Get well - read all about it

Mental Health Nursing,  Nov 2005  by Donaghy, Gerard

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Getting stuck into a book may be escapism for some. For the people of Wales however, it can offer a pathway out of depression. Gerard Donaghy looks at a simple but radical approach to encouraging self-help

One of my most vivid memories visiting a GP as a child is the poorly rendered artwork of posters adorning the walls to encourage health promotion.

One in particular showed an irate mother at a GP surgery's reception desk with her son, who had the misfortune of having a vase stuck on his head. Above the picture was the aphorism: 'You don't need a pill for every ill'.

The scenario might be rather less comical, but the thinking behind a novel scheme in Wales is pretty much the same.

Book Prescription Wales promotes an alternative to medication in the treatment of mental health problems, and has already proven extremely successful in a citywide pilot scheme in Cardiff.

And yes, it does exactly what it says on the tin. Patients with mild to moderate psychological problems are prescribed a self-help book using a traditional-type prescription pad, which can be exchanged at their library for the book. Service users don't need to be a member of the library service, while borrowing times are as long as 12 weeks.

The scheme was launched in August at the local library in Dowlais, a disadvantaged area of Merthyr Tydfil, which is around 30 minutes from Cardiff. Once a stable town that was one of the hubs of the iron, steel and coal industries, Dowlais saw a decline in coal industry the 1920s and the closure of Dowlais Steelworks in 1930.

However the Welsh Assembly Government's director of mental health, Phil Chick, believes Merthyr Tydfil is the ideal town for the launch of Book Prescription Wales: 'Merthyr Tydfil has some of the highest rates of depression and anxiety, of common mental health problems, because deprivation is so high here. We think this has got a huge amount to offer an area like this.

'There's a tradition of using libraries in the valleys of South Wales and we hope that this is something that will really enable people to access these books.'

Professor Neil Frude, who developed the idea, found it hard to believe that similar schemes had not yet been implemented: 'We just used the infrastructure that was already there and joined up the dots in a very simple efficient way', said Professor Frude.

This is a form of treatment that is highly effective, that's extremely cost effective, that's preferred by many patients, that's promised in many policy documents, and is deliverable.'

Book Prescription Wales is based on the award-winning Cardiff scheme, which began in 2003. This saw the city's 24 branch libraries stock 35 recommended self-help books, for a total cost of less than £10,000 - the result, according to Professor Frude, of 'a very powerful collaboration between the local authority and the NHS'.

There were more than 3,000 loans in the first year, an impressive number for one city alone. However the founders of the Cardiff scheme feel it was even more effective than this number suggests, as people may have opted to buy a book rather than borrow it.

Mr Chick cites the positive feedback from service users who have been enlightened to a resource that has, in some cases certainly, changed their life.

He said: The messages coming back from the people who have used those materials, are comments like "this book could have been written for me" and they have really been very positive in terms of the outcome.

'I know it's only anecdotal evidence, but it seems that the impact of the books has been quite significant because there has been a low rate of people coming back (to their GP).'

Book Prescription Wales, is not intended to replace medication or one-to-one therapy. There is a place for it, however, in complementing existing treatments, an idea that is endorsed across the whole spectrum of those involved in mental health services, from service users to the health minister, Doctor Brian Gibbons.

Commenting at the launch in Merthyr he said: The management of mental illness is very much a medical model, but that is an inappropriate model.

'In many cases, evidence suggests that psychological approaches, like self-help books, can often be as effective, if not more effective, than drug therapy.'

Similarly, Professor Frude added: 'In the primary care setting, over 90 per cent of the treatment offered is actually pharmacological rather than psychological.

'Everybody recognises that there is a need for psychological therapies at the primary care level. You wouldn't, perhaps, want to give anti-depressants to someone who has a half-evolved depression - but to give them a book, that would be absolutely acceptable.

'Surveys of patient preference have actually shown that many patients would prefer the psychological treatments rather than medication or medication only.'

As well as being preferred by the patient and being incredibly cheap, bibliotherapy, as it is called, has proven to be exceptionally effective.

'Some researchers looked to see what the effects were of somebody having a book while they were on the waiting list (for psychological treatment),' said Professor Frude. 'What they found was that if somebody had one of these books to work with while they were on the waiting list, it reduced the number of sessions of live treatment they needed by 50 per cent.