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Strange bedfellows: economics, happiness and mental disorder

Published online by Cambridge University Press:  11 April 2011

Brian Cooper
Brian Cooper*
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, London (United Kingdom)
*
Address for correspondence: Professor B. Cooper, Bachstrasse 34, 69121 Heidelberg (Germany). E-mail: [email protected]
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Summary

Aim – The high economic and social costs associated with the ‘common mental disorders’, and the need to scale up appropriate care services, are now widely recognized, but responses vary from country to country. In Britain, a current government initiative to promote psychological therapy is driven both by economic pressures and by research on the factors of happiness, or life-satisfaction. This article provides a short critical review of the project. Method – A health policy analysis, with regard to problem definition; objectives; sources of information; criteria for evaluation; impact on existing services, and comparison with alternative strategies. Results – The new programme, Improving Access to Psychological Therapies (IAPT), aims to expand treatment services by training 3,600 ‘psychological therapists’ in cognitive behavioural therapy (CBT), which they will then apply in the wider community. This service, with an initial budget of £173 million, will provide treatment for depression and chronic anxiety from local centres across the country. The programme is intended to pay for itself by reducing incapacity costs. Closer examination, however, raises questions concerning the project’s theoretical basis, logistics and research methodology, and casts doubt on its advantages over alternative approaches. Conclusions – The IAPT project is ill-designed to achieve its objectives and unsuitable as a model for treatment and care of the common mental disorders in other countries. An alternative strategy, based on closer integration of community mental health and primary health care, should be tested and on previous experience seems likely to prove more cost-effective.

Declaration of Interest: None.

Keywords

Depressionanxiety disorderscognitive behaviour therapymental health services
Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 18 , Issue 3 , September 2009 , pp. 208 - 213
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

Banks, R. & Gask, L. (2008). It’s time to talk: rekindling the relationship with primary care: editorial. Advances in Psychiatric Treatment 14, 84–85.CrossRefGoogle Scholar
Brown, G.W. & Harris, T. (1978). Social Origins of Depression. A Study of Psychiatric Disorder in Women. Tavistock: London.Google Scholar
Care Services Improvement Partnership (CSIP) (2006). Designing Primary Care Mental Health Services. Gateway Ref. 6784. Dept. of Health: London.Google Scholar
Centre for Economic Performance (2006). The Depression Report. A New Deal for Depression and Anxiety Disorders. London School of Economics: London.Google Scholar
Clark, D.M., Layard, R. & Smythies, R. (2008). Improving Access to Psychological Therapies: Initial Evaluation of the Demonstration Sites. CEP Working Paper No. 1648. London: London School of Economics. Retrieved December 7, 2009, from http://www.iapt.nhs.uk/wp-content/uploads/2008/09/lse-report-final.pdfGoogle Scholar
Department of Health (2007). Framework for Procuring External Support for Commissioners (FESC). Gateway Ref. 7822. DH Publications: London.Google Scholar
Department of Health (2008a). Improving Access to Psychological Therapies: National Guidelines for Regional Delivery. Gateway Ref. 9427. DH Publications: London.Google Scholar
Department of Health (2008b). Improving Access to Psychological Therapies: Commissioning Toolkit. Gateway Ref. 9590. DH Publications: London.Google Scholar
Ferguson, I. (2007). Neoliberalism, happiness and wellbeing. International Socialism 117 posted 18.12.07). Retrieved May 6, 2009, from http://www.isj.org.uk/?id=400Google Scholar
Foresight Mental Capital and Wellbeing Project (2008). Final Project Report. Government Office for Science: London.Google Scholar
Freud, S. (1919). Lines of advance in psycho-analytic therapy. Standard Edition 17, 159–168.Google Scholar
Goldberg, D. (2003). Psychiatry and primary care. World Psychiatry 2, 153–157.Google ScholarPubMed
Goldberg, D., Jackson, G., Gater, R., Campbell, N. & Jennett, N. (1996). Treatment of common mental disorders by a community team based in general practice: A cost-effectiveness study. Psychological Medicine 26, 487–492.CrossRefGoogle Scholar
Holmes, J. (2002). All you need is cognitive behaviour therapy? British Medical Journal 324, 284–296.Google ScholarPubMed
Improving Access to Psychological Therapies (IAPT) (2008a). The IAPT Pathfinders: Achievements and Challenges. Gateway Ref. 10719. Dept of Health: London.Google Scholar
Improving Access to Psychological Therapies (IAPT) (2008b) Outcomes Toolkit, 2008/. Retrieved May 6, 2009, from http://www.iapt.nhs.uk/2008/07/improving-access-to-psychologi-cal-therapies-iapt-outcomes-toolkit/Google Scholar
Johns, H. & Ormerod, P. (2007). Happiness, Economics and Public Policy. Institute of Economic Affairs: London.Google Scholar
Layard, R. (2006). Happiness. Lessons from a New Science. Penguin: London.Google Scholar
Middleton, H., Shaw, I., Hull, S. & Feder, G. (2005). NICE guidelines for the management of depression. British Medical Journal 330, 267–268.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (NICE) (2004). Depression: Management of Depression in Primary and Secondary Care. Clinical Guideline No. 23. NICE: London.Google Scholar
Office for National Statistics (2002). Psychiatric Morbidity among Adults Living in Private Households, 2000. Gateway Ref. 2002. ONS: London.Google Scholar
Patton, C.V. & Sawicki, D.S. (1993). Basic Methods of Policy Analysis and Planning. Prentice & Hall: Englewood Cliffs, NJ.Google Scholar
Pollock, A.M., Price, D., Viebrock, E., Miller, E. & Watt, G. (2007). The market in primary care. British Medical Journal 335, 475–477.CrossRefGoogle ScholarPubMed
Priebe, S. (2006). The provision of psychotherapy: an international comparison. Journal of Public Mental Health 3, 12–22.CrossRefGoogle Scholar
Pullen, I.M. & Yellowlees, A.J. (1988). Scottish psychiatrists in primary health-care settings: a silent majority. British Journal of Psychiatry 153, 663–666.CrossRefGoogle ScholarPubMed
Rost, K., Pyne, J.M., Dickinson, L.M. & LoSasso, A.T. (2005). Cost-effectiveness of enhancing primary care depression managementon an ongoing basis. Annals of Family Medicine 3, 7–14.CrossRefGoogle Scholar
Strathdee, G. & Williams, P. (1984). A survey of psychiatrists in primary care: the silent growth of a new service. Journal of the Royal College of General Practitioners 34, 615–618.Google ScholarPubMed
Tansella, M. & Thornicroft, G. (Eds.) (1999). Common Mental Disorders in Primary Care: Essays in Honour of Sir David Goldberg. Routledge: London.Google Scholar
Weiner, J. (2005). Johns Hopkins Bloomberg School of Public Health. Health Policy Analysis Checklist. Retrieved January 13, 2009, from http://ocw.jhsph.edu/courses/IntroHealthPolicy/PDFs/Bardach_Outline_IHP_7b.pdfGoogle Scholar
World Health Organization (2008). Mental Health Gap Action Programme. Scaling up Care for Mental, Neurological and Substance Abuse Disorders. Geneva: WHO.Google Scholar