Good to talk

The pledge by the National Institute for Health and Clinical Excellence (NICE) to review how the body assesses the effectiveness of psychotherapy and other talking therapies could mean that the range of such treatments available on the NHS, increases – and this has to be good news.
NICE’s incoming chair, Professor David Haslam, made the pledge in response to questions by Grahame Morris MP, at the Health Select Committee.

This review will be timely because the evidence base for the effectiveness of psychological therapies is growing. For example, in the past couple of weeks, researchers from the Cochrane Library have found that children and teenagers diagnosed with post-traumatic stress disorder showed signs of improvement up to three months after treatment with psychological therapies.

NICE has been criticised in the past – notably by the Centre for Social Justice (CSJ) earlier this year – for not recommending more talking therapies, as it currently requires the same level of supporting evidence as treatments for chemotherapy or open heart surgery before they are approved. As a result, NHS services tend to stick to the narrow range of NICE-approved talking therapies, which can leave people with common conditions such as depression or anxiety, on long waiting lists or on medication.

While private and voluntary providers offer a wider range of psychological therapies – including non-NICE recommended ones – they can also have waiting lists, or people have to pay for them, something that those with mental health problems may not be able to do. As Benjamin Fry, who co-authored the CSJ’s report and is a psychotherapist with his own private practice, said earlier in the year: "The needs of those who cannot afford to pay for treatment, but whose recovery will not be achieved through the limited range of therapies IAPT [Increasing Access to Psychological Therapies] offers, are going unmet; some of them will die. It is a complete disgrace. Tight specifications and narrow guidelines have squeezed out countless other forms of therapies which have been proven to work and are what the patients ask for.”

So, a review of how NICE approves talking therapies is welcome. Its reliance on randomised control trials as the best evidence for efficacy has meant that therapies that have been proven to be effective in other ways, have so far not been recommended by the body. If a review leads to a change in NICE’s criteria, it could help more people access therapies that can help to improve their mental health, for free, which could only be a good thing.

However, so far, it is simply a pledge to review the evidence, so enthusiasm has to be tempered. But the hope is there and professional bodies such as the UK Council for Psychotherapy are keen to get involved and make the case for change. Watch this space.