The following correction was printed in the Guardian's Corrections and clarifications column, Monday November 6 2006
The comment piece below stated that the £750 cost of a 16-week cognitive behavioural therapy course is equivalent to that of one month's incapacity benefit. In fact, incapacity benefit alone would be significantly less; the comparison incorporated the costs of housing and council tax benefits and the loss of income tax revenue.
Imagine there was a new policy, sitting on a shelf somewhere, that could, at surprisingly low cost, and in just a matter of months, transform millions of people's lives. Moreover, imagine that it was scientifically proven, and that it would make people more employable and better parents, thereby increasing productivity, cutting the benefits bill and reducing antisocial behaviour. Oh, and that it would achieve all this simply by making people measurably more stable, hopeful and happy.
Such an idea is surely a conceit, you are probably thinking, designed to illustrate some less fanciful point. Actually, no. Such a policy exists, and in the next few weeks we will discover whether it becomes a reality or remains the dream of the LSE academic who developed it. Today the five main mental-health charities are pledging support for his plan in their report We Need to Talk.
It was five years ago that Richard Layard, a respected economist, focused his attention on the causes of happiness and discovered some extraordinary facts: one in six people are suffering from depression or anxiety. A million receive incapacity benefit. A third of all GP visits concern these two conditions. He concluded that they were the biggest cause of "measured misery".
Yet the provision of NHS therapy is patchy, and, even where it is available, the waiting list is usually longer than a year. Four out of five GPs end up prescribing pills even though they'd prefer to prescribe therapy. This despite Nice - the body that decides what treatments the NHS should provide - unequivocally advocating therapy as a treatment for depression and other disorders.
Paul Farmer of Mind, the National Association for Mental Health, says simply: "The NHS would never be allowed to fail to provide a drug or operation that was mandated in Nice guidance, yet that is exactly what happens here." It's analogous to Nice finally agreeing to provide Herceptin for cancer patients, only for them to be told by their GPs "sorry, we only had one bottle and it's gone".
So why have millions been denied such basic treatment? It's not a question of economics. Layard has costed a 16-week course of therapy at £750 - equivalent to one month of incapacity benefit. Lower demand for benefits, increased productivity from those in work and a reduction in GP appointments and prescriptions would largely offset costs.
Maybe it's due to lingering doubts about the efficacy of therapy. But there is now overwhelming scientific evidence which shows that a course of cognitive behavioural therapy (CBT) is effective for depression, anxiety and several other problems. It doesn't work for everybody. But crunching through the evidence, Layard concludes that about half of all people who undergo a course of treatment will get better.
The minister for mental health, Rosie Winterton, this weekend congratulated a pilot scheme in Doncaster for seeing it's thousandth patient in just three months. Layard is pushing for 250 such centres, employing 10,000 therapists.
The money for all this would come from a bid being put together as part of the Treasury's comprehensive spending review. By 2011 the cost would be about £200m a year. It sounds like a lot but is, in fact, just 0.2% of total NHS funding.
Therapists have welcomed the proposals but are anxious that CBT isn't the only treatment available simply because it's the easiest one to measure and therefore have its effectiveness "proved". Like most therapists, I don't focus on CBT in my work, which is why I favour - and am developing - a treatment menu that I have labelled "CBT+". This would also provide more ongoing, deep-level psychodynamic work for those whom CBT fails to reach or who are suffering from multiple or intractable problems, which often originate in childhood. Already, Layard himself says that non-CBT therapies will make up 30% of the proposed treatments.
But first we have to get the proposal off the ground. Anyone who cares about this, and there is barely anyone whose family is untouched by mental illness, should write to their MP urging that Layard's proposals be implemented in full. Because the idea, while gaining support, could still fall by the wayside of competing spending bids. It could also, even if implemented in parts, become a victim of future NHS cuts.
Layard has dealt definitively with the excuses of cost and effectiveness. If we fail to take up this opportunity it will be, I think, because we remain uniquely ashamed of mental illness and its potential to enter and destroy our lives. Yet we can no longer justify our inaction with the pretence that we can't do anything about it. For while it would be facile to claim that we can make misery history we can - for many, many people - make depression and anxiety a thing of the past.
· Derek Draper is a psychotherapist and former New Labour adviser
