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November 20, 2017

No-cost talk therapy for all: Inside England's mental health care initiative

Daily Briefing

    In 2008, England created a no-cost talk therapy program, aiming both to help people with mental illnesses and to fight the stigma of seeking help. Since then, the program has demonstrated major successes—but it's struggling to meet demand, and some psychologists argue that it takes an unduly limited approach to mental health treatment, Benedict Carey writes for the New York Times.

    How the program began

    In 2005, David Clark, a professor of psychology at Oxford University, and Richard Layard, an economist at the London School of Economics who is also a member of the House of Lords, began pressing an economic argument for no-cost talk therapy.

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    "We made the case that, just on lost work alone, the program would pay for itself," said Layard. "If someone has a broken leg, he or she immediately gets treatment. If the person has a broken soul, they usually do not," said Clark.

    Three years later, in 2008, the program kicked off with $40 million in funding from Gordon Brown's Labour government. The program established 35 clinics that covered around a fifth of England, and it trained 1,000 therapists, social workers, graduates in psychology, and others.

    Since then, the program has grown dramatically. Its current budget of around $500 million is expected to double over the next few years.

    The program now serves around a million people each year. Before the program launched, about one-quarter of adults with common mental disorders in England had received some sort of mental health treatment; now, that number is one-third—and still growing.

    Proponents of the program say that it increases the accessibility of mental health care. "You now actually hear young people say, 'I might go and get some therapy for this,'" said Tim Kendall, the National Health Service's clinical director for mental health. "You'd never, ever hear people in this country say that out in public before."

    How the program works

    When patients call into the program, they generally receive a call back within a few days. This has proven to be exceptionally important, as data suggest that many patients abandon the program if they don't hear back quickly.

    Then, a therapist evaluates the patient to determine the severity of their condition and whether they face any safety risks. Staff then determine whether the patient requires low-intensity phone therapy or in-person group or individual therapy.

    Over the course of treatment, each patient completes weekly questionnaires evaluating their levels of anxiety and depression. The findings are logged anonymously in a government database.

    The data collected so far indicate that about 50 percent of patients who participate in at least two sessions experience recovery—as high a rate as in the most positive studies conducted in labs.


    One of the major criticisms of the program is that it currently offers only one type of talk therapy: cognitive behavioral therapy (CBT).

    "If you think CBT is the end-all, then you don't understand mental health," said Peter Kinderman, the president of the British Psychological Society. "So if the program turns into a CBT monopoly, that's bad. But I'm an optimist; I think we'll begin to see multifactorial approaches as the program matures."

    Other critics have said that because many patients book appointments with therapists on their own, without consulting their general practitioners, many primary care providers are losing experience in treating mental illnesses.  As a result, general practitioners "know less about mental health than they did 20 years ago," says Rachel Jenkins, a professor emeritus at King's College London. "They've become de-skilled" (Carey, New York Times, 7/24).

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