Therapy for depression can be delivered effectively by non-specialists
Posted on 16 February 2011
The study, led by Durham University’s Mental Health Research Centre, in collaboration with the University of York and Hull York Medical School (HYMS), 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. 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 and the University of York, is published in the British Journal of Psychiatry.
The 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 with the group who received ‘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 to help the person engage in a more rewarding daily structure.
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. His research was conducted as part of his PhD studies at the Department of Health Sciences, University of York.
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.”
Dr Dean McMillan, of the University of York and HYMS, said: “This is a very important study and shows for the first time that mental health nurses can deliver this form of treatment in an effective manner.”
If this type of therapy were to be adopted more widely in the NHS, then the benefits to patients would be enormous.
Professor Simon Gilbody, University of York and HYMS
Professor Simon Gilbody, also of the University of York and HYMS, added: “If this type of therapy were to be adopted more widely in the NHS, then the benefits to patients would be enormous. This is a realistic and cost effective treatment that can be delivered by the existing NHS workforce; even within the current economic climate.”
Professor Christine Godfrey, Head of Department in Health Sciences, said: “This is a first class piece of research from a very able Doctoral student in the Department. We are especially proud to have supported this work and it reflects our commitment to research by healthcare professionals which can improve NHS care.”
Depression is the third most common reason for people visiting their GP, according to the Office of National Statistics. Depression occurs in 1 in 10 adults in Britain at any one time, with 1 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.”
*Source: Mind website
Notes to editors:
The paper Behavioural activation delivered by the non-specialist: phase II randomised controlled trial, Ekers et al, is published in the British Journal of Psychiatry.
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