Therapy can slash soaring mental health costs

By GLYNIS HORNING Time of article published Nov 10, 2014

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Mental health illness affects one in three South Africans at huge personal and financial cost – but cognitive behaviour-al therapy (CBT) could slash that, according to experts.

Discovery paid out 40 percent more for mental illness in 2012 than five years earlier, and the medical aid industry as a whole paid out five times more, said Dr Maurice Goodman, the medical scheme’s head of health professional strategy.

He was speaking at a South African Depression and Anxiety Group/Discovery Mental Health Summit in Cape Town recently.

“CBT is an effective evolving treatment with a sound empirical foundation,” said leading CBT specialist Professor Stefan Hofmann, a psychology professor at Boston University’s clinical programme in the US, and president of the International Association for Cognitive Psychotherapy.

“Mental illness is the biggest health problem in rich countries,” he said. “CBT is deceivingly simple, yet highly cost effective – it saves taxpayers an enormous amount of money.”

Because of this, the UK was currently on “a big CBT rollout” – 3 600 new CBT therapists had been trained and the aim was to train 8 000, plus nurses.

The overall cost-saving was estimated at £700 million (about R12.4 billion). CBT rollouts were also under way in European countries such as Germany, and in Australia.

Hofmann said CBT was based on a truism expressed by Greek Stoic philosopher Epictetus: “Men are not moved by things, but the view they take of them”, and developed in the 1960s by psychiatrists Aaron T Beck and the late Joseph Wolpe.

“Wolpe was a South African, so it’s shocking that CBT is not the first line of intervention in this country.”

Unlike psychoanalysis, CBT was not concerned with patients’ past experiences, he explained. “It works in the here and now, training people to use coping skills to deal with problems.”

It centred on showing how habitual thinking patterns caused problems by colouring views, causing anxiety or anger. Rather than go into what formed those patterns, it taught one to examine views objectively, so one felt and coped better.

“CBT is short-term, requiring just 16 sessions of less than an hour each,” Hofmann said. “You can overcome problems of decades in just three months.”

It had been the subject of numerous meta-analyses – 269 since 2000 alone – and consistently outperformed, or was as good as, pharmacological and other treatments for anything from OCD and phobias to depression. “But some pharma (drugs) can speed up learning in CBT,” he said.

Professor Crick Lund, director of the Centre for Public Mental Health and associate professor in Psychiatry and Mental Health at UCT, reiterated the “growing evidence of the social and economic benefits” of CBT and its importance in South Africa, where “one in six people can be diagnosed with depression, anxiety and substance-use disorders during a year”.

There was a strong association between poverty and common mental disorders, he said, with poverty feeding into the disorders and the disorders feeding into poverty.

Psychological and educational help were needed to help break the cycle.

The SA depression and anxiety group, Sadag, reports that in the World Health Organisation World Mental Health Survey 2012, South Africa was listed among the bottom four countries providing mental health treatment.

For help with depression or other mental health problems, call Sadag at 0800 21 22 23, SMS 31393.

* Horning is a freelance writer and winner of the 2014 Pfizer Mental Health Journalism Award for Print: Magazines.

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