Mental health services have been characterised as the ‘Cinderella service’ of the NHS. Although it is true that compared with some of the high technology and advanced drug research conducted in other areas of medicine – including HIV – mental health has lagged behind, this is as much to do with the nature of mental illness as it is to tack of resources. The social nature of much mental distress means that there will never be a perfect pharmacological or surgical intervention to ‘cure’ or treat it. Mental health is as much a matter of learning to live as productively and successfully in society as one can it is of correcting some inner imbalance in the brain. This especially applies to the neurotic conditions like depression, anxiety and adjustment problems that form the vast majority of mental illness.

Because of this as well as NHS services a whole profession – counselling and psychotherapy – has emerged over the last century. While some therapists work within the NHS, others can only be seen privately or offer some of their time to voluntary organisations. This inevitably and unfortunately means that social inequality is built into mental health services: those that can pay for it tend to get the best help.

However, while there are not as many resources as there used to be in the provision of counselling and support within HIV organisations, it is still possible for people with HIV to get dedicated counselling or psychotherapy – usually of a time-limited nature – for free or at subsidised cost.

Emphasising counselling or psychotherapy does not imply that pharmacological interventions are not of value. In the case of people with severe problems like schizophrenia or bipolar illness they may be absolutely necessary for the person to live a life with any degree of quality. Even with more common conditions, the impact of severe depression or acute anxiety is often so intense – and intensely physical – that drug treatment is often necessary to help the person get into a state where they can think and respond clearly enough to benefit from psychotherapy.

However antidepressants and other drugs, though they may offer symptom relief, do not in themselves help the person resolve personal crises or address deep-seated life patterns that may have caused the mental distress in the first place. A number of studies (see, for instance, de Jonghe) have found that antidepressant treatments work better if combined with psychotherapy than they do alone, and cognitive therapy (see below) may have particular value in preventing the recurrence of depression (see, for instance, Bockting).

When it comes to anxiety, several studies (e.g. Antoni) have not only shown that cognitive psychotherapy helps to reduce anxiety symptoms but also improves the immune function of people with anxiety.