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Computerised Cognitive Behavioural Therapy: Lottery


Wednesday, March 4th, 2009 Computerised Cognitive Behavioural Therapy: Lottery

Mary O’Hara of the Guardian (03 02 09) reports on the issues surrounding a therapeutic programme which has been praised by ministers as a hi-tech, cost-effective solution to Britain’s growing problem of depression and anxiety has been widely ignored by the NHS. Invariably this means that thousands of potential patients are being
deprived of the treatment.

It has been 2 years since the launch of computerised cognitive behavioural therapy (cCBT). Yet from that point of view only a fraction of the existing health authorities in England have accessed the service. despite being approved for widespread NHS use by the National Institute for Health and Clinical Excellence (Nice).

The government has come under criticism, both opposition parties and charities argue that a post code lottery has emerged.

Notwithstanding nine of 152 primary care trusts (PCTs) have fully complied with official guidance requiring them to offer cCBT, while 38 have failed to comply at all according to figures supplied by the designers of the programme.

The programme known as ‘Beating the Blues’ primarily is a computer-based version of face-to-face cognitive behavioural therapy, recognised by Nice as an effective alternative treatment to expensive prescribed medication for many people. Alas from a cynical perspective, it could be argued that the health authorities that do not use cCBT could be accused of keeping expensive drug treatment at the forefront therefore costing the NHS more money than necessary.

Furthermore and ostensibly the lack of treatment availability is more likely to prevent the need for more expensive treatments and thus is a false economy.

The government have been asked to explain their stance as to why the treatment is not available nationally by both MP’s and Lords, including Lord Howe, Baroness Tonge and Liberal Democrat health spokesman Norman Lamb.

Nevertheless, the director of Ultrasis, the company which designed Beating the Blues, John Smith, claims the government has been “taking credit” for a policy whose implementation it has failed to ensure, leaving potentially hundreds of thousands of people without access to the treatment they were promised. He says that while ministers have publicly endorsed cCBT, the latest was Dawn Primarolo, minister for public health during parliamentary questions in December last year when she called it “integral” to the government’s wider ‘talking therapies’ programme, there has been “official inertia” when it comes to implementation.

“I don’t think the government have chased PCTs up on this,” Smith said.

In addition he also argues that cCBT could cost as cheaply as £30 per session and potentially save millions on the NHS every year. “If the Nice binding guidance was followed there would be a cost benefit to the NHS of £126m a year.”

Back in May 2007 the Department of Health (DOH) heralded cCBT as “one of the greatest technological innovations of the decade.” Notably, it was introduced to compliment the government’s much-publicised broad package of reforms to widen the availability of “talking therapies” including face-to-face cognitive behavioural therapy on the NHS.

The government became very focused on the issues of talking therapies as a result of Lord Layard, a London School of Economics professor and author of the book Happiness, claimed that mental health was the country’s “biggest social problem.” 10 Downing street were convinced that the introduction of psychological therapies would have significant economic ad health benefits.

Lamb said ministers need to take an urgent look at how cCBT has been implemented and establish a clear picture of variations of provision across the country.

“I think its intolerable that this treatment, which has been approved by Nice, is not available in many parts of the country,” Lamb said.

“This is a proven, cost-effective treatment. Its another example of mental health not being a priority in the same way as physical health.

“The government’s rhetoric on this is brilliant but it doesn’t match what’s happening on the ground.”

Sophie Corlett, the director of external relations at mental health charity Mind, said: “Nice has made mandatory recommendations that cCBT should be offered to people with mild depression and anxiety and as yet this guidance has been largely ignored. PCTs are failing the millions of people who could benefit from this treatment.”

The director of external relations at mental health charity Mind, Sophie Corlettargues, “Nice has made mandatory recommendations that cCBT should be offered to people with mild depression and anxiety and as yet this guidance has been largely ignored. PCTs are failing the millions of people who could benefit from this treatment.”

However the DOH have said that cCBT implementation data was not held by central government and the treatment was just one part of a broader commitment to talking therapies.

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