Here is the latest report on the value of counselling (talk therapy), and you are invited to express your opinion in the poll and in the thread. With only 10 options available, the obvious one of the competency of the counsellor has been left out of the poll, but not forgotten .
The link to the report at Medscape Today News is at -
http://www.medscape.com/viewarticle/750 ... ws&spon=12
and the large print version is below -
and the original source is atReferral to Talk Therapy Cuts Costs, Improves Outcomes
by Megan Brooks
October 5, 2011 — Adults with common mental health problems such as depression and anxiety consume more health resources than those without, a new study from the United Kingdom confirms.
"This is across the board," Professor Simon de Lusignan, MD(Res), from the Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom, told Medscape Medical News. They have more inpatient days, outpatient and emergency department visits, and sick days than those patients without common mental health problems, he said.
Professor Simon de Lusignan
Importantly, Dr. de Lusignan added, the study also shows that referring patients with common mental health problems to psychological therapy reduces healthcare utilization and sick time, and may improve adherence to drug therapy.
The improved adherence is "probably the most important finding because if people take their medications they generally will remain healthier, which will save money in the long run," Philip R. Muskin, MD, clinical psychiatry professor at Columbia University in New York City and distinguished fellow of the American Psychiatric Association, noted in an interview with Medscape Medical News.
The study was published online October 3 in the Journal of Epidemiology and Community Health.
A Model for the United States?
The Improving Access to Psychological Therapies (IAPT) program is a fairly new government-backed initiative in the United Kingdom. It was piloted in 2006 and is now available nationwide.
The program is designed to help people cope better with their mental health problems through timely access to effective interventions and reduce the economic burden to society of psychological illness, Dr. de Lusignan and colleagues explain in their report.
The investigators set out to quantify the effect of common mental health problems on the use of health services and see what effect the IAPT program is having. They assessed routinely collected healthcare data for 152,328 patients registered with primary care physicians in East London and Yorkshire.
They found that 22% of these individuals had been diagnosed with depression or anxiety at some point, and that these individuals used significantly (P < .001) more health resources than those without mental health problems.
The patients with depression or anxiety also logged more days in the hospital or the emergency department and had more outpatient visits. They were also issued nearly 10 times more sick notes than those without mental health problems.
This is not surprising, Dr. Muskin said. "It's well known that depressed people are high users of medical care because they are unhappy and physically miserable; they have aches and pains, they don't do what they are told, and those are just the big issues," he said
Reduced Use
According to Dr. de Lusignan, the "before and after comparison of people referred for psychological therapies showed that referral was associated with subsequently attending the emergency department less, having fewer sickness certificates, and complying better with antidepressant medication." All comparisons were significant at a P value < .001.
"The message (if repeated in other studies) is that referral to psychological therapies may reduce presentation with physical illness and sickness absence," Dr. de Lusignan said.
Antidepressant use also increased with referral to psychological services. This "may signify better compliance with therapy or possibly indicate that those referred to IAPT were presenting in a more acute phase," the investigators write.
Unfortunately, only about 6% of patients with a mental health problem were referred to the program during the study period. The vast majority of those referred were between 20 and 54 years old; "relatively few" were older than 65 years. Nearly two thirds were women. Referred patients tended to be white and from more socially deprived areas.
"At a time where there is pressure to control increasing health costs, this study suggests that IAPT may contribute to reducing health service usage," the study team concludes.
Savings in the Long Run
"In general," said Dr. Muskin, "this class of research basically shows that the more effort you make, the better people do, and generally the less it costs. That is, with collaborative care there is better care and less utilization, although that's not true up front because you're adding in psychologists, nurses, and social workers, for example."
"Early on," he added, "collaborative costs more, and it takes a couple of years until you break even, and then you start to see overall savings. This isn't where peoples' heads are these days; it's more 'How much less can it cost now?' "
"I think this article exposes that you can give better care, which eventually saves money. Good care always saves money, but you have to put money into the system," he said.
"It's a nicely done study," Dr. Muskin added; "it's not biased in anyway; no one is looking over your shoulder in this kind of study."
The study was supported by the National Institute for Health Research. The authors and Dr. Muskin have disclosed no relevant financial relationships.
J Epidemiol Community Health. Published online October 3, 2011. Abstract
http://jech.bmj.com/
Mars
