Therapy for depression can be delivered effectively by non-specialists
(16 February 2011)
Depression can be treated effectively with psychotherapy by mental health nurses with minimal training, according to new preliminary research findings.
The study, led by Durham University's Mental Health Research Centre, shows that patients with severe depression can be treated successfully with behavioural activation - a psychotherapy for depression - by non-specialist mental health staff which could potentially lead to considerable cost-savings for the NHS.
Currently, psychotherapies, such as behavioural activation, are delivered by specialist clinicians and therapists. In the study, the mental health nurses received five days training in behavioural activation and one hour of clinical supervision every fortnight.
Although the findings are preliminary, the researchers say they could pave the way for increasing access to psychological therapies for people with depression and could help to alleviate the shortage of specialist therapists. Estimates suggest that less than 10 per cent of people with depression, who need some form of psychological therapy, get access to it.
The research, conducted by Durham University, University of Exeter, and the University of York, is published in the British Journal of Psychiatry.
In the study, researchers compared behavioural activation treatment delivered by mental health nurses with usual care delivered by GPs. Forty seven patients participated in the trial. They found that the patients treated with behavioural activation by the nurses showed significantly more signs of recovery, were functioning better and were more satisfied with the treatment compared to the group who received what is classed as 'usual care' by their GP.
Behavioural activation is a practical treatment where the focus is on pinpointing which elements in someone's life influence their moods. Changes over time in these person-environment relationships are explored and worked on to help the person engage in a more rewarding daily structure. This is done through self monitoring, scheduling and exploring difficult situations and the person's responses to these.
Lead author of the study, David Ekers, is an Honorary Clinical Lecturer at Durham University and Nurse Consultant at Tees, Esk and Wear Valleys NHS Foundation Trust.
He said: "This is a small-scale study and certainly more research with bigger trials is needed but it shows some very promising early findings. The results indicate that with limited training, generic mental health workers can be trained to deliver clinically effective behavioural activation to people with long-standing depression.
"Behavioural activation therapy has already been shown to be equally effective as cognitive behavioural therapy but previous studies have always tested it with experienced psychotherapists. This is the first time it has been shown that behavioural activation can be an effective treatment when delivered by 'inexperienced' therapists.
"All of this is particularly relevant in the current economic climate whereby there may be increased risk of depression, and demands on the NHS in that area could become heavier."
Depression is the third most common reason for people visiting their GP, according to the Office of National Statistics. Depression occurs in one in 10 adults in Britain at any one time, with one in 20 people at any one time suffering from major or 'clinical' depression.*
Colin Walker, Policy and Campaigns Manager for mental health charity Mind, commented: "Mind has found evidence that one in five people with mental health problems are waiting over a year between asking for help and receiving access to talking therapies. Expanding the types of therapies on offer and how they are delivered might be an effective way of reducing the time that people wait to receive support but much more research is necessary to ensure that this approach is truly effective.
"It's vital that mental health workers inexperienced in providing talking therapies are adequately trained to deliver such services and that this is not just adopted as a cost saving exercise to replace other types of treatments."
*Source: Mind website - www.mind.org.uk/help/research_and_policy/statistics_1_how_common_is_mental_distress#depression