Last chance for meaningful NHS treatment choice for those living with depression

20 July 2018

Nearly 1 in 5 of the British public will experience symptoms of anxiety or depression at some point in their lives according to the ONS. 

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Obviously their experiences will differ greatly. However draft guidelines for the treatment of depression expected to be published in the autumn restrict patient choice of treatments and suggest patients will have to try things which may well not help them before being allowed to request different therapies. 

Together with a number of other organisations spanning the patient, clinical and research worlds, we at the Tavistock and Portman have been seeking amendments to these guidelines and fundamental changes to the way therapies are evaluated in this context. The coalition, which is spearheaded by our very own Dr Felicitas Rost, who is also President of the Society for Psychotherapy Research UK, has gained the support of a cross-section of MPs. You can read the coalition’s position statement.

Since 2009, patients have been restricted in the therapies and treatments they can access if they suffer from depression. Increasingly, patients are offered either antidepressants and /or only one modality of psychological therapy, CBT, which is also increasingly delivered online or in groups. This year we have a chance to improve access to a wider range of evidence-based therapies, but the methods NICE used for their review of the guidelines have limited what interventions were considered for different types of patients, and restricted access to more intensive interventions to patients who both have more severe presentations and who also refuse other treatments or where other treatments have failed. Faced with an uproar from across the mental health community, NICE granted a second consultation on the issue. They are now considering whether to amend the guidelines further. If the guidelines are not radically reconsidered, they will limit access to talk therapy in the NHS.

At the Tavistock and Portman we offer a range of interventions, often to patients whose experience of depression is chronic and not been helped by shorter term interventions.

Our entire way of conceptualising and thinking about depression, as described in this article by Dr David Bell and Dr Julian Stern, is fundamentally at odds with the way depression has been approached by NICE in devising these guidelines. Their focus is on short-term symptom alleviation. That approach fails entirely to consider long term quality of life and patient satisfaction measures.

Guidelines are merely guidelines, and we are fortunate to work with flexible local commissioners and doctors who have seen the benefits of our methods. Reasonably confident that these services will continue to operate outwith the guidelines, our concerns are not so much with our own survival, however we are deeply concerned that these guidelines will have a devastating impact in areas where there isn’t an established 100 year old highly regarded clinic to deliver these often life-altering interventions. We are also concerned about the impact on research in this area which will continue to favour short-term interventions and medication at the expense of longer term outcomes and interventions which lead to lasting change.

We hope NICE will reconsider its approach and seek a more adapted way to review interventions for long term mental health conditions such as depression, putting patient choice, together with follow up over a longer period, at the heart of their work.

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