The Arts Council-funded project to promote self-help books for mental health conditions was widely reported in the media last week. In true Daily Mail style, their coverage was accompanied by an image of a bikini-clad woman, apparently reading one of the ‘books on prescription’ whilst sitting on an idyllic beach with her toes resting in the gently lapping water – not exactly the experience of most patients in the throes of an episode of depression! The inappropriate visuals notwithstanding, the scheme was generally well reported, and there is much to be said in its favour – including formal backing from the RCGP. The challenge will be to make it really work to the benefit of patients, and to avoid any risk that it will be used as an excuse to cut an existing service.
From May 2013 libraries will be stocked with a list of 30 self help books on a range of topics from depression and anxiety to obsessive compulsive disorder, along with a sister list of ‘mood-boosting’ novels and non-fiction titles. GPs are to be encouraged to issue a ‘Reading Prescription’ to patients suffering from mild-moderate mental health problems who will then receive library membership as well as access to the full reading list. At first glance it seems odd to use the term prescription – these books will be freely available to anyone who cares to visit the library after all – but perhaps there is sufficient power in the doctor-patient relationship that a recommendation from your GP could carry significant weight. I have a small handful of self-help books which I encourage my patients to dip into, and I am always encouraged by how frequently they take up the suggestion and the positive results that follow.
There is certainly evidence in favour of the role of self-help books in the management of depression in primary care, including a recently published randomised controlled trial. What this trial and my own experience with self-help books have in common, however, is guided support. In the trial this consisted of 3-4 face-to-face appointments totalling 2 hours of contact, while my own practice would involve a small number of typical 10 minute GP appointments – either way, the self-help books were not used in isolation. What seems especially important in my own practice is to be able to recommend a book which I have read personally – that way I can choose the right book for the right patient, and explain exactly why I think it will suit them. It is the importance of this personal touch that left me concerned by one quote, from the Daily Telegraph, which reported Debbie Hicks, director of research at the Reading Agency as saying: ‘All 30 books could also be picked up by library members who wanted to avoid the perceived “stigma” of visiting their GP for mental health issues.’
If the scheme is to succeed, then GPs will need to have faith in the books we are prescribing. That the list has been carefully compiled and has Royal College approval is certainly a good start, and will bring confidence that these titles are a cut above the many thousands of mediocre self-help books out there, but something more needs to be done to really breathe life into the project. At the very least GPs should be sent more information about the books on offer – a brief summary and a personalised review so that we can see beyond the book title. There is plenty of time until we are due to kick off in May, so perhaps someone, somewhere is already penning these helpful hints – let’s hope so.
One thing is certain – the options available to patients with mental health problems who present to their GP are too limited. As Pulse reported recently, waiting times for talking therapies are often too long to be a viable treatment, and medications are sometimes all that is left to fill the void. We should welcome any new alternatives that can bring benefit to patients – and, just maybe, people will be more prepared to see their GP if they think they might be given a book rather than a pill.