A national survey of health service infrastructure and policy impacts on access to computerised CBT in Scotland

Abstract

BackgroundNICE recommends computerised cognitive behavioural therapy (cCBT) for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS) in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS.MethodsA telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT.ResultsOverall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult.ConclusionsConclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.

Online Cognitive Behavioral Therapy for Bulimic Type Disorders, Delivered in the Community by a Nonclinician: Qualitative Study

“…The implementation of cCBT will also aid the achievement of the NHS targets as it allows the treatment of high numbers of patients with minimal therapeutic input. However, the results of a recent survey of Scottish NHS boards indicated that NHS policy and infrastructure may not be fully in place to support to implementation of cCBT in many areas [17]. Overall, most of the health boards possess the required software to use cCBT programs.…”

A Survey of Attitudes towards Computerized Self-Help for Eating Disorders within a Community-Based Sample

“…This is not unexpected for this sample of people recruited online. However, our recent national surveys of access to online resources via the NHS in Scotland (Kenicer, McClay and Williams, 2012) and England (Andrewes, Kenicer, McClay and Williams, 2013) has identified a lack of provision for those who do not have their own access to computers at home. In effect this means that those who are unemployed or older may have limited opportunity to access such resources.…”

A national survey of the infrastructure and IT policies required to deliver computerised cognitive behavioural therapy in the English NHS

“…However, IT policies were more likely to be restrictive in Scotland with English trusts being more than twice as likely to provide patients with computer and internet access, and significantly more likely to allow patients access to cCBT sites on their computers. 18 No other studies to date have audited the accessibility of cCBT within NHS trusts. A limitation of this study includes the knowledge of the IT representatives completing the survey.…”

“…17 Despite this, a recent national survey of the provision of cCBT within Scottish National Health Service (NHS) mental health boards highlighted that patient accessibility to cCBT within the NHS is restricted by local Information Technology (IT) policies, software and equipment availability. 18 That survey found that 64% of health boards do not provide dedicated computers for patient use, and 36% do not permit members of staff to offer email contact or support to patients. This means that email support sessions (a valuable component of the guided self-help approach) cannot be delivered.…”

“…22 With the rise of the IAPT 16 programme across England, the present study aims to ascertain the extent to which IT infrastructure and local IT policy across English mental health trusts support the delivery of cCBT for mental health problems. This study utilises the same survey methodology as the previous Scottish study 18 and also allows a comparison of progress to achieve wider delivery in both countries.…”