Mental Health Taskforce report: My View

Mental Health

The last few years have seen serious cuts in provision of mental health care against a background of increasing hardship for many people and a rise in suicide rates. The Five Year Forward View ‘Taskforce’ report for mental health, published on 15th February, promises major investment in mental health services in England. But what does it offer from the perspective of those of us who experience depression?

The first line of help for most people with depression is their GP and primary care in this country is under a great deal of strain at the present time, with some people having to wait a long time for appointments. The report once again stresses the importance of training in mental health by ensuring that all new GPs (not just over half, as at present) receive mental health training and practice nurses have appropriate training too. Once again there is a move to have GP specialists with additional experience in mental health. The Improving Access to Psychological Therapies Service (IAPT), which has varied considerably in how well it has been implemented across the country (and in the time people still have to wait for an assessment), will be further expanded, with a particular emphasis on people with chronic physical conditions, who are at particularly high risk of depression – such as those of us with cardiovascular disease and diabetes.

There is also a welcome call for these services to be better integrated with both primary care and specialist mental health services. One of the problems has been the lack of access for people with depression to both psychological therapy and antidepressant medication (the NICE recommendation for severe depression). IAPT services mostly rely on GPs to prescribe and many are not able to prescribe second line treatments with confidence. However, it may be difficult for GPs to get appropriate advice without the patient meeting the increasingly stringent referral criteria for access to specialist care. Furthermore, those being treated in specialist care may have difficulty getting access to NICE recommended psychological therapies because they are either not locally available or, are only accessible via primary care referral. This situation really has to be addressed.

I do have a few major concerns. The focus on employment as an outcome, and integration of employment advisers into IAPT, suggests that being in work is now seen as the most important outcome for those of us with anxiety and depression. This is not the case for people in any other sector of healthcare. Being unemployed is bad for your mental health, but research has revealed that being in unsuitable work is just as bad for your health, and many people suffer from depression because of problems at work.

From reading the report, depression seems to be viewed as primarily a ‘problem’ for primary care and IAPT services without recognition that many people with more severe and complex problems do require expert help – psychological, pharmacological and social. There seems to be a belief that GPs and IAPT (which primarily provides short term interventions and time-limited CBT) with some specialist support is all that is required – and indeed it will be for many people; however, thought needs to be given to implementing what we know from the research about how these services can all work together more effectively. So, I wish development of a specific ‘depression’ pathway had also been proposed, rather than simply a focus on IAPT. For those who cannot benefit from CBT there is still negligible access to the other therapies mentioned in NICE – such as Interpersonal Therapy and Couples Therapy. Psychodynamic therapy has been cut to the bone, yet real evidence is now emerging that it is of major benefit for people with chronic depression.

In some parts of the country there is still access by referral to specialist centres providing‘super-specialist’ care. They have multidisciplinary staff with a great deal of experience in prescribing medication and specific forms of psychological therapy. I’ve been under such care for some time. Last weekend I received notice from the Mental Health Trust that provides this care, that the specialist service is under review and in line with others not considered ‘core’, such as psychosexual problems and chronic fatigue, may be cut. My GP is about to retire and I am not sure if another will be willing to prescribe the ‘off-label’ medication required to keep me well without such support. I am worried about the future – and many others will be too. We need better recognition that depression is not always a‘mild-to-moderate’ disorder, but can also be severe, complex, and life-threatening. Services must plan to address this. I do hope, despite the ‘light touch’ on depression in the Taskforce report that we can still bring this about.

First published on the Depression Alliance blog