BACP broadly welcomes the draft guidance for consultation published today by the National Institute for Health and Care Excellence (NICE).
The recommendations on Depression in adults: recognition and management will be seen by the counselling professions as a step in the right direction.
BACP has been engaging with NICE, providing a wide range of contributions and evidence to support the case for counselling as a treatment for depression in adults.
The guideline recommends the delivery of a range of psychological interventions, including: cognitive behaviour therapy (CBT), behavioural activation, interpersonal therapy, counselling, short-term psychodynamic therapy and behavioural couple’s therapy, within a structured stepped care protocol. However, CBT retains its place as the first line treatment offered.
Counselling and CBT lead to equivalent patient outcomes
Research collated by BACP indicates that counselling delivers comparable patient outcomes to CBT. The most recent reported annual datasets from the NHS’s Improving Access to Psychological Therapies programme (IAPT) - outcomes from patients treated in the NHS - show marginally better outcome rates for counselling than for CBT and were delivered in fewer sessions.
Dr Andrew Reeves, Chair of BACP, recently met with NICE Chair David Haslam and senior colleagues. Andrew said: "We welcome the draft guidance for consultation published today by NICE, this is broadly in line with our views, and we are pleased that NICE supports the case for counselling as a treatment for depression in adults.
Additionally, we strongly support the new specification that interventions for people with depression ought to be provided in a framework, including an assessment of need, the development of a treatment plan, and routine outcome monitoring and follow up".
Dr Reeves also commented that: “Traditionally NICE’s approach to what constitutes evidence, privileges evidence from randomised control trials (RCTs) and does not include routine outcome data about how patients respond to therapy in everyday health care services. Now that NICE is recommending this type of data be collected, BACP strongly encourages NICE to make use of what is probably the largest collection of outcome data on adults with depression in the world, through IAPT, to help inform its guidelines.
BACP believes that the clinical utility of NICE guidelines, for patients, therapists and commissioners, would be enhanced if NICE were to use both evidence from RCTs and from routine outcome data. Both have strengths and weaknesses. BACP is calling on NICE to consider IAPT data as it develops its guidelines. There is a need for both evidence-based practice and practice-based evidence.
However, because it is not derived from a RCT design, this ‘practice-based’ data is not currently considered in NICE guideline developments. For BACP, this over-reliance on RCTs by NICE fails to use important feedback systems from patients and their NHS services. It is inconceivable that such data, collected at the public’s expense, should not influence the guidance that impacts on that service’s delivery.
Public strongly supports counselling
Last month, BACP commissioned Populus to conduct an independent survey of 2,000 adults in Great Britain and Northern Ireland into public attitudes towards counselling and its availability on the NHS for treating depression. The survey showed beyond any doubt that the public want and expect counselling to be available on the NHS.
When asked, 98% of those who expressed a preference agreed that counselling should be available through the NHS for adults who are suffering from depression, while 86% of those who expressed an opinion said that they expect the NHS to offer counselling to those who suffer with depression.
The consultation in response to the document runs from 18 July to 12 September 2017, with an expected publication date of 24 January 2018.
Notes to editors
To find out more about the NICE consultation and BACP’s plans please contact firstname.lastname@example.org or ring 01455 206393.
Spokespersons are available for broadcast media.