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Assessing the Benefits of Psychotherapy

The Economic Approach

Published online by Cambridge University Press:  02 January 2018

G. McGrath*
Affiliation:
University Hospital of South Manchester
K. Lowson
Affiliation:
North West Regional Health Authority, Manchester
*
Department of Psychiatry, University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester M20 8LR, UK

Abstract

Recent debate about the place of psychotherapy in the National Health Service, while emphasising the importance of economic evaluation, has concentrated almost exclusively on issues of clinical outcome. This paper argues that the debate has focussed on too narrow a definition of psychotherapy and too limited a view of the possible effects of psychotherapy, both good and bad. It reviews evidence concerning the demand and need for psychotherapy services in a number of clinical settings, and discusses the economic implications of the provision of such services. Economic studies of psychotherapy are reviewed and a conclusion drawn that it might be possible to justify the provision of psychotherapy services on economic grounds, but that considerably more research needs to be done in this area. The directions such future research might take are outlined.

Type
Research Article
Copyright
Copyright © 1987 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1982) Commission on the Psychotherapies: Psychotherapy Research-Methodological and Efficacy Issues. Washington, DC: American Psychiatric Association.Google Scholar
Anderson, S. A. & Hasler, J. C. (1979) Counselling in General Practice Journal of the Royal College of General Practitioners, 29, 352356.Google ScholarPubMed
Andrews, G., Goldstein, G., Lapsley, H. et al (1985) The economic costs of schizophrenia. Archives of General Psychiatry, 42, 537543.Google Scholar
Anonymous (1984) Psychotherapy: effective treatment or expensive placebo? Lancet, 1, 8384.Google Scholar
Ashurst, P. M. (1982) Counselling in General Practice. In Psychiatry in General Practice, (eds A. W. Clare & M. Lader). London: Academic Press.Google Scholar
Avelinb, M. (1984) What price psychiatry without psychotherapy? Lancet, ii, 856858.Google Scholar
Binner, P. R., Holpen, J. & Potter, A. (1973) Patients, programs and results in a comprehensive mental health centre Journal of Consulting and Clinical Psychology, 41, 148156.Google Scholar
Bird, J., Marks, I. M. & Lindley, P. (1979) Nurse therapists in psychiatry: developments, controversies and implications. British Journal of Psychiatry, 135, 321330.Google Scholar
Bloch, S. (1983) Psychotherapy. In Recent Advances in Clinical Psychiatry, Vol. 4. London: Churchill Livingstone.Google Scholar
Bloch, S. & Lambert, M. J. (1985) What price psychotherapy? A rejoinder. British Journal of Psychiatry, 146, 9598.Google Scholar
Borus, J. F., Olendzki, M. C., Kessler, L. et al (1985) The “offset effect” of mental health treatment on ambulatory medical care utilisation and charges: month-by month and grouped month analyses of a five year study Archives of General Psychiatry, 42, 573.Google Scholar
Bridges, K. & Goldberg, D. (1984) Psychiatric illness in inpatients with neurological disorders: patients' views on discussion of emotional problems with neurologists. British Medical Journal, 289, 656658.Google Scholar
Catalan, J., Gath, D., Edmonds, G. et al (1984a) The effects of non-prescribing of anxiolytics in General Practice I. Controlled evaluation of psychiatric and social outcome. British Journal of Psychiatry, 144, 593602.Google Scholar
Catalan, J., Bond, A. et al (1984b) The effects of non-prescribing of anxiolytics in General Practice II. Factors associated with outcome. British Journal of Psychiatry, 144, 603610.Google Scholar
Cay, E. L., Vetter, N., Philip, A. E. & Dugard, P. (1972) Psychological status during recovery from an acute heart attack Journal of Psychosomatic Research, 16, 425435.CrossRefGoogle ScholarPubMed
Culyer, A. J. (1976) Need and the National Health Service: Economics and Social Choice . York Studies in Economics. Oxford: Martin Robertson.Google Scholar
Cummings, N. A. (1977) Prolonged (ideal) versus short-term (realistic) psychotherapy Professional Psychology, 8, 491501.Google Scholar
Drummond, M. F. (1980) Principles of economic appraisal in health care. London: Oxford University Press.Google Scholar
