The pursuit of Happiness

Exactly five years ago, at 10 Downing Street a group of politicians and academics came together to discuss how to improve the well-being of the British people.

Professor (Lord) Richard Layard had written a paper for the meeting: in it he noted how NHS funding in mental health had been reduced for less severe but still disabling conditions, and that many of the two million people who were receiving medication from non-specialists, in consultations of just ten minutes (still standard in general practice today), were keen to try psychotherapy.

Previously, in his 2004 book Happiness Professor Layard had suggested that UK income tax should increase to the levels of other West European countries, because higher taxes increase happiness, by discouraging people from working too hard. The French, at least, seem to have disagreed by voting for Nicolas “work harder and earn more” Sarkozy as their President in 2007.

Following the Downing Street seminar, new funding over 2009 – 2011 means that more people will be able to receive NHS cognitive behavioural therapy (CBT). But at least two questions remain. Firstly, the referring GP’s consultation will still probably be only ten minutes, so will the newly-trained CBT therapists adequately assess the patient’s diagnosis? As Professor Layard himself noted “…it is estimated that GPs misdiagnose mental illness at the first GP visit on a third of occasions”.

Second, is CBT really as evidence-based as claimed (1) ? Parts of the Layard group’s glossy The Depression Report: A New Deal for Depression and Anxiety Disorders sound rather similar to the “sales talk from drug companies” (2) which the Professor noted in his seminar paper. CBT is “new…forward-looking” rather than “backward-looking”, “short” as opposed to “endless”. There are “Hundreds of clinical trials” mentioned, without making it clear that this includes therapies other than CBT; or that only recently have psychotherapy trials begun to be registered in advance, so we cannot be sure how many negative trials up to 2006 remain unpublished.

In private, many clinical psychologists agree that CBT has been hyped. I must get round to asking them what they think about higher taxes as therapy.



(1) As I said in my talk at the April 2009 ADDISS conference, I would generally encourage anyone who is offered CBT on the NHS, to try it. I will look at why people with developmental conditions might do less well, or even be harmed, by “standard” CBT in a future posting.

(2) In fact, I doubt that any 2005/6 pharmaceutical marketing material would have been so “hard sell”.

The documents referred to can be found on the London School of Economics website.

This post was published at on 22nd January 2010, and transferred to on 7th October

About Dr Neil MacFarlane MRCPsych

Independent Psychiatrist providing culturally informed mental health opinion, advice, and a few new facts. Based near London, UK. Main qualifications: BA MBBS MA MRCPsych.

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