✅ L1 - Mental health interventions and services in the global and UK context Flashcards
What are the stats on how widespread mental health conditions are?
- 1 in 8 live with a mental health condition (13% global prevalence)
- Mental disorders are the 7th leading cause of ‘years lost to disability’ -> depression and anxiety disorders are ranked first
- Anyone can have mental health conditions, but some groups are more vulnerable.
Statistics in gap between mental health and actually receiving support/treatment for it?
- There are gaps between need and treatment in all countries
- Statistics on those who received any treatment:
- In the UK: 35% with moderately severe, 65% of severe cases
- In the previous 12 months (globally) with severe cases:
+ China: 11%
+ Nigeria: 21%
+ USA: 59% - More than 85% of the world’s population live in low- and middle-income countries (LMICs). In the top 10 causes of health-related disabilities in LMICs are: Depression, schizophrenia, bipolar disorder, and alcohol use disorders.
What are the barriers to access mental health care in low- & middle-income countries (LMICs) as compared to high-income countries?
LMICs:
1. Substantial lack of services and shortage of resources
2. Shortage of well-trained workforce and tools for detection of mental disorders
3. Financial cost to families (direct and indirect)
4. Perceived barriers to professional help-seeking (e.g. stigma)
HICs:
1. Increased uptake of treatment for mental disorders since 1990
2. Treatment still “not reaching adequate standards”
3. Not reaching those in the population who need it the most; e.g. ethnic minorities, young people (perceived barriers to professional help-seeking and ‘real’ structural barriers)
Why mental health beliefs and attitude prevent mental health help-seeking?
- Stigma: viewing the individual affected by mental health difficulties in a negative way.
- Discrimination: when someone treats the individual in a negative way because of mental health difficulties.
=> Both make these individuals reluctant to seek help from services.
- Three levels of stigma: Internalised/self-stigma (negative self-beliefs) -> Public stigma (prejudice from surrounding circles) -> Structural stigma (policies and practices leading to unfair treatment)
What are mental health interventions and describe the types of interventions?
- They are methods of:
- providing treatment and support to individuals (or groups) experiencing mental health difficulties
- reducing risk of mental health difficulties, building resilience and establish supportive environments - Types of intervention:
- Prevention:
+ Universal: for all in a given society
+ Selective: focused on groups known to be at risk
+ Indicated: Sub-clinical, prodromal, ‘at risk’ state
- Treatment (diagnosis, early & standard treatment)
- Continuing care (long-term engagement)
How does the social-ecological help us think about mental health intervention?
- Social-ecological model: policy -> community -> institutional -> interpersonal -> intrapersonal
- Interventions can be implemented at different and multiple levels.
- Interventions at a higher level can affect lower levels
- Psychologists can be involved at all levels (policy to interpersonal) – provides a ‘big picture’ approach to thinking about mental health
What is meant by evidence-based interventions?
- Mainly randomised controlled trials (RCTs) to provide evidence base for specific mental disorders and their treatments
- Maintain standard and shared understanding of terminologies in professionals
- Forming the UK’s National Institute for Clinical Health and Excellence (NICE) - clinical guidelines considering both evidence and cost
What is meant by IAPT when talking about the mental health services in the UK?
- IAPT = Improving Access to Psychological Therapies
- MH care in the UK are structured around primary, secondary and tertiarycare in NHS
- IAPT: provide widespread access to treatments for common MH disorders in the UK (2008)
- Apply step-care model to improve access via primary care or self-referral
- Provide evidence-based intervention (from needs)
- A key reason: therapies largely pays for itself by reducing other public costs (e.g. welfare) & increase working tax
- Addresses greatest population need for severe cases treatments
Provide an in-depth description of the IAPT? (UK)
- Step 1: Primary care (GP) - largest base
- Step 2: Low intensity service - Mainly offers guided self-help, computerised CBT and group-physical activity programmes.
- Step 3: High intensity service (1-to-1 sessions with trained therapists, CBT, EDMR and IPT interventions)
- Step 4: Chronic/complex - senior CBT therapists & highly qualified specialist (dealing with severe and recurrent disorders, complex trauma and if other treatments fail)
Evaluate the benefits and drawbacks of IAPT (UK)?
- Benefits:
- Decreased waiting times
- Client’s condition improved (58% to 67%)
- Recovery improved (43% to 51%) - Drawbacks:
- Only half of referred patients go onto treatment
- Unclear if its interventions tailored enough to meet the actual complexity of its clients
- Unclear if IAPT prevents need for onward referral to secondary care
Describe the study researching experience of low-intensity interventions (step 2) in IAPT?
- How: Qualitative research of 8 participants, where their anxiety
and depression varied from mild to severe - Treatment type? 3-6 sessions of a brief transdiagnostic group OR low-intensity CBT
- Results? 4 experiencing changes, while more severe Ps were referred to higher-level treatment.
- Evaluation:
- Time to talk, normalization and personal approach were beneficial & vice versa (adapting therapists are more beneficial)
- Individual’s own goals, expectations and sense of stigma were factors outside of the therapy that impacted psychological change
