks ago, health secretary Alan Johnson announced the Department of Health was to spend £170m annually on improving access to psychological therapies (IAPT), by 2011.
This means that, for the first time, this group of patients will no longer find accessing talking therapies hard in what feels like a ‘Cinderella service', but will be able to choose to ‘go to the ball', and get timely access to CBT, in your area, by 2010/11, or sooner. You can read more on the IAPT programme at www.mhchoice.csip.org.uk and clicking on psychological therapies.
This depression special report contains a cracking series of articles that will help you manage patients with common mental health problems.
Linda Gask's article on antidepressants contains a wealth of advice on the pharmacological management of depression, and practical guidance for use in day-to-day consultations; a brilliant, clear resource for us all.
The next two reports show that you don't have to wait for the therapists to arrive in your area to start making improvements. The article by Rebecca Martinez and Chris Williams will give you lots of things you can build into your practice, starting today, beginning with self help, then bibliotherapy, computerised CBT, and group CBT. Some of these are available now, and at no cost.
Implications for all practices
Dave Richards' feature builds on his experience with the Doncaster IAPT pilot – which has successfully treated 4,000 patients from a standing start. The implications of this will reach every practice.
He shows how ‘collaborative care', and innovative use of the telephone mean that patients can be treated with ‘low intensity' therapy, incorporating guided self-help, often only having to see their therapist once, with all the other treatment happening on the telephone.
This way of working challenges traditional practice – but can your practice counsellor treat 16 patients a day like the Doncaster therapists can?
Those of us involved in commissioning would do well to read this article carefully, and make sure that it is also read by colleagues working in counselling, and mental health trusts. This style of therapy will be coming to your patients soon, and providers need to begin changing so that they are in position to deliver on time. Those in ‘traditional' therapy posts, such as counsellors, have little to fear. Although about 90% of those in Doncaster are treated with low intensity therapy, about 10% ‘step up' to longer, face-to-face, ‘high intensity therapy'. There is plenty of work for everyone.
In a separate feature, I summarise how to gain QOF points on depression and introduce some simple principles for deciding a joint management plan with your patient. And having just read the previous two articles you will have more options on what to include in it.
Finally, two recent Cochrane reviews look at the evidence for SSRIs in the young and therapy for antenatal depression.
I hope this special report helps to place you in a position to understand the way that services will develop, and how you can start working now to help Cinderella find her prince at the ball.
Dr John Hague is a GP in Ipswich and mental health adviser to Suffolk PCT
Competing interests None declared