Branwen Jeffeys looks at some of the key dilemmas facing the NHS.
Programme 1
Tuesday 1 July 2008
Which treatments should the NHS fund? Dementia vs. Mental Wellbeing
Two expert advocates each champion an historically overlooked but now growing area of healthcare. The burden on the families and carers of dementia patients is intense; in the case of mental health, the potential cost to society is huge, with estimates that as many as one in four of the population will face mental health issues at some point in their lives.
On the one hand, Alzheimer's patients and their families are challenging NICE's ruling about drug treatments in court. On the other, mental health advocates are calling for wider provision of effective but costly talking therapies over traditional drug treatments.
Given limited resources, which should take priority and how should the decision be made?
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Have your say
Which treatments should the NHS fund? Dementia vs. Mental Wellbeing
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Caroline, Surrey The increased incidence of dementia is going to make us look more carefuly at the implications of going for quality of life rather than quantity of life. I think that we have to determine an age at which you have to have an assessment of mental acquity before going into hospital for any elective proceedure and once there in an emergency. Those suffering from dementia are vulnerable in hospital (when they are not able to seek help with feeding and toileting). They tend to have a defaultanswer to any enquiry like "Oh I'm fine thanks." Which means that they can be left lying in soiled nappies or be regarded as refusing food. This means that they need a carer with them outside visiting hours and especially at meal times to ensure that the nursing assistants, who do not understand the implications of dementia, have help and do not take the answers of those with dementia as being thought out answers to questions. Once an assessment of menatl capacity and in due course with various different co-morbidities requiring hospital admission an assessment of how steep the rate of decline is then it should be possible to assess whether dying from the immediate threat to life would be preferable to the agonisingly slow decline into complete handicap that comes at the end of dementia. Dying when you have lost all mental function to include movement, speech and even swallowing is truly ghastly for all those involved. Your discussion did not mention one of the major problems with dementia- that is the denial on the part of the patient and those around them when faced with perniciously, gradually increasing symptoms. My proposal may reduce some expensive highly technical interventions and open doors to appropriate care. Unfortunatley your speaker this morning did not tell us what these wonderful interventions were that could help with early stage dementia - did he mena the drugs NICE will not allow? Limited CBT resources should be focused on those with a real hope of rehabilitation. Those with dementia need to be allowed carers to be their voice at hospital consultations and not to be forced into isolation as a result of well intentioned rules aimed at controlling MRSA etc but framed on the assumption that the patient can remember anything the doctor tells them. Or that they are in a hospital for that matter. I have lost 2 very close relatives to differently presenting dementias in the last 18 months and am very aware that the lack of system failed them.
Rose, Shropshire If someone had a compound fracture no-one would consider treating it as if it were a simple fracture because this would lead to greater problems. If someone does have a compound fracture it may be that there is not a complete mend - the person may limp a bit or always have a weakness on that side. In the mental health services it seems that peoples' problems are going to be treated firstly as if they are the equivalent of a simple fracture. However within psychiatry and in those people seeking help for depression and anxiety many people have had the equivalent of a compound fracture of experiences in their childhood and adult life. These people need to be entitled to long term help and the staff/therapists need to be free to be patiently alongside the person. It may be that "the desired effect" is the demand from society to be back at work etc. which may be untenable for many years if ever possible. If both therapist and patient are viewed as failing this is no help to the patient at all. It is also not helpful to the moral of the therapist. The pain of mental distress may be different from the pain of physical illness but it can be as or more debilitating. Can someone tell me how much a triple by-pass operation costs and how many sessions of psychotherapy this would pay for? Surely we need to get a new balance between mental and physical needs.
Emma, Solihull I am 28 and have lived with depression and anxiety for the past 11 years. I am unable to work full time and am on medication. I have been trying to get CBT for the past 5 years but to no avail. Despite the effect that these conditions have on my life and on my ability to contribute to society I have been told by so-called mental health professionals to accept that I will not get treatment and to just get on with it as best as I can.I am now studying psychology through the OU with the view to be able to help others in my situation.
Jan Having heard the debate in Radio 4 comparing the funding for dementia versus the funding for anxiety and depression, I'm compelled to argue in favour of the funding for anxiety and depression. I am a clinical psychologist working in chronic illness, I am faced with numerous cases of anxiety and depression and the impact these psychological issues have on ones family is phenomenal. I ask us to consider, widening the debate: how long term depression within the family impacts on our children, partners and carers. How our children have to sometimes cover up and support some parents because of these crippling problems, and the long term effects this has on these individuals for their long term economic contribution and quality of life (for example a father who is unable to confront his emotional difficultites who perhaps drinks to avoid this emotion). Furthermore, a speaker commented on the current wastage within the NHs, and I am at my wits end in terms of the cutbacks that we have had to endure. For example I am the only psychologist working for chronic illness within my locality, supporting a nurse specialist for parkinsons disease, which account for 10+ in the region. Where do all the other patients go? Nowhere! There is nowhere for them and their families to find psychological support. In fact, the issue within primary care for psychological problems is much the same: there is simply no funding for psychological services in a lot of cases. mental health sufferers have suffered tragically historically, and even over the last 5 years, it has been these services that have experienced the most severe cutbacks. If we want to see increased economic activity and reduced benefit claim, I urge the governement to support highly trained individuals such as psychologists to provide the necessary high quality care, and increase the training available, both for trainees as well as qualified psychologists.
Ian, Colchester I am a psychotherapist working in the NHS and privately. I find it rather annoying that Layard continues to ignore a wide range of evidence that shows CBT is NOT ANY MORE EFFECTIVE than any other modality (including humanistic, psychodynamic, and others). As an economist, he shows his true colours by leaning clearly towards the so-called cost-effective option. As NHS services are increasingly put out to tender to lowest-price companies, we will find the truth in psychotherapy holds just as it does in other areas - the cheapest ain't always the best.... or as my Dad says, "buy cheap, buy twice..."
Ruth, Nottingham Listening to the programme there was alot of focus on the effects of Dementia on families and carers but much less mention of the effects of depression and anxiety on families. Depression effects the whole family too, it can remove a breadwinner from the workforce, often causes relationship problems and in some cases can lead to children being taken into care (albeit rare). The effects are multi generational and severe, more so because of stigma making it difficult to discuss. There's little help for relatives who are just left to cope and worry - and perhaps to become ill themselves.
gwyn higginson cognitive behavioural pschotherapis Why have we to choose between the two. I have a project looking at an innovative model of early detection of the early presymptomatic stage of dementia (vascular cognitive impairment/mild cognitive impairment by picking up on mental health alerters using a cognitve behavioural theraPY FRAMEWORK which uses the work of professor Paul gilberts work on shame and self attacking and development of a compassionate mind framework. This uses a process model to assess anxiety/depression and identify emotional distress in response to experiece of thinking difficulties---not memory loss we are about to commission the service which sits in primary care mental health but at the beginning of the dementia pathway.Interestingly the project crosses age boundaries in mental health services age 50 plus-addresses the darzi review principles looking at prevention of vascular dementia and alzheimers disease looking at vascular risk management which liks to physical health pathways for vascular risks.We have developed innovate CBt approachers to dealing with the emotional distress in response to thinking difficulties-not necessarily memory problems in the stage and introduced a new concept of 'vaSCULAR ANXIEtY re ---so why choose we need both working together--why choose ??????? are not both linked.,why is this not seen.-because we are all in boxes!!Publication re theory and model and new service delivery.
