Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions

Abstract

BackgroundIn the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities.MethodsNarrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care.ResultsThe narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a) community engagement (b) addressing the quality of interactions in primary care and (c) the development and delivery of tailored psychosocial interventions.ConclusionsThe model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model.

A pilot randomised controlled trial of cognitive behavioural therapy for antenatal depression

“…These issues could have implications for the cost-effectiveness, as providing CBT at home reduces the capacity of the therapist. However, there is growing evidence from other studies that telephone based and internet CBT is more accessible, as acceptable and effective as face to face CBT [52-54], therefore the mode of delivery needs to be considered to ensure generalisabilty without compromising effectiveness.…”

Community Engagement in a complex intervention to improve access to primary mental health care for hard‐to‐reach groups

“…Applied in the context of access for vulnerable groups, ‘candidacy’ (Box ) describes a person's readiness to identify their problems, or those of others, as legitimate reasons for health care or treatment. The lack of perceptions of a right, or need for care by patients, family members, or clinicians was identified as an important personal, social and cultural barrier to access …”

“…However, many groups with high levels of mental distress are disadvantaged because care is not available to them in the right place and time, or when they access it, their interaction with caregivers deters help seeking or diverts it into forms that do not address their needs. Drawing on a systematic reviews, secondary analysis of existing data sets and a conceptual review, we developed a complex intervention to improve access to mental health in primary care comprising three inter‐related components: community engagement (CE), promoting well‐being (comprising offer of a psychosocial therapeutic intervention) and improving quality of primary care provision.…”

Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care

“…A marked difference between groups included meeting the language needs of some minority patients, however deep rooted communication issues such as differential mental health models [21], perceived candidacy for treatment [22] and recursivity in cultural expectations of treatment [23] exist in both groups [8]. …”