The runaway giant: ten years of the Better Access program

Rosenberg, Sebastian; Hickie, Ian B.

doi:10.5694/mja2.50068

Cited by 20 publications

(15 citation statements)

References 6 publications

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“…Given its status as the largest social experiment in the psychological therapies and the invaluable data collected, we would encourage improving access to such data so that it can be shared more widely in order to inform policy/decision-making to improve outcomes for clients and to enhance knowledge of the psychological therapies. This would be timely given increasing interest internationally in how to deliver quality, publicly funded primary care mental health services [14] and the arguments that the evidence base for the effectiveness of psychological treatments for mental health within primary care needs to be strengthened [15].…”

Section: Discussionmentioning

confidence: 99%

The 2018 UK NHS Digital annual report on the Improving Access to Psychological Therapies programme: a brief commentary

et al. 2019

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This commentary examines publicly available information on 2017–2018 outcomes in the UK government’s Improving Access to Psychological Therapies (IAPT) programme, a National Health Service (NHS) primary care mental health programme in England. In that year there were 1.4 million referrals into IAPT and over 500,000 people completed a course of treatment. The IAPT database collects routine session-by-session outcome monitoring data for this population, including outcomes for depression and anxiety in a stepped care model which includes a range of psychological therapies, among them Cognitive Behavioural Therapy (CBT) and Person-centred Experiential Therapy, known in the IAPT programme as Counselling for Depression (CfD). In 2017–18, 32% of all referrals were for anxiety and stress disorders, 26% for depression, and 35% were unspecified. The definition of treatment completion is receipt of 2 sessions or more and on this basis 60% of all referrals in 2017–18 did not complete treatment, predominantly because they failed to attend the initial appointment, or ended after only one session. Four years of data on outcomes for CBT and CfD suggests these therapies are broadly comparable in terms of both recovery rate and average number of sessions, though the number of referrals to each therapy varied widely. Data on treatment choice and satisfaction was favourable but there were issues with low return rates and invalid data. Information on outcomes for ethnicity, sexual orientation, disability and religion, as well as a measure of local economic deprivation, indicate lower outcomes for a number of patient groups. Data on employment status outcomes suggest little overall change, including for the category of those on benefits payments. The data published alongside the annual IAPT reports mean there is an increasing amount of information in the public domain about IAPT performance, but it is time consuming to extract and evaluate. This report highlights a number of points of concern which suggest the need for improvement on multiple axes. We suggest that improved researcher access to the huge IAPT dataset can allow for more detailed evaluations of IAPT that can inform policy/decision-making to improve outcomes for clients.

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Section: Discussionmentioning

confidence: 99%

The 2018 UK NHS Digital annual report on the Improving Access to Psychological Therapies programme: a brief commentary

et al. 2019

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“…Increased resources to both mental health and Medicare were overdue and welcome, despite problems and limitations regarding the implementation of the BA Program. 5,6…”

Section: Ten Years Of Rapid Growth In Psychological But Not Psychiatrmentioning

confidence: 99%

W(h)ither psychiatry? Contemporary challenges in Australian mental health workforce design

Rosenberg

Hickie

2020

Australas Psychiatry

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Objective: To consider the changing profile of Australia’s mental health workforce and the implications, particularly for specialist psychiatry services. Method: We analyse data from a national collection that describes changes in the workforce over a decade, to 2017–2018. Results: While single practitioner-based psychological services flourish, other areas of more complex and team-based care are struggling to remain relevant. Psychiatry and mental health nursing, two areas that previously led Australia’s response to complex mental illness, are under enormous pressure. Conclusion: The shifting balance of specialised mental health workforces is affecting the mental healthcare available in each region of Australia. Questions arise regarding the desired or optimal mix of professionals we wish to deploy. What roles should each professional group play and how should they work together? What does this mean for how various groups should be trained and paid? These data challenge the role specialist psychiatry wishes to play in leading reform. Current mental health reforms risk foundering should psychiatrists fail to take up the challenge of leadership.

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“…Major changes in mental health systems had been suggested and were already underway before 2020 with notable examples in Europe [6] , such as the full-scale national reform enacted in Belgium [7] ; and Latin America [8] . They have also been planned in Australia [9] , against a backdrop where available mental health funding (7.6% of the health budget), fails to properly respond to the burden of disease (12%) [10] . The disruption caused by COVID-19 now further spurs the opportunity for mental health reform changes, in the context of a second global financial crisis [11] which is already having a major impact in mental health [12] .…”

Section: Introductionmentioning

confidence: 99%

International experiences of the active period of COVID-19 - Mental health care

Rosenberg

Mendoza

Tabatabaei‐Jafari

et al. 2020

Health Policy and Technology

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Highlights Overall, COVID-19 has had massive impacts on mental health care internationally. Most mental health systems were under-resourced and under-prepared, both to manage existing clients and to manage new clients. There were significant differences between sites, depending on the explosivity of COVID-19 and the readiness of the mental health system. Integrated, community mental health systems exhibited greater adaptability in contrast to services which depended on face-to-face and hospital-based care. There is an urgent requirement to use the lessons of COVID to drive the next wave of mental health reform, which should prioritise local, community and digital solutions.

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The runaway giant: ten years of the Better Access program

Cited by 20 publications

References 6 publications

The 2018 UK NHS Digital annual report on the Improving Access to Psychological Therapies programme: a brief commentary

The 2018 UK NHS Digital annual report on the Improving Access to Psychological Therapies programme: a brief commentary

W(h)ither psychiatry? Contemporary challenges in Australian mental health workforce design

International experiences of the active period of COVID-19 - Mental health care

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