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Abstract
This article considers the potential of a self-management programme for primary care treatment of patients with chronic disease and co-exisiting mental health problems such as depression and anxiety. The authors conclude that a growing body of evidence suggests that such a resource should be high on the list of referral options for GPs and other health professionals.
Keywords
Primary care, chronic disease, depression, anxiety, Expert Patients Programme
At any given time, around one in six people in the UK will be experiencing a mental health problem, typically depression and/or anxiety (Singleton et al 2001). Further, patients with chronic physical heath conditions such as arthritis or multiple sclerosis experience higher rates of these common mental health problems because of fatigue, functional limitations, pain and uncertainty about further deterioration. Nearly a third of GP consultations are related to mental health problems (Jenkins et al 2002). Medication for mental health problems costs over £600 million a year including £401 million for antidepressants (Department of Health, 2005). The National Institute for Clinical Excellence (NICE) guidelines (2004a; 2004b) for treating the most common episodes of mental health problems (for example, mild anxiety and depression) recommend that patients should not be prescribed medication 'because the risk-benefit ratio is poor'. Rather psychological therapies such as self-help/self-management cognitive behavioural therapy (CBT) with an established evidence base should be the first treatment option. However, few patients are routinely offered these therapies due to a shortage of trained therapists. This can be frustrating for GPs and patients alike. Sixty per cent of GPs would prescribe anti-depressants less frequently if other treatment options were readily available. Some commentators have recently advocated the training of an extra 10,000 clinical CBT therapists to deliver brief therapy (London School of Economics, 2006).
In this article, we will highlight the potential of an existing self-management intervention informed by CBT theories and methods, the Expert Patients Programme (EPP), for treating primary care chronic disease patients with co-existing mild to moderate anxiety and/or depression. The EPP has an established evidence base (Barlow et al 2006; Griffiths et al 2005; Kennedy et al 2007; Lorig et al 1999), is relatively inexpensive (in part because it is delivered by volunteer lay tutors), and could alleviate psychological distress for large numbers of patients....