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Spreading a little happiness
Are mental health drop-in centres, where the public discuss their psychological problems with professionals, the solution to tackling Britain's rising tide of misery, as this week's Layard report says? Mark Gould reports
Mark Gould
Wed 21 Jun 2006 18.55 EDT
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Consultant psychologist Ben Wright
Consultant psychologist Ben Wright in Newham, east London. He will lead a mental health walk-in service for some 80,000 residents. Photograph: Graham Turner
Imagine the situation. You have had a relationship breakdown. It has left you depressed, alone and turning to alcohol. Work is impossible. But, thankfully, your local NHS "happiness centre" is just around the corner. Part sanctuary, part psychology laboratory, happiness centres are a sort of Ikea for the mind, where the feelgood factor is flatpacked for you to take home. A branded chain of open-access outposts offering the latest talking therapies for some of the most common and distressing mental illnesses. No long waits. No need for a referral - simply turn up and get help.
Well, that's the vision. Consultant psychiatrist Ben Wright shares it, though he doesn't refer to them as happiness centres. The pilot project he will launch on Friday is called a psychological treatment centre (PTC). Yet, ultimately, collective happiness is what it strives for. If it goes to plan, PTCs could trigger a seismic shift in the NHS approach to mental wellbeing.
The pilot, in Newham, east London, will test the work of economist, government adviser and "guru of happiness" Lord [Richard] Layard, who claims that mental illness has taken over from unemployment as today's greatest social problem, costing £17bn a year. His proposed solution is the creation of a network of 250 high street drop-in centres, staffed by 10,000 therapists offering a range of evidence-based talking therapies for depression, post traumatic stress disorder, social phobias and anxiety disorders, helping around 800,000 people annually. On Monday, Layard threw down the gauntlet to politicians when he and six others published The Depression Report, which suggests a new deal for those with depressive illness (see 'Number crunching' below).
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People with mental health problems who visit their GP are in 90% of cases treated with psychiatric medication. But the joint project run by Newham PTC, East London and City mental health NHS trust, Newham council, and the charity Mental Health Matters will offer talking therapies, including cognitive behavioural therapy (CBT), which focuses on thoughts, assumptions and beliefs and has been hailed as one of the most effective treatments for depression. There is currently a three- to six-month wait for an NHS referral through a GP.
Wright will lead one of the two pilots (the other is in Doncaster). He says the set-up costs of the centre are tiny compared with the savings that could be made to the NHS and the wider economy through fewer referrals to GPs, fewer expensive hospital stays, fewer prescription drugs and less time off work.
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Collective ecstasy
Wright's PTC is in one of the most deprived boroughs in Britain, and Newham has a 40% greater demand than the national average for mental health services. Yet just across from his office stands one of the most iconic images of a nation in collective ecstasy - a statue of England's 1966 World Cup-winning captain Bobby Moore, triumphantly waving the trophy and being carried on the shoulders of team mates Geoff Hurst, Martin Peters and Ray Wilson. But a walk down Green Street reveals some reasons why Newham is unwell. It has the highest number of refugees of any London borough, the highest number of asylum seekers, and the third highest unemployment rate in the capital.
Despite the Treasury, the Department of Health and the worlds of therapy and psychiatry scrutinising Wright's every move (the project hopes to demonstrate the effectiveness of the approach to feed into the next comprehensive spending review), he seems unfazed when describing how for 15 months his team will be offering PTC and employment support services to a third of the borough - more than 80,000 people. "Every single one of us is affected by mental ill-health," he says. "Whether it's in the family or you can't get a train because of staff illness."
He stresses that the services must fit the need; some people might need an alternative therapy to CBT. He also highlights the importance of matching skills to patient need; it's a waste of everyone's time if a massively qualified therapist is taking on simple cases or, more worryingly, if a relative beginner is out of their depth dealing with a serious illness. Furthermore, all this matching must be done in the context of the cultural needs of what is officially the most diverse community in the UK - 62% of Newham residents belong to minority ethnic groups and 130 languages are spoken.
Wright expects to see around 2,300 patients a year, offering a package of measures including six to eight sessions over 10 weeks in mild cases and 16 to 20 sessions over nine months in more severe conditions. The project will attract clients who walk in individually, as well as those from jobcentres, GP surgeries, hospital referral or from employers. He is in talks with the sugar company Tate & Lyle - a big local employer - about setting up a referral service for its staff.
Patients should expect a short delay before therapy starts. Wright believes "a short wait of 12 weeks is OK, and you can start clients on work while they are waiting - we recommend people take away books". He points to a copy of a best-selling introduction to CBT.
The project has a £1.5m budget but is still one therapist short of the eight required for a full team. That is, in part, because of the short-term funding of the pilot: "So many therapists want to work in the NHS but they can't get jobs because there is no money for the service - it always gets siphoned off," Wright says. He believes it is vital that future NHS funding for therapy is ringfenced.
If the project is a success, Wright has big plans: "A UK-wide rollout - I see a whole chain of warm, comforting, architecturally designed, extremely attractive places." Happiness centres, perhaps?
· Number crunching
When Lord (Richard) Layard last year published his book Happiness: Lessons for a New Science, and subsequently recommended that the government fund 10,000 new NHS therapists to tackle depression and anxiety, he kick-started a national debate that would help shape political priorities.
The Depression Report, published this week and co-authored by Layard, an LSE professor, became the latest chapter in what is now known as the "happiness agenda" when it suggested that everyone who needs it should have access to therapy on the NHS.
The government has already given the go-ahead for two pilot NHS therapy treatment centres, and the Tory leader, David Cameron, has recently given a speech on "wellbeing". But why are politicians so keen to back this new "happiness agenda?"
As always, it comes down to money. Layard, an economist, has made a convincing financial case. He has won favour by linking mental health to the government's desire to reduce incapacity benefit (IB). He argues that the cost of talking therapies pale in significance compared to the £7bn annual bill for 1 million people - a large proportion of whom have a mental illness - claiming IB. It will also, he says, be cheaper in the long run than drug treatments.
But while Layard has his fans, his proposals have been greeted with some caution. Among the questions being asked are: where will 10,000 new therapists come from, and is too much faith being placed in cognitive behavioural therapy when it does not work for everyone? There are also worries that when it comes to crunching the numbers, the funding will be found by plundering it from already cash-strapped acute services.
Mary O'Hara
· More on the Layard report at SocietyGuardian.co.uk/socialcare
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