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A nurse-led Cognitive Behavioural Therapy service for local authority employees

David Hitt, Cognitive Behaviour Therapy Nurse Therapist, Cardiff and Vale University Health Board

David's case study was completed in October 2015 and reflects 2015 prices

In 2008-09, 11.4 million working days were lost in Britain due to work-related stress, depression or anxiety. Cognitive Behavioural Therapy (CBT) intervention is recognised as clinically and cost effective for individuals with anxiety or depression who have been off work for four or more weeks. Despite strong evidence, access to psychological therapies is by no means universal.

The City of Cardiff Council recognised this unmet need in its workforce and partnered with the department of Liaison Psychiatry at Cardiff and Vale University Health Board, to provide psychological services, namely CBT.

This provision enabled the Council's occupational health department to refer employees who presented with anxiety or depression for a psychological assessment with the aim of promoting an earlier return to work.

David Hitt, cognitive behaviour therapy nurse therapist at Cardiff and Vale University Health Board, carried out an economic assessment of the new CBT provision.

Within the timeline of the economic assessment, 51 people had completed a course of CBT. The average course of CBT was 12 sessions, with each session lasting approximately one hour.

For every pound spent by the City of Cardiff Council, the total benefit was £2.47. Even allowing for the potential for natural recovery of 22% of patients in this case, the return on investment for every pound spent resulted in a £1.92 return.

David recommended incorporating these methods into the training of nurses and other front line staff to empower them to work with commissioners to avoid waste and release much needed cash within the health care system.

You can email David at

Case study
One page summary