Follette, W. & Cummings, N. A. (1967) Psychiatric services and medical utilisation in a prepaid health (dan setting. Medical Care, 5, 2535.Google Scholar
Glass, N. J. & Goldberg, D. (1977) Cost-benefit analysis and the evaluation of psychiatric services. Psychological Medicine, 7, 701707.Google ScholarPubMed
Goldberg, D. P. (1979) Detection and assessment of emotional disorder in a primary care setting. International Journal of Mental Health, 8, 3048.CrossRefGoogle Scholar
Goldberg, D. P. (1984) The recognition of psychiatric illness by nonpsychiatrists. Australian and New Zealand Journal of Psychiatry, 18, 128133.Google Scholar
Goldberg, D. P. (1986) Mental health aspects of general health care. In Psychosocial Perspectives in Health. WHO Monograph (eds N. Sartorius & D. Hamburg), (in press).Google Scholar
Goldberg, D. P. & Jones, R. (1980) The costs and benefits of psychiatric care. In The Social Consequences of Psychiatric Illness (eds L. N. Robins, P. J. Clayton & J. R. Wing) New York: Brunner/Mazel.Google Scholar
Goldberg, D. P. & Huxley, P. (1980) Mental Illness in the Community. London: Tavistock.Google Scholar
Goldberg, D. P., Krantz, G. & Locke, B. Z. (1970) Effect of a short-term outpatient psychotherapy benefit on the utilisation of medical services in a prepaid group practice medical program. Medical Cart, 8, 419428.CrossRefGoogle Scholar
Gwynne Jones, H. (1985) Psychotherapy research Journal of the Royal Society of Medicine, 78, 35.Google Scholar
Hagard, S., Carter, F. & Milne, R. G. (1976) Screening for spina bifida cystica. British Journal of Preventive and Social Medicine, 30(I), 4053.Google Scholar
Hawton, K. (1981) The long-term outcome of psychiatric morbidity detected in general medical patients. Journal of Psychosomatic Research, 25, 237243.Google Scholar
Hoeper, E. W., Nycz, G., Cleary, P. et al (1979) Estimated prevalence of RDC mental disorder in primary medical care. International Journal of Mental Health, 8, 615.Google Scholar
Hogarty, G. E. & Goldberg, S. C. (1973) Collaborative study group: drug and social therapy in the aftercare of schizophrenic patients. Archives of General Psychiatry, 28, 5464.Google Scholar
Hogarty, G. E., Schooler, N. R., Ulrich, R. et al (1979) Fluphenazine and Social therapy in the aftercare of schizophrenic patients. Archives of General Psychiatry, 36, 12831294.Google Scholar
Johnstone, A. & Goldberg, D. (1976) Psychiatric screening in General Practice. Lancet, i, 605608.Google Scholar
Karon, B. P. & Van Den Bos, G. R. (1976) Cost/benefit analysis: psychologist versus psychiatrist for schizophrenics Professional Psychology, 7, 107111.Google Scholar
Koch, H. C. H. (1979) Evaluation of behaviour therapy intervention in General Practice. Journal of the Royal College of General Practitioners, 29, 337340.Google Scholar
Kogan, W. S., Thompson, D. J., Brown, J. R. et al (1975) The impact on integration of mental health services and comprehensive medical care. Medical Care, 13, 934942.Google Scholar
Langsley, D. G., Machotka, P. & Flomenhaft, K. (1971) Avoiding mental hospital admission: a follow-up study. American Journal of Psychiatry, 127, 13911394.Google Scholar
Leff, J., Kuipers, L. & Berkowitz, R. (1982) A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141, 121134.Google Scholar
Lesser, A. L. (1983) Hypomania and marital conflict. Canadian Journal of Psychiatry, 28, 362366.Google Scholar
Levitan, S. J. & Kornfeld, D. S. (1981) Clinical costs and benefits of liaison psychiatry. American Journal of Psychiatry, 138, 790793.Google Scholar
Lowson, K., Drummond, M. F. & Bishop, J. (1981) Costing new services: Long-term domiciliary oxygen therapy. Lancet, 11, 11461149.Google Scholar
Maguire, G. P., Julier, D., Hawton, K. et al (1974) Psychiatric morbidity and referral on two medical wards. British Medical Journal, i, 268271.Google Scholar
Maguire, G. P., Goldberg, D. P., Hobson, R. F. et at (1984) Evaluating the teaching of a method of psychotherapy. British Journal of Psychiatry, 144, 575580.Google Scholar
Marks, J., Goldbero, D. & Hillier, V. (1979) Determinants of the ability of General Practitioners to detect psychiatric illness. Psychological Medicine, 9, 337353.Google Scholar
Moffic, H. & Paykel, E. (1975) Depression in medical in-patients. British Journal of Psychiatry, 126, 346353.Google Scholar
