Talking treatments may cut sick leave and health costs

By Sophie Ramsey

BMJ Group News

What do we know already?

Lots of research shows that talking treatments can help people cope with depression and anxiety, two of the most common mental health problems. One of the best-studied treatments, cognitive behaviour therapy (CBT), involves working with a therapist to recognise unhelpful or negative thoughts and replace them with good thoughts. Studies show this can improve people’s symptoms and increase their chances of making a full recovery.

However, talking treatments aren’t always available on the NHS. In some areas there aren’t enough trained therapists to go round.

To remedy this, the NHS has been gradually rolling out a programme called Improving Access to Psychological Therapies (IAPT), which provides new or expanded talking treatments through primary care trusts around England. Its goals are two-fold: to provide people with timely access to these treatments, and to reduce the costs linked to poorly treated depression and anxiety, such as more time in hospital, more time off work, and greater disability.

But is the programme achieving its objectives? To find out its effects on health care costs and sick leave, researchers gathered data from the health records of more than 152,000 people in East London and Yorkshire. About 1 in 10 had a ‘common mental health problem’ - usually depression or anxiety - during the 18-month study.

What does the new study say?

Just over 6 in 100 people with a mental health problem were referred for talking therapy through the IAPT programme during the study. The researchers found that they were less likely to be admitted to hospital, spend time in hospital, or visit A&E. They also had fewer sick notes from their doctor for missed work.

Of course, it’s possible that some of this change was due to improvements over time. To account for this, the researchers compared IAPT participants with people not involved in the programme. Although both groups used health services less over time, the drop was greatest for those in the IAPT group.

Surprisingly, people in the IAPT group were actually prescribed more antidepressants after talking therapy than before. The researchers think this might be because they were more likely to stick to their overall treatment plan after seeing a therapist. So their improvement could have been because they were more likely to take their medicine, as a result of their talking treatment.

How reliable is the research?

This was a thorough study that looked at health records from several large government databases, covering primary care, hospitals, and clinics. However, we need to be a bit cautious about its findings, as health records aren’t always complete or accurate. For example, some people with depression or anxiety might have been misdiagnosed. And some sick notes from GPs might not have been recorded.

Also, we can’t be certain that having talking therapy was what led to the drop in hospital admission and sick notes among people in the IAPT programme. Other factors might also have had an impact, including lifestyle changes and other non-drug treatments. However, the researchers didn’t explore these.