Why we must stand up for depression
Like many mental health conditions, depression suffers from a stereotype. If schizophrenia is characterised by an inappropriate association with violence, depression can tend to be trivialised as something which is within an individual’s control to “pull themselves together” from – more of an issue of attitude than a real illness.
As Robin Williams’ experience and many powerful testimonies from people who have lived with depression show all so clearly, nothing can be further from the truth. To be stuck in the depth of depression is a truly awful place to be, a place which can lead someone to consider that taking their own life is preferable to continuing to live through what they are experiencing. Whether in touch with mental health services, or more likely not, people with depression will account for a large proportion of the more than 4000 people who take their own life in this country each year.
Even if not as extreme as that, depression can be a profoundly debilitating condition which significantly impacts on an individual’s quality of life, their ability to hold down a job, their ability to make and retain relationships and family life. From a societal perspective, depression is one of the largest causes of health related unemployment as well as impacting on the productivity of those who are able to stay in work.
Furthermore there is a strong link between depression and long term physical health conditions and where there is co-morbid depression it is likely that outcomes for individuals will be much poorer. So for instance, people living with diabetes are 2-3 times more likely to have depression than the general population and patients with chronic heart failure are 8 times more likely to die in 30 months if they have depression. All in all, poor mental health in this population is estimated to cost the NHS at least £8 billion every year.
Like many conditions, however, depression presents itself on a spectrum. For some people depression can be a self-limiting condition, the symptoms of which they are able to manage without medical intervention. For others medication, CBT or other short forms of talking therapies can provide effective relief of symptoms. However for a significant group of people symptoms are severe, long term and deeply disabling.
The Government has taken some action to address the individual and societal impact of depression and the introduction of the Improving Access to Psychological Therapies (IAPT) Programme in 2007 has made an important start to improve access to talking therapies for those affected. Those such as Lord Richard Layard and others who have campaigned and cajoled Governments of all hues to invest in this programme deserve much credit.
It would however to have been criminal not to accept this case and there is much more to do. 70% of people with depression do not have access to treatment – just try repeating that sentence with cancer rather than depression in the sentence. For those who do get access to treatment, waiting times can still be too long – it was very saddening to read, last week, the account of a father whose son with depression took his own life while on waiting to access the IAPT service.
Furthermore the options for people with depression are still too limited. Cognitive Behavioural Therapy (CBT) is a good intervention which offers benefits for many patients. However it does not work everybody and it is still very difficult for people, especially with more chronic and intractable problems, to seek a wider range of longer term therapies. There is the option to use the new right of choice in mental health introduced this April to address this but it is still hard to see how this would work in practice and how funding would flow to support patient preference
So this is yet another illustration of the scale of the challenge which faces Governments and the NHS if we are to deliver to worthy intention to create a parity of esteem between physical and mental health. Given the numbers affected (it is estimated that 8-12% of the population will experience some form of depression in any given year) and the impact the condition has both on those individuals and our society and economy more generally this is a challenge which cannot be ignored.
Picture thanks to Emma Scutt – @emmylouscutt