When some British doctors see a patient with mild to moderate depression or anxiety, they pull out their pads and prescribe a self-help book.
Under a new program in the United Kingdom, patients take the prescription to their local library, where they check out reserved titles such as "Overcoming Depression" and "The Feeling Good Handbook."
Doctors say they began prescribing books out of concern that too many depressed people were either being medicated too hastily with antidepressant drugs or going untreated. They also saw it as a cost-saving strategy.
The state-run health care system here could not afford one-to-one counseling for everyone -- waiting lists can run up to 18 months -- leaving medication or no treatment the remaining options.
The programs, called bibliotherapy or "guided self-help," were endorsed by Britain's National Institute for Clinical Excellence in December. The agency warned of overuse of antidepressants in patients with mild depression and recommended that doctors try guided self-help or other kinds of counseling before medication.
Bibliotherapy raises some concerns. Some patients fail to check out or read the books. And, in a few cases, severely depressed people have been directed to the self-help program when more serious treatment was needed, counselors say.
"Until recently, the only thing available to a physician was to write a prescription for a drug. What this does is give the physician two prescribing pads," says Neil Frude, a Cardiff University psychologist who started the self-help-book trend by setting up a program in Wales three years ago.
Bibliotherapy, he adds, also frees up busy counselors to deal with more seriously depressed or mentally ill patients.
In Britain, the National Health Service covers medicines and doctor visits, free of charge. Bibliotherapy has been used to treat thousands of patients so far and could, within a few years, reach up to a quarter of a million patients nationwide, Frude estimates.
Most cases of depression and anxiety are diagnosed at a general physician's office, where the average visit lasts just seven minutes. In nearly 100 physicians' offices in Devon, a county in southwest England, doctors now send mildly to moderately depressed patients down the hall to a mental-health worker, who tries to determine the core problem. Then the mental-health worker prescribes a self-help book and meets four more times with the patient to discuss the book and its exercises and ensure that the treatment is working.
Sami al-Haboubi, a 23-year-old mental-health worker in Devon, lets patients talk about what is troubling them and asks a list of 14 questions that help score the person's level of depression or anxiety. One woman says she came to see al-Haboubi recently for panic attacks brought on by a stressful work environment. The attacks would leave her hyperventilating and feeling she could not cope with anything.
"The doctor told me I could go to counseling, but there would be a wait, or that Sami could help me quickly," she said in a phone interview in which she asked to remain anonymous. Al-Haboubi prescribed "Overcoming Anxiety" by Helen Kennerley. Some of the book's suggestions -- including breathing and muscle-relaxation exercises -- helped calm some of the woman's panic symptoms, she says.
Al-Haboubi is not a fully trained counselor -- Devon's mental-health workers have undergraduate degrees in psychology or a related field and take a one-year training course to administer bibliotherapy. Al-Haboubi keeps a stack of self-help books and his laptop in his car, traveling among three doctors' offices to meet patients. Many of the books are from the "Overcoming" series published by London-based Constable & Robinson Ltd., including "Overcoming Panic" and "Overcoming Childhood Trauma."
Libraries are stocking up on the prescribed books, and some patients are also buying them. Constable & Robinson says worldwide sales of its most popular "Overcoming" books will grow 20 percent to 25 percent this year thanks to bibliotherapy, with most of those sales coming from Britain. Frude says other publishers are also vying to get on the lists of approved books, which doctors in each region generally compile.