Mooney, G. H. & Drummond, M. F. (1982) Essentials of health economics (series of six articles) British Medical Journal, 285,949.Google Scholar
Mooney, G. H., Russell, E. M. & Weir, R. D. (1980). Choices for Health Care. London: Macmillan.CrossRefGoogle Scholar
Morgan, H. G. (1984) Do minor affective disorders need medication? British Medical Journal, 289, 783.Google Scholar
Mumford, E., Schlesinger, H. J., Glass, G. V. et al (1984) A new look at evidence about reduced cost of medical utilisation following mental health treatment. American Journal of Psychiatry, 141, 11451158.Google Scholar
Nabarro, J. (1984) Unrecognised psychiatric illness in medical patients. British Medical Journal (Leader), 289, 635636.Google Scholar
Neuhauser, D. & Lewicki, A. M. (1975) What do we gain from the sixth stool guaiac? New England Journal of Medicine, 293, 226228.Google Scholar
Office of Health Economics (1985) The Measurement of Health. London: Office of Health Economics.Google Scholar
Orleans, C. T., George, L. K., Houpt, J. L. et al (1985) How prinary care physicians treat psychiatric disorders: A national survey of family practitioners. American Journal of Psychiatry, 142, 5257.Google Scholar
Querido, A. (1959) Forecast and follow-up. An Investigation into the clinical, social and mental factors determining the results of hospital treatment. British Journal of Preventitive and Social Medicine, 16, 1349.Google Scholar
Robson, M. H., France, R. & Bland, M. (1984) Clinical psychologist in primary care: controlled clinical and economic evaluation. British Medicai Journal, 288, 18051808.Google Scholar
Rosser, R., Denford, J., Heslop, A. et at (1983) Breathlessness and psychiatric morbidity in chronic bronchitis and emphysema: a study of psychotherapeutic management. Psychological Medicine, 13, 93110.Google Scholar
Rubenstein, J. S., Armentrout, J. A., Levin, S. & Herald, B. (1978) The parent-therapist programme: alternative care for emotionally disturbed children. American Journal of Orthopsychiatry, 48, 654662.Google Scholar
Russell, I. T., Devlin, H. B., Fell, M., Glass, N. J. & Newell, D. J. (1977) Day case surgery for hernias and haemorrhoids: A clinical, social and economic evaluation. Lancet, 1, 844847.Google Scholar
Schlesinger, H. J., Mumford, E. & Glass, G. V. (1981) Reducing medical costs through mental health treatment: research problems and recommendations. In Linking Health and Mental Health (eds A. Broskowski et al). Beverly Hills: Sage.Google Scholar
Shepherd, M. (1984) What price psychotherapy? British Medical Journal, 288, 809810.Google Scholar
Shepherd, M. (1985) What price psychotherapy? British Journal of Psychiatry. 146, 555557.CrossRefGoogle Scholar
Shepherd, M. et al (1966) Psychiatric Illness in General Practice. London: Oxford University Press.Google Scholar
Shepherd, M., Harwin, B. G., Depla, C. et al (1979) Social work and the primary care of mental disorder. Psychological Medicine, 9, 661669.Google Scholar
Siostrom, R. (1985) Effects of psychotherapy in schizophrenia. Acta Psychiatrica Scandinavica, 7, 513522.Google Scholar
Washburn, S., Vanicelli, M., Longabaugh, R. & Scheff, B. J. (1976) A controlled comparison of psychiatric day treatment and in-patient hospitalisation Journal of Consulting and Clinical Psychology, 44, 665675.Google Scholar
Whitlock, F. & Siskind, M. (1979) Depression and cancer: a follow-up study. Psychological Medicine, 9, 747752.Google Scholar
Wilkinson, G. (1984) Psychotherapy in the market place. Psychological Medicine, 14, 2326.Google Scholar
Wilson, S. & Wilson, K. (1985) Close encounters in General Practice: experiences of a psychotherapy liaison team. British Journal of Psychiatry, 146, 277281.Google Scholar
Yates, B. T. & Newman, F. L. (1980a) Approaches to costeffectiveness analysis and cost-benefit analysis of psychotherapy. In Psychotherapy: Practice, Research, Policy (ed. G. R. Vandenbos). Sage Studies in Community Mental Health 1. London: Sage.Google Scholar
Yates, B. T. & Newman, F. L. (1980b) Findings of cost-effectiveness and cost-benefit analyses of psychotherapy. In Psychotherapy: Practice, Research, Policy (ed. G. R. Vandenbos). Sage Studies in Community Mental Health 1. London: Sage.Google Scholar
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