LONDON — England is in the midst of a unique national experiment, the world’s most ambitious effort to treat depression, anxiety and other common mental illnesses.
The rapidly growing initiative, which has gotten little publicity outside the country, offers virtually open-ended talk therapy free of charge at clinics throughout the country: in remote farming villages, industrial suburbs, isolated immigrant communities and high-end enclaves. The goal is to eventually create a system of primary care for mental health not just for England but for all of Britain.
At a time when many nations are debating large-scale reforms to mental health care, researchers and policy makers are looking hard at England’s experience, sizing up both its popularity and its limitations. Mental health care systems vary widely across the Western world, but none have gone nearly so far to provide open-ended access to talk therapies backed by hard evidence. Experts say the English program is the first broad real-world test of treatments that have been studied mostly in carefully controlled lab conditions.
The demand in the first several years has been so strong it has strained the program’s resources. According to the latest figures, the program now screens nearly a million people a year, and the number of adults in England who have recently received some mental health treatment has jumped to one in three from one in four and is expected to continue to grow. Mental health professionals also say the program has gone a long way to shrink the stigma of psychotherapy in a nation culturally steeped in stoicism.
“You now actually hear young people say, ‘I might go and get some therapy for this,’” said Dr. Tim Kendall, the clinical director for mental health for the National Health Service. “You’d never, ever hear people in this country say that out in public before.”
A recent widely shared video of three popular royals — Prince William, Prince Harry and Kate, Dutchess of Cambridge — discussing the importance of mental health care and the princes’ struggles after their mother’s death is another sign of the country’s growing openness about treatment.
The enormous amount of data collected through the program has shown the importance of a quick response after a person’s initial call and of a triage-like screening system in deciding a course of treatment. It will potentially help researchers and policy makers around the world to determine which reforms can work — and which most likely will not.
“It’s not just that they’re enhancing access to care, but that they’re being accountable for the care that’s delivered,” said Karen Cohen, chief executive of the Canadian Psychological Association, which has been advocating a similar system in Canada. “That is what makes the effort so innovative and extraordinary.”
Oliver is the just the type of person the program’s two creators had in mind when they first proposed that the government fund it, a decade ago.
At 30, he was scrambling to manage a job and a young family — and unraveling fast. After nights out with friends, he would wake up the next morning with a visceral sense that he had done something awful.
“I knew I’d done nothing wrong, I knew it, but I would start to think, ‘O.K., I better check to make sure — that, like, I hadn’t hit somebody, or something,’” said Oliver, now 32 and a graphic designer outside London, who asked that his last name be omitted to protect his privacy. By the spring of 2015, after the birth of Oliver’s second child, the anxiety had so infiltrated his life that he had trouble leaving the house. “I was broken,” he said.
In 2005 David Clark, a professor of psychology at Oxford University, and the economist Richard Layard, a member of the House of Lords, concluded that providing therapy to people like Oliver made economic sense.
“We made the case that, just on lost work alone, the program would pay for itself,” Dr. Layard said in an interview in his office at the London School of Economics.
Dr. Clark, in his university office, said: “If someone has a broken leg, he or she immediately gets treatment. If the person has a broken soul, they usually do not.”
The program began three years later, in 2008, with $40 million from Gordon Brown’s Labour government. It set up 35 clinics covering about a fifth of England and trained 1,000 working therapists, social workers, graduates in psychology and others. The program has continued to expand through three governments, both ideologically left and right leaning, with a current budget of about $500 million that is expected to double over the coming few years.
Under the old system, Oliver might have gotten a drug and, possibly, some general psychological guidance and support. But he had never sought mental health treatment before, and he most likely would have gone years before getting any talk therapy because he had no idea it was available. The area where he lives had scores of practicing therapists but no centralized system for ensuring that people got scientifically backed approaches tailored to their specific problem.
Oliver learned from his doctor about Healthy Minds, the program’s local center, and he immediately called. He got a call back the next day.
The promptness of that initial reply appears to be crucially important, data collected by the program suggest. If patients don’t hear back in the first few days, many of them can be lost for good because the courage it took to make the call can dissipate fast.
Andrew Prinsloo, 43, a graphic designer living in Feltham who had anxieties similar to Oliver’s, said he got a call back minutes after sending an email to Healthy Minds in late 2015. “I was having these terrible thoughts about what I might do and, honestly, I was very reluctant to talk to anyone because I thought they’d lock me up,” he said in an interview.
This first call is more than…