bridget stap, chichester Having lived in France for 27 years and been back here for two, I am quite simply appalled at the fact that people go into hospital, fall ill with superbugs and end up worse than when they were admitted!! Money in great quantities is not needed, but "clean" rules are! Nurses' and doctors' uniforms should stay on site and be washed by the hospital laundry. Just take a clean size 14 or whatever from the linen store every day - doesn't matter if it's "yours" if it's clean. ALL staff should wear "crocs" as although they are ugly, they can be scrubbed and again it doesn't matter if they're "yours" as long as they fit, if they're clean. All staff should wear masks so as not to spread MRSA, if they believe it's carried in nostrils. It should not be "inevitable" that longstay patients get Cdiff (I quote a nurse who said this to my friend about her father!) All visitors should wear disposable shoe covers, and masks if necessary. I did not touch my mother once during a two-week stay recently and I took in clean linen every day. If staff don't wash their hands after using a toilet, there's no hope so that means wearing throwaway gloves - 20 patients seen means 20 pairs of gloves. Why are wards not wet-cleaned with disinfectant in the water? Cleaning means washing, not dry-mopping. It doesn't matter whether or not the rules would inconvenience staff - they should be applied without quibbling over trivialities. So you have to be at work 10 minutes earlier to change? Live with it as it may mean others might stay alive too.
Jayne I was unable to hear the whole of the debate as I was listening whilst travelling to work at an NHS Hospital but it seems to me that whenever debates like this are set up no real choice is allowed. I would prefer to see more money per se going to Mental Health Services. This could be released by restricting the costly government led initiatives that have been over recent years responding only to a small but vocal percentage of our Society. As one of your contributers pointed out the Governments priorities are not necessarily the same as those of the wider public.
Jennifer Madden, Cheltenham Having to make a decision between one human condition and source of suffering and another, and basing that decision on funding, seems to be putting the cart before the horse. Depression is not an illness that can be 'cured', it is a state of mind - both personal and collective - which left unattended can cause immense suffering: physical, emotional, social, spiritual. Sometimes there has to be crisis before we will turn within and look at ourselves and find the answers we search for. Our 'horse' - in Greek mythology named Pegasus, holds all the power and creativity we need for the journey but we have neglected him. He needs feeding and nurturing or we keep on delving into 'daddy's' wallet hoping that funding will get us out of trouble.
Lees, Sheffield A huge push to fund dementia would benefit mental health as they are linked The main problem already is resourcing.& shortage of trained staff available every day of the year! eg weekends, holidays & winter illness At some point in life ALL THE POP. fears dementia. It attacks people when most vunerable eg,age,income, general health, bereaved etc. One fears it because of the unremittng drip/steady loss of all one values. How does one know when to seek advice, who to ask & whether the advice will be in one's best interests. eg My father age 66 had &died from bowel cancer, my husband died after a very short illness this Feb from an undected cancer, probably pancreatic. Now my requests for a scan are met with excuses re.unwarranted expense. For peace of mind and early detection it seems justified. Indeed I believe scans, & dementia tests for all 55+, & then every 3yrs, would be hugely beneficial to the individual & the state & be fianacially efficient as money would be better spent on real provisions needed instead of GP's guessing as to why people are presenting certain symptons, - as happens with both cancer & dementia! _ Consider all the waste in time & money guessing engenders, as well as grinding down the patient & carer, adding to the stress & potential health deterioration of all concerned. Scans & tests would overcome dependence on the limited knowledge of GP's!
Peter Whitestone, Biddenden, Kent Thank you for the interesting discussion about dementia and depression and the personal, social and financial advantages of their treatment on the NHS.Surely the reasons of gain in quality of life and savings in expenditure on care and compensation apply also to mental conditions such as autism, and the NHS should therefore include their relevant research and treatment as positively within its remit.
Emma Rowell- Owen I am a 2nd yr CBT Ba Hons student who cannot get a clinical placement with NHS.(They are unwilling to offer training places to universities who do not have a financial agreement with them). So it would appear that despite the govt accepting Lord Layards recommendations they are delaying acting on them.This means that in a year a number of CBT grauates will be available for employment but have never had the experience of working in the NHS. Who, we are told are desperate for well trained therapists.This will result in delaying delivery of mental health servies longer than is necessary and keep people on long waiting lists. This is a shame because the +ve outcomes for Talking Therapies reported in the research and referenced by Lord Layard in your programme will not come about about. I fear delivery for both Dementia and Mental Wellbeing will be talked up but never really appear as in Maternity services.
David Bowker Manchester UK It was a mistake to pose one proposal against another - both are to some degree funded now and should continue to be. The economist's argument for cognitive behaviour therapy was I believe flawed in that the large core number of unemployed have multiple problems connected with personality, circumstances and ablities, and CBT is unlikely to motivate more than a minority of these. Other individuals will have either self limiting or milder conditions susceptible to medication (which is cheaper) and will only be away from work for short periods. While training is important the personality, experience and intelligence of the therapist are more crucial. It also takes a number of years before therapists will have learned enough from their errors to be useful and effective.I feel that QUALYS have been a pernicious development (the economists again!) - the question of treatment and the quality of lifes should always be an issue for the clinician and the individual patient (and family), and not for central bureaucrats. It is a pity that NICE mixes both effectiveness and economics when it would have been better(for patients) to stick with the former. One can have little faith in politicians as the mental health services have been starved of funds for many years despite being a so-called priority area, and as recently pointed out in-patient wards for the more severely ill can be intolerable and untherapeutic. CBT for milder conditions will have no effect on this problem.
Surely the debate should be to determine the level of free NHS treatment in all areas and for all conditions.Everyone anywhere in England should know what will be provided free and what will not and it should be the same all over the country.Both of these conditions are worthy of being 'above the line' and therefore treated free at the point of need. Some conditions currently funded by the NHS at enormous cost may fall 'below' the line and would therefore free up funding if removed from the 'free' list.The list should be decided by public debate and with full publicity so we all accept the result
Anon Scotland Mental Wellbeing in young people needs special mention. These youngsters are evolving into adulthood and get a poor, illdefined service nationwide. NICE cannot just say that age does not matter. These adolescents despair and die for the lack of good psychological treatments, and they are often the ones who are caring and sensitive, and if handled well, would give back to society which would include care of those with Dementia.
