NICE-recommended digital therapies for depression and anxiety could free up thousands of NHS therapist hours
NHS Talking Therapies for anxiety and depression services saw record referrals in 2023/24.
Demand for NHS Talking Therapies has reached an all-time high. The service received 1.82 million referrals in 2023/24. This is slightly higher than 2021/2022, and more than double the 884,000 received in 2012/13.
As more people come forward for help, the NHS is looking to use NICE-recommended digital therapies to help increase the support available.
Figure 1: Record number of referrals to NHS Talking Therapies
Referrals received, by financial year.
Source: NHS England. The 2023/24 figure might slightly increase once final data is published.
NHS Talking Therapies offer NICE-recommended psychological therapies for adults with common mental health conditions such as depression, stress, social anxiety, phobias or post-traumatic stress disorder (PTSD). Some programmes extend their support to young people aged 16 and 17.
“COVID had a big impact,” said Sarah Watts, Clinical Lead for Staffordshire and Stoke-on-Trent NHS Talking Therapies. “The good thing is that more people are coming forward. People are recognising that they need therapy and support, and they are asking for it.”
We recommend 7 digitally enabled therapies to treat depression and anxiety disorders in adults. The technologies can be used in NHS Talking Therapies while more evidence is generated on their clinical and cost-effectiveness.
Evidence from current practice provided by NHS England and analysed by us indicates that digital therapies recommended for PTSD could save over 5,000 hours of therapist time per 1,000 people. Almost 2,500 therapist hours per 1,000 people could be saved for social anxiety disorders, and 600 for depression.
Figure 2: Estimated therapist time that could be saved by NICE-recommended digital therapies for social anxiety, PTSD, and depression
The actual number of hours saved will depend on the proportion of patients who opt to use digital therapies.
These technologies can be accessed online or through apps and include materials based on cognitive behavioural therapy (CBT). They must be used with support from a trained practitioner or therapist, who monitors progress, risks, and outcomes. Some of these therapies are already in use in the NHS.
Ms Rebecca Morley, specialist committee member and team manager at NHS North Yorkshire Talking Therapies said: “We consider digital inequalities in terms of accessibility. Clinicians can offer technological support to help patients either enter digitally enabled therapies or maintain them, depending on their needs.”
“A digital therapy is an additional tool in the toolbox that will be appropriate for some people,” said Ms Watts. “Patient choice is absolutely key.”
Improving access to mental health care is a top priority for the NHS. The pandemic led to rising pressures, with more people than ever before now in contact with mental health services. NICE-recommended digital therapies can increase the support available to people where appropriate, alongside therapists, and help NHS staff to provide care in a flexible and timely manner.
The future of digital mental health
NICE also recommends 4 digital technologies that can help children and young people with feelings of anxiety or low mood, and another 4 technologies for people with psychosis: 3 digital therapies to help manage symptoms or prevent relapse in adults, and a virtual reality (VR) technology to treat severe agoraphobia in those over 16. They are Early Value Assessments and can be used while more data is being collected on their clinical and cost-effectiveness.
“Digital mental health over the next decade will embrace new technologies including artificial intelligence, wearables, and extended reality,” said Professor Chris Hollis, specialist committee member and Chair of Child and Adolescent Psychiatry and Digital Mental Health at the University of Nottingham. “There will be a greater shift to prevention and early intervention.”
Dr Maria Loades, specialist committee member and Clinical Psychologist at the University of Bath noted: “We need to be open-minded to these innovations. We need to ensure that choice and flexibility remain in the system, and that human support is available where it is needed and in a timely manner.”
Mental health services are facing record demand, and these digitally enabled therapies can help the NHS get support to more people faster.
Our rapid assessments show they have promise and the additional evidence collected during this period will help us make sure that they are clinically effective and represent good value for money for the taxpayer. This guidance underscores NICE’s commitment to focusing on what matters most to people and the health and care system.
Notes:
There was not sufficient data available to calculate savings for generalised anxiety or body dysmorphic disorder.
All technologies will need Digital Technology Assessment Criteria (DTAC) approval before they can be adopted by the NHS. They will also require an NHS Talking Therapies Digitally Enabled Therapy assessment from NHS England, and CE or UKCA mark approval.