Digital depression, anxiety therapies backed for NHS use

Gadiel Lazcano

NICE has followed through on plans to make a series of digital therapeutics (DTx) for adults with anxiety disorders or depression in England, although it acknowledges more data is needed on their effectiveness and cost-effectiveness.

The nine cognitive behavioural therapy (CBT) based DTx – delivered either through a website or app – could help improve access to treatment at a time when the NHS is struggling with long waiting times, exacerbated by staff shortages, with some patients waiting for weeks or months to see a therapist.

NICE’s final guidance covers six therapies for anxiety and three for depression, and comes after the cost-effectiveness watchdog also backed digital CBT for children with anxiety. More than 500,000 people are referred to talking therapists for anxiety and depression every year, according to NHS England data.

Evidence on the performance of the DTx will be gathered over the next few years, to gauge how well they are working in routine practice. Not all have been given regulatory approval yet.

The draft guidance was published today in the midst of Mental Health Awareness Week, when patient organisation MIND reported the results of a poll that found almost half (48%) of people in England and Wales report their mental health being negatively affected by the financial impact of the cost-of-living crisis.

NICE said that expanding access to digital therapies will help people “to access help in a way that may be more suited to their personal needs by offering flexibility around both time and location of treatment.”

It will also “free up clinical resources that could be used elsewhere in services to increase access or reduce waiting times,” as the depression therapies typically require on average 90 minutes of time with a therapist, compared to around eight hours with standard care. For anxiety, they can be delivered with four hours of practitioner time, versus 10 hours currently.

“How many more people will be able to be seen overall will depend on how many people opt for digitally enabled therapies,” said NICE.

The decision was welcomed by Miranda Wolpert, director of mental health at Wellcome, who predicted that digital therapies will become an increasingly important and potentially scalable way to reach people with mental health problems around the world.

“We will always have to find the right balance between putting them through the right level of scrutiny, but also making them available for people without too many barriers in place,” she said. “It is exciting to see these recommended digital interventions from NICE that could help people who experience anxiety and depression as early as possible, potentially transforming lives.”

Prof Tony Kendrick, professor of primary care at the University of Southampton, noted that there are varying degrees of evidence for the effectiveness of the apps, which is acknowledged by NICE.

“The point is well made that further evidence of effectiveness and cost-effectiveness needs to be gathered, and the relevant metrics for evaluation are listed,” he said. “We also need more evidence, however, on the possible risk of widening inequality of access to treatments.”

Prof Kendrick is concerned that “people who are less Internet savvy will miss out, although, if therapies become more available as a result of the wider adoption of digital therapies, then it may help everyone.”

Mental health charity Sane told the BBC that it was concerned that the digital approaches would not be an effective substitute for face-to-face talking therapies, and could leave patients feeling more isolated, but agreed they could be useful for some.

Photo by Gadiel Lazcano on Unsplash