Flopsy, London I am a young physically disabled woman.My priority would be for funding for CURES over funding for treatment.People of a working age should be treated before retired people.NHS doctors are often concerned with empire building. A body of sick people often forms a power base and NHS doctors abuse this.Take all decion making out of the hands of doctors. Let the debate rest with patients
Barry Anderson Milton Keynes Top up Funding for Charities is a solution to NHS costs.I was a trustee of the local branch of the Westminster Pastoral Foundation. This is a long established national organisation for for couselling and accredited training in Counselling. Clients were often referred by GP's and we asked clients to pay according to their means. In 2002 this was mostly around £10/hr but upto £35. Our break even rate was about £12/hr. By the nature of the work many people could not pay this and since we could not be selective we had to close.£5000/annum would have allowed us to continue and £15000/year would have allowed us to expand.We had applied for Learning and Skills funding but the amount of top up was so small that in all honesty it was impractical for them to help. Their money should have been available through a local source but their rules restricted money to start up and capital items not for running costs. Local Authority money was targeted at the young and families and although many of our clients would have been in this category a number would not.We finally applied to the local Primary Care Trust but they claimed they covered all the needs for counselling. This was patently untrue (we had a contract with the local hospital for counseling their staff). We involved a local MP who could not believe what she was hearing but to no avail so we closed. To be fair I believe Primary Care Trusts in other parts of the country do give top up funding. I think I heard on your programme NHS costs of £75/hr(in 2008) for a particular treatment which I suspect is typical for counselling costs and I am sure we could have been cheaper and we gave a bonus of training at the same time. I realise this raises the issue of, if the NHS cannot supply a service free should they be able to subsidise a service which asks clients to pay something.
I have worked with people with dementia for 14 years, six of them as a Nurse Consultant in a large General Hospital. The knock on effect of poor staff training about dementia,along with inadequate assessment & diagnosis made far too late, currently means that both professional and family carers fail to reach their full skill potential. Other patients suffer consequences of their own 'diluted' care and the person with dementia loses their remaining skills far more quickly than they should, thus accelerating them into more complex and costly institutional care.For a family carer, this combination has a devastating impact, reducing their ability to work, maintain their own optimal physical & mental health, and manage their finances This is a vicious cycle, that further exhausts people, services and funding. More creative and wide reaching staff training, higher levels of public information, earlier and more informed diagnosis are a matter of urgency. There are too few knowledgeable people,trying to do far, far too much in a service that is so valued that the greatest proportion of staff working with this group of people (nursing assistants and home carers)are paid the same as(or in some cases even less )than Supermarket check-out staff and with less training. Many people are forced to pay for this level of service by selling their homes.In a democratic and allegedly 'civilised' society this is nothing short of scandalous. Dementia should be the priority, otherwise the incidence of depression, anxiety and ill-health, amongst many of those family and professional carers who have to deal with the consequences of failing to do so will continue to rise.
Dr Richard Turner This is an important set of programmes - Could they be added to the list of programmes which can be "listened to again" ? - the website says "listen again no longer available"
Saira Ahmad, Walsall I would rather spend money on training and employing therapists than lining the pockets of the pharmaceutical companies if ,as I understand it, both therapies are equaly effective.I hope Gerry Robinson and Alyson Pollock have the ear of the Government - they seem to be the only analysts I have heard who seem to understand the economics of the NHS, Darzi, Warner, and all recent ministers haven't a clue.
Dr C A Trotter Old Age psychiatrist Portsmouth I listened to this mornings debate on depression and dementia. You invited audience participation by e mail or texting. This is totally age discriminatory as most older people do not have computers or mobile phones.
Mrs C.Maitland .Norwich .Norfolk My husband and I are in our 60's pay over £100 a month in health insurance for such things as hip replacements which we may never need .We can ill afford this therefore why cant we pay a reasonable amount to the NHS instead of paying for this private insurance when we may never need to use it.
Mike Cain All mental health problems have long been neglected, with NHS patients receiving the minimum care that 'should' keep them quiet. Dementia has risen because it is affecting many middle class families. Its sad that it has come to this, but the vocal community seem to be well placed to voice their views (in many areas). We dont understand how the brain works. Its an important organ, but we seem to spend little on investigating and researching how it works. Being cynical (with reason) we seem to spend a lot with the drug companies and nothing on non drug research. Private industry will not spend as there is no return, and our political masters dont want to be seen as 'wasting' money. But money spent in mental health is an investment
Sue of Surrey April before last Patricia Hewitt announced all PCTs had an obligation to provide computerised CBT (cCBT). Prof. Kevin Gournay (from Behaviour therapy governing body) was commissioned to look into free cCBT already available on the internet which was favourable.NICE costed computerised CBT AGAINST talking therapy (wrongly) and came up with a solution where they spent millions on renewable license fees to a software company for ‘FearFighter’ and ‘Beating the blues’.What happened to that plan? What happened to all the money?CBT is only one therapy – many feel like sticking plaster over deeper issues.When they say not enough therapists, they MEAN not enough CBT therapists.
As a qualified nurse and midwife I have seen the effect of poor decision making and wastage in the NHS at first hand. I also have Bi-Polar disorder and have been made very ill by over prescribing and lack of any other support. I an now off medication, against advice and studying for a BSc full time. The period I have spent off work through ill health and the poor treatment I recieved have cost the country an enormous amount of money. I could have been earning and contributing to the econemy and earned towards care fore others.
Miss W Louise Warren As a general comment, there should be more money spent on prevention rather than cure. In other words, let preventative methods be used earlier for example dementia drugs should be issued sooner rather than later to ensure that people have a better quality of life.
Maria You cannot make one or other a priority. But, what you can do is have good quality programmes that would reduced the crisis costs of each, and that would in itself reduce costs on both sides.
I have been under the NHS Mental Health services on and off from the age of 17. I have been on various types of anti-depressent drugs and recieved talking therapies. 5 years when I was 28 I attempted suicide and since been on incapacity benefit. I have seen my local services deminish totally. Had to wait 2 years for a psychologist when she suddenly left she wasn't replaced I had no option but to pay privatly for CBT which was of huge benefit. At £75 per hour I could only aford a limited amount of sessions. Having benefitted from the sessions I wish I could aford to continue with it.The impact and frustration for me and my husband is huge. Mental well being is underestermated in NHS bugets. What measure can be applied to being emotionally free to live.
Yan I am a single father of a 14 year old boy and have been suffering with depression and anxiety for over 5 years. My doctor has stated that I am unfit for work, the doctor who examined me on behalf of the benefits agency proclaimed that because I could bend over and touch my toes, do a couple of squats, I was fit for work. The result of this is that I have been on highly reduced benefits (£108 per week inclusive of CTC and CB) I am wondering how much pressure these new councilors will be but under by the government to declare people fit for work when in actual fact they are not, in order to get even more clearly unwell people off the IB books?
Lizzie Worcestershire I am a CBT therapist in a prison. Many of the men I treat committed their crime when depressed. In male working class culture dpression is the sign of a 'nutter', so at best they seek help for a headache. More education is needed about depression and simple ways of overcoming it.
derek kennington plymouth the treatments being discussed are funded by the health service whilst the projected savings often benefit another area of government-for example the benefits system. Is there any possibility of treatment designed in part to get people back to work being funded by the benefits agency, or some of the benefit savings being transferred to the health budget from the benefits budget?
