Evidence-based psychological treatments for mental disorders: Modifiable barriers to access and possible solutions

Abstract

The prevalence of mental disorders is high and appears to be growing, yet the majority of individuals who meet diagnostic criteria for a mental disorder are not able to access an adequate treatment. While evidence-based psychological treatments (EBPTs) are effective single or adjunctive treatments for mental disorders, there is also evidence that access to these treatments is diminishing. We seek to highlight modifiable barriers to these problems at the patient, therapist, treatment, organization and government-levels of analysis. A range of solutions to each set of contributors is offered and domains for future research are highlighted. In particular, we focus on the need to continue to work toward innovation in treatment development while also solving the difficulties relating to the dissemination of EBPTs. Several relatively new concepts in the field will be discussed (implementation cliff, program drift, voltage drop and deployment treatment development) and we contrast America and England as examples of government-level processes that are in the process of major change with respect to EBPTs. We conclude that there is a need for people in our field to become more knowledgeable about, and get involved in, shaping public policy.

Addressing critical gaps in the treatment of eating disorders

“…Based on service use data from two representative surveys of the US general population in 1998 ( N = 22,953) and 2007 ( N = 29,370), spending on psychotherapy declined by more than a third, from $12.74 billion in 1998 to $8.35 billion in 2007 (for ease of interpretation, these amounts are in current dollars, as of 2016); in contrast, the use of patients receiving psychotropic medication only increased from 44.1% to 57.4% (Olfson & Marcus, ). Importantly, it is not known the extent to which the treatments delivered were EBPIs but tempting to speculate that it might be a small proportion (Harvey & Gumport, ). Also there is the issue that the programs training the major providers of psychotherapy (i.e., psychiatrists, psychologists, social workers) are generally not providing competency‐based instruction in EBPIs; although programs may provide exposure to EBPIs, few programs require the acquisition of competence through both a didactic and clinical supervision (Sudak & Goldberg, ; Weissman et al, ).…”

“…The past decades have seen the development and evaluation of empirically‐supported psychological therapies in rigorous, randomized controlled efficacy studies (Nathan & Gorman, ). There is substantial evidence that patients are not receiving these treatments in routine clinical care (Beidas & Kendall, ; Harvey & Gumport, ). Even when patients do receive these treatments, they are often not competently delivered (Shafran et al, ).…”

Literasi Kesehatan Mental dan Sikap Komunitas sebagai Prediktor Pencarian Pertolongan Formal

“…Berdasarkan kajian literatur yang telah dilakukan faktor-faktor yang memengaruhi pencarian pertolongan sangat beragam, berbeda dalam tiap konteks dan juga cukup meluas. Kedua variabel prediktor yang diuji dalam penelitian ini hanya sebagian kecil dari faktor-faktor lainnya, salah satunya hambatan eksternal yang sering terjadi di lapangan yaitu faktor geografis, akses transportasi, dan faktor ekonomi (Harvey & Gumport, 2015), serta kemampuan identifikasi tenaga kesehatan terkait kesehatan mental (Marastuti, 2014).…”

Developing a roadmap for the translation of e-mental health services for depression

“…However, only one in three Australians with a mental health problem seeks help from a health professional (Burgess et al, 2009). In addition, mental disorders are under-diagnosed (Goldman et al, 1999;Kessler et al, 2002;Mann et al, 2005), and use of evidence-based treatments is inadequate (Burgess et al, 2009;Goldman et al, 1999;Gyani et al, 2012;Harvey and Gumport, 2015). Meanwhile, the costs of providing mental health services are increasing, as evidenced through expenditure rising from AUD3.4 billion to AUD4.2 billion between 2006and 2010(Australian Institute of Health and Welfare, 2012.…”