Despite what many may believe, depression is not a symptom of our modern consumer age. "A grief without a pang, void, dark, and drear," wrote Samuel Taylor Coleridge in 1802, in his work, Dejection: An Ode. "A stifled, drowsy, unimpassioned grief, which finds no natural outlet, no relief, in word, or sigh, or tear". Even as great a philosopher as John Stuart Mill endured what he called "a crisis in my mental history", describing the mood that came upon him: "I felt ... that mine was not an interesting, or in any way respectable distress. There was nothing in it to attract sympathy. Advice, if I had known where to seek it, would have been most precious." The state both writers outline is felt by the one in six of working-age adults in this country who suffer from depression and chronic anxiety. Yet only a quarter of them receive treatment. Most of the rest are, as Mill described, lost in a dark and hopeless world.
It need not be like that. Today a sensible and practical call for action is launched, led by London School of Economics Professor Richard Layard. In the Depression Report, Prof Layard and colleagues set out the scale of the mental health problem in this country and suggest that most people with mental illness should be offered the option of psychological therapy. Few people would argue against that. But as is so often the case with health issues, the larger question is where the money is to come from. Given that the appetite for demands on the National Health Service is inexhaustible and funds are limited, an additional responsibility for a substantial increase in treating mental illness would strain already over-stretched budgets. As things stand, treating depression and chronic anxiety accounts for just 2% of NHS spending. That proportion is scandalously small, an indication of the low priority given to the issue over the years. Yet Prof Layard's report offers a strong argument that increased spending on mental health now will lead to greater savings elsewhere.
Although recent changes in government policy and the buoyant labour market have had success in reducing the numbers involved, there are still more than four and a half million working-age adults either on incapacity benefits or not seeking jobs because of long-term sickness. Around a third of these are thought to be as a result of depression or anxiety. Prof Layard estimates that the economic cost to the UK is £12bn a year of lost output - equivalent to 1% of annual national income. The cost to the exchequer is £7bn in benefits and foregone taxes. Yet the additional spending required to successfully treat mental illness is tiny: just £600m a year, according to the report. It outlines an example of 100 people given therapy for a 16-week period, and calculates that 50 of those treated would lose their symptoms by the end of that period. Since each course costs £750, and the combined cost of a month's incapacity benefit and lost taxes is £750, the treatment offers a very rapid payback. Then there are the additional savings for the NHS: lower spending on drugs and easing the burden on GPs, with mental illness currently accounting for about a third of GPs' time.
What this ambitious plan needs is the resources to fund the increased numbers of therapists required to reduce the current nine-month long waiting list for therapy. A careful phasing in of the expansion at the scale required by this report should make it possible to at last address the national challenge that mental illness confronts us with.