Bridget Herbert, Twickenham Depression and anxiety have increased ten fold since the end of the second world war - and are increasing ever more as we lose the structure of extended families and community. We work longer hours, we are under more financial pressure, under pressure to perform, to have, and to succeed. On top of that, many people have turned away from religious and spiritual beliefs that might provide a greater framework in which to explore 'meaning' in life.All this adds up to more mental/emotional disturbance in people, but no infrastructure to deal with it - apart from medication dispensed by the GP. The number of people takeing SSRIs is ever increasing. Eventually, this lack of mental/emotional wellbeing becomes a contributory factor in physical diseases -starting with 'stress-relasted' problems like IBS, Chrohns, High Blood Pressure, High Cholesterol, Heart Disease, eating disorders. Furthermore, more serious diseases such as cancer will also have an emotional/mental element to them. Research shows people living happy and healthy lives will live longer and suffer fewer physical problems.Hence mental/emotional wellbeing should be of prime and paramount importance -and more emphasis should be placed on this, right from the beginning. In the long run, the NHS would save money by tackling mental/emotional problems.
Biddy Tarrant. West Yorkshire Dementia must represent some of the worst fears for those over 55. It brings a frightening emotional isolation at a time when life may be presenting diminishing financial and physical competence. I would support moves to ensure that the growing number of 'baby boomers' do not have to live their final days with insecurity and with less dignity than they deserve.
Ian Keith What about the more cost effective adoption of computer assisted CBT as reccommended by NICE.
Amy, Colchester Depression & Anxiety problems come first. So many people suffer. It affects this country's attitude and happiness. Also it can lead to other illnesses and problems which the NHS have to spend money on; e.g. paranoid people & hypercondriacs go from doctor to doctor. I had more money spent on me because I was taking antidepressants which masked back pain, I was not moving much and slouching etc because I was depressed - I ended up needing a back operation which cost the NHS £1,000s. Depressed and anxious people don't look after themselves and develop problems which the NHS need to pay money for.
Paul, Harrow As someone that has been suffering from anxiety related depression for 4 years and has given up all hope of the NHS Providing a talking therapy. The question is wrong. Talking therapies should be supplied by the NHS just to save money on Benefit payments. If the Health Dept. will not fund it, Work and pensions should. Its a no brainer, but does not override the importance of diagnosing and treating dementia, which is a more complex and challenging problem.
Chris Culshaw from Lancaster The real cost of mental health may often be borne by the children of the sufferer. How do you explain depression to a small child? She/he can understand how a broken leg will mend and mum/dad will be back to normal soon. But a 'broken' head? Tens of thousands of young people are affected by the mental ill health of those they love. Many become carers. What price this support?
James Fisher, Norwich How do these valuable comments about quality of life in mental health outcomes marry up with Dinesh Bhugra's (president of Royal College of Psychiatrists) comments in the Guardian yesterday about the poor state of inpatient mental health services. How are qaly's exalted here, where as inpatients this measure seems to have been lost.
Douglas Arnold Please? Give me the NHS I will sack the lot of them. The system is rotten to the core and needs a good manager
Andy, Liverpool It seems to me that because people with mental health issues tend to remove themselves from society. Its the perfect illness to brush under the carpet in terms of funding and treatment. I'm suffering from depression and cannot seem to find any help unless I try to top myself. The irony is my depression stems from helping a friend who did kill herself and after lots mental health treatment.
Alistair Edwards, York When the NHS was established, there was a n assumption that a lot of money would have to be spent initially but then the whole nation would become healthy. Then the NHS could just 'tick over'. Of course, this was wrong because as cures are found for one illness, we just die from something else. There will NEVER be enough money. This is because of our mortality - and our unwillingness to face it. As cancer becomes more curable (for instance), I think we will live longer - and then die of Alzheimers.The only viable reaction is (as is being discussed on the programme) to concentrate not on quantity of life - but quality.
Kathleen O'Neill, Hampshire What is the correlation between lack of intellectual stimulation and dementia? From what I have seen, the NHS is providing support to a sector of the non working elderly and I must reiterate I am not saying it is all the elderly, who are preoccupied with their ailments. Perhaps CBT and funding for courses/exercises etc. may relieve the NHS of this burden.
Linda from Kent I have had bi-polar for about 30 yrs and in that time I have had about 3 'lots of 12' psvchotherapy/counselling. Until the last year when I was offered Art Therapy. It has been the best year and most progressive time in my life. I have been on the list for CBT for more years than I can remeber
Louise I think there needs to be a look at the way money is spent on mental health services. My husband is in the system, but I do not think he is being helped effectively and that treatment other than drugs should be considered. I think that at least 6 months has been wasted in pointless weekly visits to the hospital where they just kept changing his medication but didn't really talk to him. It is a nightmare of how to find out what is available and what to do for the best. There is also little advise how I can help him. I am sure that with better help he could now be considering how to renter society and doing some kind of work. (I wish to remain anonymous)
David Hughes Lisburn Northern Ireland I run support groups for people with depression and the economic argument, the return to work argument sounds rather thin. What these people want is to have their very real pain reduced, the pain which leads so many of them to suicide. Yes work helps restore self esteem, but work of course is also what so many people have found a significant factor in the onset of their depression.
Jason, London As a sufferer of an anxiety disorder I would advocate more funding for Mental wellbeing. I had a severe panic / anxiety attack at work in February and have been on medication since as well as being referred for CBT. I have been told that I will need to wait another 2-3 months before my theraphy can begin, all the while I have to try and deal day to day with the effects of the fear and panic associated with my anxiety. Most days I am able to go to work and function albeit in a constant state of anxiety, however some days I just feel overwhelmed by my condition and can end up having panic attacks randomly. On days like these I find it hard to cope and function
Sue of Surrey We do not need to train any more therapists. There are thousands of fully qualified therapists in private practise (often because formal employment in the field is not available). Why not harness them? And probably hundreds of fully qualified therapists, like myself, out of work. Before we train more therapists, where are all the jobs for currently qualified therapists?
catherine I want the NHS to fund dementia. Our family has been devastated by the disease. It is affecting my father in a very serious form. I meet many people with dementia and families of people with the ilness. If the illness increases I think it will have a devastating effect on our elderly population and health services. Better to invest now, before the numbers of patients increases.
Dr Pauline Brimblecombe Cambridge As a GP both these areas are essential to fund appropriately. But by more careful use of acute services, money can be diverted into community/social care.
David, Lisburn Northern Ireland The impact of these two conditions is equally devastating on families and friends. And there is no nobility in being a carere for people with depression as there is for people caring for people with dementia.
Gaynor The counselling service I and my son received for depression after caring and the death of my husband enabled both of us to stay in work. I believe that without it we may have had real breakdowns and may still be unable to work.
Jill London Is one of the problems that dementia is a generic term to cover many conditions?
