In the first of a series of articles about the National Institute for Health and Care Excellence (NICE) consultation on its Depression Guidance, Dr Andrew Reeves highlights BACP's broad concerns with the proposed recommendations.
It was with trepidation that I initially read through NICE’s latest draft guidance when it emerged on Tuesday. Like many in the profession, we had expected to see counselling and psychodynamic psychotherapy removed from the guidance as viable interventions, due to the inflexibility of NICE’s evidence model. BACP was therefore delighted to see that our robust engagement with NICE over the past two years has paid off with both interventions being retained as recommended treatments for adults with depression.
This is an important endorsement and will be viewed by many across the profession as a step in the right direction. It also chimes very much with public opinion. A BACP commissioned independent survey of adults showed that 98% who gave an opinion agreed that counselling should be available through the NHS for adults suffering from depression.
Whilst BACP is pleased with this result, we remain concerned about the longstanding emphasis on cognitive behaviour therapy (CBT) as the main recommended intervention. We believe this does not reflect the evidence and also the experience of patients and our practitioners in the field. The most recent reported annual datasets from IAPT – data from patients treated in the NHS - show marginally better outcome rates for counselling than for CBT and were delivered in fewer sessions. IAPT data also shows that patients receive fewer sessions of counselling compared to CBT.
One of the big challenges that has led to the prioritisation of CBT is NICE’s approach to evidence gathering and hierarchy. This privileges the use of randomised control trials (RCTs) despite the existence of probably the largest collection of outcome data on adults with depression in the world - IAPT. We believe that it is inconceivable that such data, collected at the public’s expense, should not influence the guidance that impacts on that service’s delivery.
A further concern is that there is a fundamental problem in comparing the effectiveness of counselling with other interventions. Counselling is an umbrella term for a range of talking therapies and therefore any analysis that is based on comparing the term counselling with sub-types of counselling is unhelpful at best and at worst flawed.
The consultation on the NICE guideline on depression in adults will run from 18 July until 12 September. As well as working on a joint response with our key partners - the British Psychoanalytic Council and United Kingdom Council for Psychotherapy - BACP will be submitting a robust response to the consultation. We have been heartened by the support of our members, so many of whom have written very personal reflections on what these proposed changes mean for them and their clients. We are hugely fortunate to have such active and engaged members at BACP and will of course reflect these views in the response we submit.