NICE, the National Institute for Health and Care Excellence, has come up with another set of guidelines on mental health. Why is this important? Because if NICE recommend a treatment, it gets used as a matter of course, and if they don’t, it doesn’t.
The problem is that Mental Health is very hard to assess. Very hard indeed. And NICE are not doing a good job at assessing the different methods of delivering talking therapy..
In the area of health generally, the standard of proof that NICE requires is the “double blind randomised trial.” In brief, this is where neither the patient nor the doctor knows whether the patient is being treated, and neither do they know what they might be treating the patient with. This is good, because it stops the doctor from putting his own bias onto whatever results s/he is collecting.
Of course, this kind of research is quite impossible to carry out in the field of mental health. How can a counsellor not know whether or not he is counselling a client, for instance? Success in counselling depends on the relationship between counsellor and client, and that means often (shudder from NICE) the results come from asking the clients’ opinions. Good lord, how would the NHS function if effectiveness and quality was measured by the patients. Mmmmmmmmmmmmmmmm.
So NICE is going to prefer the type of therapy that can generate statistics closest to the double blind model. By it’s nature, CBT is easier than others to collect that kind of data. NICE, therefore, seemed to have been of the opinion that CBT was the only talking therapy that is proven to work, as that was the only type to have generated the statistics they considered reliable..
Gradually, NICE has been dragged kicking and screaming to the realisation that other methods of talking therapy, and indeed other methods of undertaking valid research, might just work as well in the treatment of, say, depression. However CBT has maintained it’s place as the first line treatment, the one most recommended, in the current guidelines.
At last we can get to the point: the research clearly shows that other talking therapies are at least as effective as CBT. It’s just that NICE are wary of looking at research that doesn’t have that humanity-excluding double blind methodology. And recent research shows that counselling delivered better results than CBT in fewer sessions. Add to this the huge number of trained counsellors who don’t want to work to a CBT model, myself included, and you could cure the massive problem with access to mental health services overnight. It would be cheaper too, per course of treatment.
Incidentally, the photo is of Nice, France. It has nothing to do with this article at all, but looks like it would be a nice place to recover from almost anything. Anyone who wishes to pay for me to undertake the research personally, get in touch.