The case for change for British mental healthcare

Stanton, Emma

doi:10.1177/0141076814522144

Cited by 6 publications

(3 citation statements)

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“…As noted by NICE, 34 costing thresholds for the treatment of personality disorders have yet to be identified and broad consensus has been repeatedly noted for a change in how we measure and pay for mental healthcare in the NHS – especially when it comes to treating chronic mental health problems. 35 The high rates of comorbid personality disorder (79%) in the RefraMED trial suggest that cost considerations for our trial – and other similar trials in chronic depression – may be best understood when evaluated similarly.…”

Section: Discussionmentioning

confidence: 94%

Refractory depression – cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial

Shearer

Lynch

Chamba³

et al. 2019

BJPsych open

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BackgroundRefractory depression is a major contributor to the economic burden of depression. Radically open dialectical behaviour therapy (RO DBT) is an unevaluated new treatment targeting overcontrolled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money.AimsTo estimate the cost-effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in people with refractory depression (trial registration: ISRCTN85784627).MethodWe undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness by comparing the net cost of RO DBT with the net gain in quality-adjusted life-years (QALYs), estimated using the EQ-5D-3L measure of health-related quality of life.ResultsThe additional cost of RO DBT plus TAU compared with TAU alone was £7048 and was associated with a difference of 0.032 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of £220 250 per QALY. This ICER was well above the National Institute for Health and Care Excellence (NICE) upper threshold of £30 000 per QALY. A cost-effectiveness acceptability curve indicated that RO DBT had a zero probability of being cost-effective compared with TAU at the NICE £30 000 threshold.ConclusionsIn its current resource-intensive form, RO DBT is not a cost-effective use of resources in the UK NHS.Declaration of interestR.H. is co-owner and director of Radically Open Ltd, the RO DBT training and dissemination company. D.K. reports grants outside the submitted work from the National Institute for Health Research (NIHR). T.L. receives royalties from New Harbinger Publishing for sales of RO DBT treatment manuals, speaking fees from Radically Open Ltd, and a grant outside the submitted work from the Medical Research Council. He was co-director of Radically Open Ltd between November 2014 and May 2015 and is married to Erica Smith-Lynch, the principal shareholder and one of two directors of Radically Open Ltd. H.O'M. reports personal fees outside the submitted work from the Charlie Waller Institute and Improving Access to Psychological Therapy. S.R. provides RO DBT supervision through her company S C Rushbrook Ltd. I.R. reports grants outside the submitted work from NIHR and Health & Care Research Wales. M. Stanton reports personal fees outside the submitted work from British Isles DBT Training, Stanton Psychological Services Ltd and Taylor & Francis. M. Swales reports personal fees outside the submitted work from British Isles DBT Training, Guilford Press, Oxford University Press and Taylor & Francis. B.W. was co-director of Radically Open Ltd between November 2014 and February 2015.

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Section: Discussionmentioning

confidence: 94%

Refractory depression – cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial

Shearer

Lynch

Chamba³

et al. 2019

BJPsych open

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“…Third, regulatory involvement can help reduce the well-documented accessibility gaps and barriers to evidence-based behavioural and mental health treatments that leave large segments of the population without care (Muñoz, 2019). The predominant model of psychological treatment delivery, which hinges on access to specialty health care providers (in-person or virtually), simply does not scale, highlighting one of the biggest challenges in health care systems today (Comer & Barlow, 2014;Gratzer et al, 2020;Stanton, 2014). The inadequate reach of evidence-based health care already disproportionately affects marginalized groups, including ethnic and racial minorities, as well as lower income and/or geographically remote individuals, families, and communities (Jones et al, 2016;Nelson & Bui, 2010).…”

Section: Practitioner Pointsmentioning

confidence: 99%

Regulating digital therapeutics for mental health: Opportunities, challenges, and the essential role of psychologists

Carl

Jones

Lindhiem

et al. 2021

British J Clinic Psychol

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With so many promising digital therapeutics for anxiety and obsessive-compulsive (OC) spectrum problems, there is an urgent need to consider how evolving regulatory oversight of digital therapeutics is poised to shift how these tools are developed, evaluated, reimbursed, and delivered. In this commentary, we discuss both opportunities and potential pitfalls associated with emerging government regulations of digital therapeutics for mental health, and we consider how applying the traditional 'prescription-based' medical approval paradigm to digital therapeutics for mental health could ultimately undermine and limit the broad accessibility of these software-based innovations that have been explicitly designed to expand the accessibility of care. For example, the vast majority of behavioural and mental health providers do not have 'prescription privileges' (a term originally rooted in pharmacologic practices), and as a result, under current regulations in the U.S. would not be authorized to make FDA-cleared digital therapeutics available to their patients. This is particularly concerning given that most digital therapeutics for mental health are directly rooted in psychological and behavioural science, yet psychologists would not be authorized to incorporate these innovations into their practice. We consider how synchronizing regulatory standards across countries may prove useful, and we conclude by arguing that multidisciplinary teams making regulatory decisions concerning digital therapeutics for mental health must include representation from the discipline and practice of psychology.

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“…Even before COVID-19, responding to mental health need was not straightforward in the UK, with increasing demand, worsening outcomes, and complex care networks and access points across primary, secondary and tertiary settings [10] , [12] . In the healthcare system considered in this study, there are six recognised ‘levels’ at which mental health care may be accessed ( Fig.…”

Section: Introductionmentioning

confidence: 99%