Both! My mother suffered from dementia. My daughter is overweight, diabetic, has depression, a gambling addiction and has twice attempted suicide. We have been told the waiting list for CBT where she lives is 12 months. We are being forced to go down the private route. The NHS needs fewer admin chiefs and more indians.
Brian , Liskeard Cornwall No one ever died of being infertile. Why are my taxes being wasted on IVF on the NHS?
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Caroline, Surrey
The increased incidence of dementia is going to make us look more carefuly at the implications of going for quality of life rather than quantity of life. I think that we have to determine an age at which you have to have an assessment of mental acquity before going into hospital for any elective proceedure and once there in an emergency. Those suffering from dementia are vulnerable in hospital (when they are not able to seek help with feeding and toileting). They tend to have a defaultanswer to any enquiry like "Oh I'm fine thanks." Which means that they can be left lying in soiled nappies or be regarded as refusing food. This means that they need a carer with them outside visiting hours and especially at meal times to ensure that the nursing assistants, who do not understand the implications of dementia, have help and do not take the answers of those with dementia as being thought out answers to questions. Once an assessment of menatl capacity and in due course with various different co-morbidities requiring hospital admission an assessment of how steep the rate of decline is then it should be possible to assess whether dying from the immediate threat to life would be preferable to the agonisingly slow decline into complete handicap that comes at the end of dementia. Dying when you have lost all mental function to include movement, speech and even swallowing is truly ghastly for all those involved. Your discussion did not mention one of the major problems with dementia- that is the denial on the part of the patient and those around them when faced with perniciously, gradually increasing symptoms. My proposal may reduce some expensive highly technical interventions and open doors to appropriate care. Unfortunatley your speaker this morning did not tell us what these wonderful interventions were that could help with early stage dementia - did he mena the drugs NICE will not allow? Limited CBT resources should be focused on those with a real hope of rehabilitation. Those with dementia need to be allowed carers to be their voice at hospital consultations and not to be forced into isolation as a result of well intentioned rules aimed at controlling MRSA etc but framed on the assumption that the patient can remember anything the doctor tells them. Or that they are in a hospital for that matter. I have lost 2 very close relatives to differently presenting dementias in the last 18 months and am very aware that the lack of system failed them.
Rose, Shropshire
If someone had a compound fracture no-one would consider treating it as if it were a simple fracture because this would lead to greater problems. If someone does have a compound fracture it may be that there is not a complete mend - the person may limp a bit or always have a weakness on that side. In the mental health services it seems that peoples' problems are going to be treated firstly as if they are the equivalent of a simple fracture. However within psychiatry and in those people seeking help for depression and anxiety many people have had the equivalent of a compound fracture of experiences in their childhood and adult life. These people need to be entitled to long term help and the staff/therapists need to be free to be patiently alongside the person. It may be that "the desired effect" is the demand from society to be back at work etc. which may be untenable for many years if ever possible. If both therapist and patient are viewed as failing this is no help to the patient at all. It is also not helpful to the moral of the therapist. The pain of mental distress may be different from the pain of physical illness but it can be as or more debilitating. Can someone tell me how much a triple by-pass operation costs and how many sessions of psychotherapy this would pay for? Surely we need to get a new balance between mental and physical needs.
Emma, Solihull
I am 28 and have lived with depression and anxiety for the past 11 years. I am unable to work full time and am on medication. I have been trying to get CBT for the past 5 years but to no avail. Despite the effect that these conditions have on my life and on my ability to contribute to society I have been told by so-called mental health professionals to accept that I will not get treatment and to just get on with it as best as I can.I am now studying psychology through the OU with the view to be able to help others in my situation.
Jan
Having heard the debate in Radio 4 comparing the funding for dementia versus the funding for anxiety and depression, I'm compelled to argue in favour of the funding for anxiety and depression. I am a clinical psychologist working in chronic illness, I am faced with numerous cases of anxiety and depression and the impact these psychological issues have on ones family is phenomenal. I ask us to consider, widening the debate: how long term depression within the family impacts on our children, partners and carers. How our children have to sometimes cover up and support some parents because of these crippling problems, and the long term effects this has on these individuals for their long term economic contribution and quality of life (for example a father who is unable to confront his emotional difficultites who perhaps drinks to avoid this emotion). Furthermore, a speaker commented on the current wastage within the NHs, and I am at my wits end in terms of the cutbacks that we have had to endure. For example I am the only psychologist working for chronic illness within my locality, supporting a nurse specialist for parkinsons disease, which account for 10+ in the region. Where do all the other patients go? Nowhere! There is nowhere for them and their families to find psychological support. In fact, the issue within primary care for psychological problems is much the same: there is simply no funding for psychological services in a lot of cases. mental health sufferers have suffered tragically historically, and even over the last 5 years, it has been these services that have experienced the most severe cutbacks. If we want to see increased economic activity and reduced benefit claim, I urge the governement to support highly trained individuals such as psychologists to provide the necessary high quality care, and increase the training available, both for trainees as well as qualified psychologists.
Ian, Colchester
I am a psychotherapist working in the NHS and privately. I find it rather annoying that Layard continues to ignore a wide range of evidence that shows CBT is NOT ANY MORE EFFECTIVE than any other modality (including humanistic, psychodynamic, and others). As an economist, he shows his true colours by leaning clearly towards the so-called cost-effective option. As NHS services are increasingly put out to tender to lowest-price companies, we will find the truth in psychotherapy holds just as it does in other areas - the cheapest ain't always the best.... or as my Dad says, "buy cheap, buy twice..."
Ruth, Nottingham
Listening to the programme there was alot of focus on the effects of Dementia on families and carers but much less mention of the effects of depression and anxiety on families. Depression effects the whole family too, it can remove a breadwinner from the workforce, often causes relationship problems and in some cases can lead to children being taken into care (albeit rare). The effects are multi generational and severe, more so because of stigma making it difficult to discuss. There's little help for relatives who are just left to cope and worry - and perhaps to become ill themselves.
gwyn higginson cognitive behavioural pschotherapis
Why have we to choose between the two. I have a project looking at an innovative model of early detection of the early presymptomatic stage of dementia (vascular cognitive impairment/mild cognitive impairment by picking up on mental health alerters using a cognitve behavioural theraPY FRAMEWORK which uses the work of professor Paul gilberts work on shame and self attacking and development of a compassionate mind framework. This uses a process model to assess anxiety/depression and identify emotional distress in response to experiece of thinking difficulties---not memory loss we are about to commission the service which sits in primary care mental health but at the beginning of the dementia pathway.Interestingly the project crosses age boundaries in mental health services age 50 plus-addresses the darzi review principles looking at prevention of vascular dementia and alzheimers disease looking at vascular risk management which liks to physical health pathways for vascular risks.We have developed innovate CBt approachers to dealing with the emotional distress in response to thinking difficulties-not necessarily memory problems in the stage and introduced a new concept of 'vaSCULAR ANXIEtY re ---so why choose we need both working together--why choose ??????? are not both linked.,why is this not seen.-because we are all in boxes!!Publication re theory and model and new service delivery.
