Multiple Access Points and Levels of Entry (Maple): Ensuring Choice, Accessibility and Equity for CBT Services

Abstract

Mental health problems contribute 23% to the global burden of disease in developed countries (WHO, 1999). In the U.K., recent legislation attempts to address this by modernizing mental health services so that they provide evidence based, accessible and non-discriminatory services for both serious and common mental health problems. Cognitive behaviour therapy (CBT) has a robust evidence base that fits very well with the thrust of policy. However, CBT's delivery systems are rooted in traditional service models, which pay little attention to the growing evidence base for brief and single-strand treatments over complex or multi-strand interventions. Services characterized by 9-5 working, hourly appointments and face-to-face therapy disenfranchise the majority of people who would benefit from CBT. In this paper we argue that the evidence exists for service protocols that promote equity, accessibility and choice and that CBT services should be organized around multiple levels of entry and service delivery rather than the more usual secondary care referral systems.

Managing common mental health disorders in primary care: conceptual models and evidence base

“…Equally, both collaborative care and replacement/referral models rely on mental health specialists (fig 2), which means that limitations in the workforce may further limit their impact on access and equity goals. The current interest in self help and stepped care is one way of achieving the effectiveness of the replacement/referral model without limiting access,17 and similar interest exists in the use of non-mental health staff (such as practice nurses) as case managers in collaborative care models. However, the degree to which these improvements in access are achievable without loss of effectiveness is unclear.…”

Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial

“…Recent mental health policy in the United Kingdom demands more accessible and effective treatments. Thus, alternative models of delivery have been proposed that aim to reduce contact with therapists and make services more accessible 4. Innovations such as computerised cognitive behaviour therapy and facilitated self help still often require patients to attend scheduled clinic appointments.…”

Combining imagination and reason in the treatment of depression: A randomized controlled trial of internet-based cognitive-bias modification and internet-CBT for depression.

“…These cognitive biases are a central target of cognitive behavioral therapy (CBT), which is recommended as a first-line treatment for depression (National Institute for Health and Clinical Excellence, 2009). Yet, due to several factors, including the necessity of specialized training of clinicians, long wait lists to access services, and financial barriers, few patients receive CBT (Lovell & Richards, 2000). This has led to increasing calls for the development of novel, accessible, and cost-effective treatments for depression (Simon & Ludman, 2009).…”