Psychological treatment centres

Editor—Layard proposes establishing 250 psychological treatment centres for cognitive behavioural therapy in the United Kingdom.¹ His cost-benefit analysis is based on one new therapist treating 80 patients a year.

One patient would receive 16 sessions of treatment. One therapist would deliver 80 lots of 16 sessions a year (each session being 50 minutes of treatment and 10 minutes of documentation), or 1280 hours a year. Assuming this therapist works effectively 40 weeks a year at 38 hours a week (1520 therapist hours), he or she in an average week would spend 32 hours seeing patients and documenting sessions but only 6 hours in supervision, team meetings, training, corporate induction, focus groups, appraisals, primary care liaison meetings, drinking tea, chatting with colleagues. This would be laudable but seems unrealistic. In most NHS settings clinicians spend considerably less than half of their time on clinical work.

Moreover, the cost-benefit calculation is presumably based on patients who complete treatment. Real world settings (unlike research trials) are unlikely to achieve dropout rates of less than 40%—a maximum of 50 patients for each therapist a year completing cognitive behavioural therapy under the above (over)optimistic conditions.

A more organic, more diverse, and less centralistic growth in psychological treatment is required in the NHS.