bridget stap, chichester
Having lived in France for 27 years and been back here for two, I am quite simply appalled at the fact that people go into hospital, fall ill with superbugs and end up worse than when they were admitted!! Money in great quantities is not needed, but "clean" rules are! Nurses' and doctors' uniforms should stay on site and be washed by the hospital laundry. Just take a clean size 14 or whatever from the linen store every day - doesn't matter if it's "yours" if it's clean. ALL staff should wear "crocs" as although they are ugly, they can be scrubbed and again it doesn't matter if they're "yours" as long as they fit, if they're clean. All staff should wear masks so as not to spread MRSA, if they believe it's carried in nostrils. It should not be "inevitable" that longstay patients get Cdiff (I quote a nurse who said this to my friend about her father!) All visitors should wear disposable shoe covers, and masks if necessary. I did not touch my mother once during a two-week stay recently and I took in clean linen every day. If staff don't wash their hands after using a toilet, there's no hope so that means wearing throwaway gloves - 20 patients seen means 20 pairs of gloves. Why are wards not wet-cleaned with disinfectant in the water? Cleaning means washing, not dry-mopping. It doesn't matter whether or not the rules would inconvenience staff - they should be applied without quibbling over trivialities. So you have to be at work 10 minutes earlier to change? Live with it as it may mean others might stay alive too.
Jayne
I was unable to hear the whole of the debate as I was listening whilst travelling to work at an NHS Hospital but it seems to me that whenever debates like this are set up no real choice is allowed. I would prefer to see more money per se going to Mental Health Services. This could be released by restricting the costly government led initiatives that have been over recent years responding only to a small but vocal percentage of our Society. As one of your contributers pointed out the Governments priorities are not necessarily the same as those of the wider public.
Jennifer Madden, Cheltenham
Having to make a decision between one human condition and source of suffering and another, and basing that decision on funding, seems to be putting the cart before the horse. Depression is not an illness that can be 'cured', it is a state of mind - both personal and collective - which left unattended can cause immense suffering: physical, emotional, social, spiritual. Sometimes there has to be crisis before we will turn within and look at ourselves and find the answers we search for. Our 'horse' - in Greek mythology named Pegasus, holds all the power and creativity we need for the journey but we have neglected him. He needs feeding and nurturing or we keep on delving into 'daddy's' wallet hoping that funding will get us out of trouble.
Lees, Sheffield
A huge push to fund dementia would benefit mental health as they are linked The main problem already is resourcing.& shortage of trained staff available every day of the year! eg weekends, holidays & winter illness At some point in life ALL THE POP. fears dementia. It attacks people when most vunerable eg,age,income, general health, bereaved etc. One fears it because of the unremittng drip/steady loss of all one values. How does one know when to seek advice, who to ask & whether the advice will be in one's best interests. eg My father age 66 had &died from bowel cancer, my husband died after a very short illness this Feb from an undected cancer, probably pancreatic. Now my requests for a scan are met with excuses re.unwarranted expense. For peace of mind and early detection it seems justified. Indeed I believe scans, & dementia tests for all 55+, & then every 3yrs, would be hugely beneficial to the individual & the state & be fianacially efficient as money would be better spent on real provisions needed instead of GP's guessing as to why people are presenting certain symptons, - as happens with both cancer & dementia! _ Consider all the waste in time & money guessing engenders, as well as grinding down the patient & carer, adding to the stress & potential health deterioration of all concerned. Scans & tests would overcome dependence on the limited knowledge of GP's!
Peter Whitestone, Biddenden, Kent
Thank you for the interesting discussion about dementia and depression and the personal, social and financial advantages of their treatment on the NHS.Surely the reasons of gain in quality of life and savings in expenditure on care and compensation apply also to mental conditions such as autism, and the NHS should therefore include their relevant research and treatment as positively within its remit.
Emma Rowell- Owen
I am a 2nd yr CBT Ba Hons student who cannot get a clinical placement with NHS.(They are unwilling to offer training places to universities who do not have a financial agreement with them). So it would appear that despite the govt accepting Lord Layards recommendations they are delaying acting on them.This means that in a year a number of CBT grauates will be available for employment but have never had the experience of working in the NHS. Who, we are told are desperate for well trained therapists.This will result in delaying delivery of mental health servies longer than is necessary and keep people on long waiting lists. This is a shame because the +ve outcomes for Talking Therapies reported in the research and referenced by Lord Layard in your programme will not come about about. I fear delivery for both Dementia and Mental Wellbeing will be talked up but never really appear as in Maternity services.
David Bowker Manchester UK
It was a mistake to pose one proposal against another - both are to some degree funded now and should continue to be. The economist's argument for cognitive behaviour therapy was I believe flawed in that the large core number of unemployed have multiple problems connected with personality, circumstances and ablities, and CBT is unlikely to motivate more than a minority of these. Other individuals will have either self limiting or milder conditions susceptible to medication (which is cheaper) and will only be away from work for short periods. While training is important the personality, experience and intelligence of the therapist are more crucial. It also takes a number of years before therapists will have learned enough from their errors to be useful and effective.I feel that QUALYS have been a pernicious development (the economists again!) - the question of treatment and the quality of lifes should always be an issue for the clinician and the individual patient (and family), and not for central bureaucrats. It is a pity that NICE mixes both effectiveness and economics when it would have been better(for patients) to stick with the former. One can have little faith in politicians as the mental health services have been starved of funds for many years despite being a so-called priority area, and as recently pointed out in-patient wards for the more severely ill can be intolerable and untherapeutic. CBT for milder conditions will have no effect on this problem.
Surely the debate should be to determine the level of free NHS treatment in all areas and for all conditions.Everyone anywhere in England should know what will be provided free and what will not and it should be the same all over the country.Both of these conditions are worthy of being 'above the line' and therefore treated free at the point of need. Some conditions currently funded by the NHS at enormous cost may fall 'below' the line and would therefore free up funding if removed from the 'free' list.The list should be decided by public debate and with full publicity so we all accept the result
Anon Scotland
Mental Wellbeing in young people needs special mention. These youngsters are evolving into adulthood and get a poor, illdefined service nationwide. NICE cannot just say that age does not matter. These adolescents despair and die for the lack of good psychological treatments, and they are often the ones who are caring and sensitive, and if handled well, would give back to society which would include care of those with Dementia.
