This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at http://www.theguardian.com/healthcare-network/2016/mar/16/depression-suicide-nhs-mental-health-problem
The article has changed 5 times. There is an RSS feed of changes available.
| Version 3 | Version 4 |
|---|---|
| Depression kills, so why aren't people getting better NHS care? Depression kills, so why aren't people getting better NHS care? | |
| (about 2 hours later) | |
| Jen is desperate. She is starting to think about taking her own life. Her GP referred her to the Improving access to psychological therapies (Iapt) programme, which started with guided self-help – an approach to supporting people with mild to moderate anxiety, depression or stress. It went on for a few weeks, but didn’t help at all. She wanted to be able to talk to the therapist but in the 20-minute sessions, she felt she never got a chance to get to know her. | Jen is desperate. She is starting to think about taking her own life. Her GP referred her to the Improving access to psychological therapies (Iapt) programme, which started with guided self-help – an approach to supporting people with mild to moderate anxiety, depression or stress. It went on for a few weeks, but didn’t help at all. She wanted to be able to talk to the therapist but in the 20-minute sessions, she felt she never got a chance to get to know her. |
| Then she saw a cognitive behaviour therapist for four sessions. She liked her, but it didn’t make a difference and she didn’t see the point of going away and reading books and filling out forms like she was told. She stopped going and was consequently sent a letter saying that she had been discharged. | Then she saw a cognitive behaviour therapist for four sessions. She liked her, but it didn’t make a difference and she didn’t see the point of going away and reading books and filling out forms like she was told. She stopped going and was consequently sent a letter saying that she had been discharged. |
| She went back to her GP who asked her if she wanted to try an antidepressant. | She went back to her GP who asked her if she wanted to try an antidepressant. |
| Jen wasn’t happy about the idea, but by then she was willing to try anything. She took the first lot every day for two months – and then changed to another. The second antidepressant helped her sleep a bit better but her doctor told her he didn’t know what else to try. He’s attempted to get her seen at the community mental health service but they say she doesn’t have severe and enduring mental illness. She’s exhausted and cannot think clearly. She feels dead inside, worthless and hopeless – but that isn’t bad enough for them to give her an appointment. | Jen wasn’t happy about the idea, but by then she was willing to try anything. She took the first lot every day for two months – and then changed to another. The second antidepressant helped her sleep a bit better but her doctor told her he didn’t know what else to try. He’s attempted to get her seen at the community mental health service but they say she doesn’t have severe and enduring mental illness. She’s exhausted and cannot think clearly. She feels dead inside, worthless and hopeless – but that isn’t bad enough for them to give her an appointment. |
| At the back of her mind are the sounds and images of the unspeakable things she went through as a child. She hasn’t told anyone very much about that. She just talked to the therapists about the problems at work, which was easier. She is still too ashamed about what happened to her. Now she has had enough. | At the back of her mind are the sounds and images of the unspeakable things she went through as a child. She hasn’t told anyone very much about that. She just talked to the therapists about the problems at work, which was easier. She is still too ashamed about what happened to her. Now she has had enough. |
| Jen is an example of countless people I have seen throughout my career as a psychiatrist. She fell through the net because she didn’t have severe enough mental health problems to warrant referral to specialist services yet her problems were too complex for both her GP and the Iapt programme. | Jen is an example of countless people I have seen throughout my career as a psychiatrist. She fell through the net because she didn’t have severe enough mental health problems to warrant referral to specialist services yet her problems were too complex for both her GP and the Iapt programme. |
| Iapt, which works for many people with mild to moderate depression stemming from issues in the present – such as work – is not set up to deal with complex mental health problems. For people with depression and who have problems with relationships that stem from underlying issues (such as child abuse) from their past, Iapt is not the right pathway, yet it is the only one available. Many people who attend cannot engage with it. | Iapt, which works for many people with mild to moderate depression stemming from issues in the present – such as work – is not set up to deal with complex mental health problems. For people with depression and who have problems with relationships that stem from underlying issues (such as child abuse) from their past, Iapt is not the right pathway, yet it is the only one available. Many people who attend cannot engage with it. |