Flopsy, London
I am a young physically disabled woman.My priority would be for funding for CURES over funding for treatment.People of a working age should be treated before retired people.NHS doctors are often concerned with empire building. A body of sick people often forms a power base and NHS doctors abuse this.Take all decion making out of the hands of doctors. Let the debate rest with patients
Barry Anderson Milton Keynes
Top up Funding for Charities is a solution to NHS costs.I was a trustee of the local branch of the Westminster Pastoral Foundation. This is a long established national organisation for for couselling and accredited training in Counselling. Clients were often referred by GP's and we asked clients to pay according to their means. In 2002 this was mostly around £10/hr but upto £35. Our break even rate was about £12/hr. By the nature of the work many people could not pay this and since we could not be selective we had to close.£5000/annum would have allowed us to continue and £15000/year would have allowed us to expand.We had applied for Learning and Skills funding but the amount of top up was so small that in all honesty it was impractical for them to help. Their money should have been available through a local source but their rules restricted money to start up and capital items not for running costs. Local Authority money was targeted at the young and families and although many of our clients would have been in this category a number would not.We finally applied to the local Primary Care Trust but they claimed they covered all the needs for counselling. This was patently untrue (we had a contract with the local hospital for counseling their staff). We involved a local MP who could not believe what she was hearing but to no avail so we closed. To be fair I believe Primary Care Trusts in other parts of the country do give top up funding. I think I heard on your programme NHS costs of £75/hr(in 2008) for a particular treatment which I suspect is typical for counselling costs and I am sure we could have been cheaper and we gave a bonus of training at the same time. I realise this raises the issue of, if the NHS cannot supply a service free should they be able to subsidise a service which asks clients to pay something.
I have worked with people with dementia for 14 years, six of them as a Nurse Consultant in a large General Hospital. The knock on effect of poor staff training about dementia,along with inadequate assessment & diagnosis made far too late, currently means that both professional and family carers fail to reach their full skill potential. Other patients suffer consequences of their own 'diluted' care and the person with dementia loses their remaining skills far more quickly than they should, thus accelerating them into more complex and costly institutional care.For a family carer, this combination has a devastating impact, reducing their ability to work, maintain their own optimal physical & mental health, and manage their finances This is a vicious cycle, that further exhausts people, services and funding. More creative and wide reaching staff training, higher levels of public information, earlier and more informed diagnosis are a matter of urgency. There are too few knowledgeable people,trying to do far, far too much in a service that is so valued that the greatest proportion of staff working with this group of people (nursing assistants and home carers)are paid the same as(or in some cases even less )than Supermarket check-out staff and with less training. Many people are forced to pay for this level of service by selling their homes.In a democratic and allegedly 'civilised' society this is nothing short of scandalous. Dementia should be the priority, otherwise the incidence of depression, anxiety and ill-health, amongst many of those family and professional carers who have to deal with the consequences of failing to do so will continue to rise.
Dr Richard Turner
This is an important set of programmes - Could they be added to the list of programmes which can be "listened to again" ? - the website says "listen again no longer available"
Saira Ahmad, Walsall
I would rather spend money on training and employing therapists than lining the pockets of the pharmaceutical companies if ,as I understand it, both therapies are equaly effective.I hope Gerry Robinson and Alyson Pollock have the ear of the Government - they seem to be the only analysts I have heard who seem to understand the economics of the NHS, Darzi, Warner, and all recent ministers haven't a clue.
Dr C A Trotter Old Age psychiatrist Portsmouth
I listened to this mornings debate on depression and dementia. You invited audience participation by e mail or texting. This is totally age discriminatory as most older people do not have computers or mobile phones.
Mrs C.Maitland .Norwich .Norfolk
My husband and I are in our 60's pay over £100 a month in health insurance for such things as hip replacements which we may never need .We can ill afford this therefore why cant we pay a reasonable amount to the NHS instead of paying for this private insurance when we may never need to use it.
Mike Cain
All mental health problems have long been neglected, with NHS patients receiving the minimum care that 'should' keep them quiet. Dementia has risen because it is affecting many middle class families. Its sad that it has come to this, but the vocal community seem to be well placed to voice their views (in many areas). We dont understand how the brain works. Its an important organ, but we seem to spend little on investigating and researching how it works. Being cynical (with reason) we seem to spend a lot with the drug companies and nothing on non drug research. Private industry will not spend as there is no return, and our political masters dont want to be seen as 'wasting' money. But money spent in mental health is an investment
Sue of Surrey
April before last Patricia Hewitt announced all PCTs had an obligation to provide computerised CBT (cCBT). Prof. Kevin Gournay (from Behaviour therapy governing body) was commissioned to look into free cCBT already available on the internet which was favourable.NICE costed computerised CBT AGAINST talking therapy (wrongly) and came up with a solution where they spent millions on renewable license fees to a software company for ‘FearFighter’ and ‘Beating the blues’.What happened to that plan? What happened to all the money?CBT is only one therapy – many feel like sticking plaster over deeper issues.When they say not enough therapists, they MEAN not enough CBT therapists.
As a qualified nurse and midwife I have seen the effect of poor decision making and wastage in the NHS at first hand. I also have Bi-Polar disorder and have been made very ill by over prescribing and lack of any other support. I an now off medication, against advice and studying for a BSc full time. The period I have spent off work through ill health and the poor treatment I recieved have cost the country an enormous amount of money. I could have been earning and contributing to the econemy and earned towards care fore others.
Miss W Louise Warren
As a general comment, there should be more money spent on prevention rather than cure. In other words, let preventative methods be used earlier for example dementia drugs should be issued sooner rather than later to ensure that people have a better quality of life.
Maria
You cannot make one or other a priority. But, what you can do is have good quality programmes that would reduced the crisis costs of each, and that would in itself reduce costs on both sides.
I have been under the NHS Mental Health services on and off from the age of 17. I have been on various types of anti-depressent drugs and recieved talking therapies. 5 years when I was 28 I attempted suicide and since been on incapacity benefit. I have seen my local services deminish totally. Had to wait 2 years for a psychologist when she suddenly left she wasn't replaced I had no option but to pay privatly for CBT which was of huge benefit. At £75 per hour I could only aford a limited amount of sessions. Having benefitted from the sessions I wish I could aford to continue with it.The impact and frustration for me and my husband is huge. Mental well being is underestermated in NHS bugets. What measure can be applied to being emotionally free to live.
Yan
I am a single father of a 14 year old boy and have been suffering with depression and anxiety for over 5 years. My doctor has stated that I am unfit for work, the doctor who examined me on behalf of the benefits agency proclaimed that because I could bend over and touch my toes, do a couple of squats, I was fit for work. The result of this is that I have been on highly reduced benefits (£108 per week inclusive of CTC and CB) I am wondering how much pressure these new councilors will be but under by the government to declare people fit for work when in actual fact they are not, in order to get even more clearly unwell people off the IB books?
Lizzie Worcestershire
I am a CBT therapist in a prison. Many of the men I treat committed their crime when depressed. In male working class culture dpression is the sign of a 'nutter', so at best they seek help for a headache. More education is needed about depression and simple ways of overcoming it.
derek kennington plymouth
the treatments being discussed are funded by the health service whilst the projected savings often benefit another area of government-for example the benefits system. Is there any possibility of treatment designed in part to get people back to work being funded by the benefits agency, or some of the benefit savings being transferred to the health budget from the benefits budget?
Bridget Herbert, Twickenham
Depression and anxiety have increased ten fold since the end of the second world war - and are increasing ever more as we lose the structure of extended families and community. We work longer hours, we are under more financial pressure, under pressure to perform, to have, and to succeed. On top of that, many people have turned away from religious and spiritual beliefs that might provide a greater framework in which to explore 'meaning' in life.All this adds up to more mental/emotional disturbance in people, but no infrastructure to deal with it - apart from medication dispensed by the GP. The number of people takeing SSRIs is ever increasing. Eventually, this lack of mental/emotional wellbeing becomes a contributory factor in physical diseases -starting with 'stress-relasted' problems like IBS, Chrohns, High Blood Pressure, High Cholesterol, Heart Disease, eating disorders. Furthermore, more serious diseases such as cancer will also have an emotional/mental element to them. Research shows people living happy and healthy lives will live longer and suffer fewer physical problems.Hence mental/emotional wellbeing should be of prime and paramount importance -and more emphasis should be placed on this, right from the beginning. In the long run, the NHS would save money by tackling mental/emotional problems.
Biddy Tarrant. West Yorkshire
Dementia must represent some of the worst fears for those over 55. It brings a frightening emotional isolation at a time when life may be presenting diminishing financial and physical competence. I would support moves to ensure that the growing number of 'baby boomers' do not have to live their final days with insecurity and with less dignity than they deserve.
Ian Keith
What about the more cost effective adoption of computer assisted CBT as reccommended by NICE.
Amy, Colchester
Depression & Anxiety problems come first. So many people suffer. It affects this country's attitude and happiness. Also it can lead to other illnesses and problems which the NHS have to spend money on; e.g. paranoid people & hypercondriacs go from doctor to doctor. I had more money spent on me because I was taking antidepressants which masked back pain, I was not moving much and slouching etc because I was depressed - I ended up needing a back operation which cost the NHS £1,000s. Depressed and anxious people don't look after themselves and develop problems which the NHS need to pay money for.
Paul, Harrow
As someone that has been suffering from anxiety related depression for 4 years and has given up all hope of the NHS Providing a talking therapy. The question is wrong. Talking therapies should be supplied by the NHS just to save money on Benefit payments. If the Health Dept. will not fund it, Work and pensions should. Its a no brainer, but does not override the importance of diagnosing and treating dementia, which is a more complex and challenging problem.
Chris Culshaw from Lancaster
The real cost of mental health may often be borne by the children of the sufferer. How do you explain depression to a small child? She/he can understand how a broken leg will mend and mum/dad will be back to normal soon. But a 'broken' head? Tens of thousands of young people are affected by the mental ill health of those they love. Many become carers. What price this support?
James Fisher, Norwich
How do these valuable comments about quality of life in mental health outcomes marry up with Dinesh Bhugra's (president of Royal College of Psychiatrists) comments in the Guardian yesterday about the poor state of inpatient mental health services. How are qaly's exalted here, where as inpatients this measure seems to have been lost.
Douglas Arnold
Please? Give me the NHS I will sack the lot of them. The system is rotten to the core and needs a good manager
Andy, Liverpool
It seems to me that because people with mental health issues tend to remove themselves from society. Its the perfect illness to brush under the carpet in terms of funding and treatment. I'm suffering from depression and cannot seem to find any help unless I try to top myself. The irony is my depression stems from helping a friend who did kill herself and after lots mental health treatment.
Alistair Edwards, York
When the NHS was established, there was a n assumption that a lot of money would have to be spent initially but then the whole nation would become healthy. Then the NHS could just 'tick over'. Of course, this was wrong because as cures are found for one illness, we just die from something else. There will NEVER be enough money. This is because of our mortality - and our unwillingness to face it. As cancer becomes more curable (for instance), I think we will live longer - and then die of Alzheimers.The only viable reaction is (as is being discussed on the programme) to concentrate not on quantity of life - but quality.
Kathleen O'Neill, Hampshire
What is the correlation between lack of intellectual stimulation and dementia? From what I have seen, the NHS is providing support to a sector of the non working elderly and I must reiterate I am not saying it is all the elderly, who are preoccupied with their ailments. Perhaps CBT and funding for courses/exercises etc. may relieve the NHS of this burden.
Linda from Kent
I have had bi-polar for about 30 yrs and in that time I have had about 3 'lots of 12' psvchotherapy/counselling. Until the last year when I was offered Art Therapy. It has been the best year and most progressive time in my life. I have been on the list for CBT for more years than I can remeber
Louise
I think there needs to be a look at the way money is spent on mental health services. My husband is in the system, but I do not think he is being helped effectively and that treatment other than drugs should be considered. I think that at least 6 months has been wasted in pointless weekly visits to the hospital where they just kept changing his medication but didn't really talk to him. It is a nightmare of how to find out what is available and what to do for the best. There is also little advise how I can help him. I am sure that with better help he could now be considering how to renter society and doing some kind of work. (I wish to remain anonymous)
David Hughes Lisburn Northern Ireland
I run support groups for people with depression and the economic argument, the return to work argument sounds rather thin. What these people want is to have their very real pain reduced, the pain which leads so many of them to suicide. Yes work helps restore self esteem, but work of course is also what so many people have found a significant factor in the onset of their depression.
Jason, London
As a sufferer of an anxiety disorder I would advocate more funding for Mental wellbeing. I had a severe panic / anxiety attack at work in February and have been on medication since as well as being referred for CBT. I have been told that I will need to wait another 2-3 months before my theraphy can begin, all the while I have to try and deal day to day with the effects of the fear and panic associated with my anxiety. Most days I am able to go to work and function albeit in a constant state of anxiety, however some days I just feel overwhelmed by my condition and can end up having panic attacks randomly. On days like these I find it hard to cope and function
Sue of Surrey
We do not need to train any more therapists. There are thousands of fully qualified therapists in private practise (often because formal employment in the field is not available). Why not harness them? And probably hundreds of fully qualified therapists, like myself, out of work. Before we train more therapists, where are all the jobs for currently qualified therapists?
catherine
I want the NHS to fund dementia. Our family has been devastated by the disease. It is affecting my father in a very serious form. I meet many people with dementia and families of people with the ilness. If the illness increases I think it will have a devastating effect on our elderly population and health services. Better to invest now, before the numbers of patients increases.
Dr Pauline Brimblecombe Cambridge
As a GP both these areas are essential to fund appropriately. But by more careful use of acute services, money can be diverted into community/social care.
David, Lisburn Northern Ireland
The impact of these two conditions is equally devastating on families and friends. And there is no nobility in being a carere for people with depression as there is for people caring for people with dementia.
Gaynor
The counselling service I and my son received for depression after caring and the death of my husband enabled both of us to stay in work. I believe that without it we may have had real breakdowns and may still be unable to work.
Jill London
Is one of the problems that dementia is a generic term to cover many conditions?
Both! My mother suffered from dementia. My daughter is overweight, diabetic, has depression, a gambling addiction and has twice attempted suicide. We have been told the waiting list for CBT where she lives is 12 months. We are being forced to go down the private route. The NHS needs fewer admin chiefs and more indians.
Brian , Liskeard Cornwall
No one ever died of being infertile. Why are my taxes being wasted on IVF on the NHS?