| Depression is the most common mental health problem associated with suicidal ideas, plans and behaviour in high income countries, according to a paper by Nock and colleagues in the British Journal of Psychiatry in 2008. The Mental Health Taskforce (pdf) has published a report that has reducing the suicide rate, which is rising again, as one of its aims. Yet there is no plan to develop a care pathway to improve care for depression. It seems to be assumed that expanding the Iapt service and training GPs will be enough. | Depression is the most common mental health problem associated with suicidal ideas, plans and behaviour in high income countries, according to a paper by Nock and colleagues in the British Journal of Psychiatry in 2008. The Mental Health Taskforce (pdf) has published a report that has reducing the suicide rate, which is rising again, as one of its aims. Yet there is no plan to develop a care pathway to improve care for depression. It seems to be assumed that expanding the Iapt service and training GPs will be enough. |
| To improve care, therapists need to work alongside GPs to ensure people get help quickly. These therapists need to be able to provide not only psychological therapy but also, when it’s needed, link a doctor with a psychiatrist and/or other specialist mental health worker. They can provide some expert prescribing advice and ensure access to more intensive help where it’s needed. Research shows this model works – it’s called collaborative care. People shouldn’t have to be hearing voices or imminently at risk of harming themselves to get this support. | To improve care, therapists need to work alongside GPs to ensure people get help quickly. These therapists need to be able to provide not only psychological therapy but also, when it’s needed, link a doctor with a psychiatrist and/or other specialist mental health worker. They can provide some expert prescribing advice and ensure access to more intensive help where it’s needed. Research shows this model works – it’s called collaborative care. People shouldn’t have to be hearing voices or imminently at risk of harming themselves to get this support. |
| People like Jen should have the option of being referred to some other type of therapy, different to cognitive behavioural therapy, that allows them to talk about what happened in the past, but in most places they have disappeared. People wishing to access them need to pay for private care in most cases. People need be able to trust a therapist if they are going to be able disclose the things they find difficult to talk about, and that’s hard to do in a short space of time. If other treatments have not worked, a person might benefit from referral to a specialist centre for depression, but these are also hard to access. | People like Jen should have the option of being referred to some other type of therapy, different to cognitive behavioural therapy, that allows them to talk about what happened in the past, but in most places they have disappeared. People wishing to access them need to pay for private care in most cases. People need be able to trust a therapist if they are going to be able disclose the things they find difficult to talk about, and that’s hard to do in a short space of time. If other treatments have not worked, a person might benefit from referral to a specialist centre for depression, but these are also hard to access. |
| There isn’t really much choice other than the GP and Iapt, and they are buckling under the strain of trying to help people with more complex problems than the services were designed for. The current way of doing things in mental healthcare is failing some of those for whom depression is a serious, life-threatening illness. | There isn’t really much choice other than the GP and Iapt, and they are buckling under the strain of trying to help people with more complex problems than the services were designed for. The current way of doing things in mental healthcare is failing some of those for whom depression is a serious, life-threatening illness. |
| Unfortunately, I know there are many people who aren’t getting the best care for depression. I’ve spent my life trying to cope with it personally too, so I know what it feels like when you’ve reached that point of desperation and cannot go on. But I know we can do better. | Unfortunately, I know there are many people who aren’t getting the best care for depression. I’ve spent my life trying to cope with it personally too, so I know what it feels like when you’ve reached that point of desperation and cannot go on. But I know we can do better. |
| Linda Gask is emerita professor of primary care psychiatry, University of Manchester, and the author of The Other Side of Silence: a Psychiatrist’s Memoir of Depression | Linda Gask is emerita professor of primary care psychiatry, University of Manchester, and the author of The Other Side of Silence: a Psychiatrist’s Memoir of Depression |
| Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. | Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |