Lecture 1 - Interventions/Services in Global/UK Context

Question 1

What is the prevalence of mental disorders globally?

Answer 1

Mental disorders 7th leading cause of years lost to disability, 1/8 live with mental health condition (13% global prevalence)

Depression followed by anxiety disorders is most years lost globally

Question 2

What is the treatment gap?

Answer 2

Gap between need + provision of treatment wide in all countries

85% of world’s population live in low/middle income countries

Depression/schizo/bipolar/alcohol use disorders in top 10 causes of health-related disability

Question 3

What proportion of people receive treatment in the UK?

Answer 3

35% moderately severe cases, 65% severe cases

Question 4

What are some barriers to accessing mental health care for low income countries?

Answer 4

Substantial lack of services/shortage of resources – limited to large psychiatric hospitals
Shortage of well-trained workforce/tools for detection of disorders
Financial cost to families
Perceived barriers (no perceived need/stigma)

Question 5

What are some barriers to accessing mental health care for high income countries?

Answer 5

Increased uptake of treatment
Treatment still not adequate standards
Not reaching those in population that need it most (minorities/young people)

Question 6

What is stigma?

Answer 6

When someone views individual affected by mental health difficulties in negative way bc of it

Question 7

What is discrimination?

Answer 7

Someone treats individual in negative way bc of it

Question 8

What does stigma lead to?

Answer 8

Leads to reluctance to seek help from services

Public (social/interpersonal) stigma: ignorance/prejudice by family/friends/community

Internalised stigma: emotionally/cognitively absorbing negative beliefs about self, based on shame/stereotypes

Structural stigma: laws/policies/practices result in unfair treatment of people w/ lived/living experience of mental health difficulties

Professionals contribute to this through conscious/unconscious biases

Question 9

What can contribute to reducing help-seeking behaviours?

Answer 9

Spirituality: attributing to spiritual cause + seeking guidance spiritually

Shame: perceiving difficulties as weakness of character/personality that reflects impacts on the family due to significant role of family in one’s life

Emotional expression: perceiving lack of emotional balance leads to mental health difficulties which may get aggravated by talking about it

Question 10

What are mental health interventions?

Answer 10

Methods of:
Providing treatment/support to individuals experiencing mental health difficulties

Reduce risk of mental health difficulties/build resilience/establish supportive enviros

Question 11

What types of interventions are there?

Answer 11

Pre-emptive treatment, evidence-based interventions

Question 12

What is pre-emptive treatment?

Answer 12

Prior to usual treatment

Universal – for all in given society

At-risk group/selective – focused on groups known to be at risk

At risk/indicated: sub-clinical, prodromal, ‘at risk state’

Eg. School based psychological resilience training, family-based psychotherapy

Question 13

What is the social-ecological model?

Answer 13

(High) Policy – Community – Institutional – Interpersonal – Intrapersonal (Low)

Intervention can be implemented at diff/multiple levels

Implemented at higher levels can influence outcomes at lower levels, psychologists can be involved at all levels

Question 14

What are evidence-based interventions?

Answer 14

Psychotherapeutic modalities + other techniques that have been shown to be effective in controlled scientific research

Primarily randomised controlled trials (RCTs), sysmatic reviews + meta-analyses of RCTs, evidence base relates to specific mental disorder

Maintains standard + professional shared understanding in technique/vocab

Governments have developed guidelines (eg. NICE)

Question 15

What are some things evidence based interventions need to consider?

Answer 15

Clinical characteristics (eg. Severity)

Evidence base remains under-developed especially w/ co-occurring disorders + underserved populations

Ethnoracial/ethnocultural minorities not well represented in RCTs

Question 16

What is Improving Access to Psychological Therapies? (IAPT)

Answer 16

Mental health in UK structured around primary/secondary/tertiary care in NHS

IAPT is programme (2008) launched to provide widespread access to treatments for common mental disorders

Use stepped-care model to improve access via primary care/self referral

Provides evidence based psychological intervention/treatment defined by elle of need + therapist input

Pays for itself

Addresses greatest pop need (treatment of severe/complex disorders)

Question 17

What are the 4 steps of IAPT?

Answer 17

Step 1: Primary care/GP

Step 2: Low intensity service – PWPs, mild to moderate depression, guided self help, computerised CBT + group activity programmes

Step 3: High intensity service – CBT/high intensity therapists, weekly face to face + one to one sessions w/ trained therapist, counselling + interpersonal psychotherapy

Step 4: Chronic/complex – Senior CBT therapists, severe + recurrent disorders, complex trauma, personality disorders

Question 18

What are the benefits/criticisms of IAPT?

Answer 18

B: decreased waiting time, 58-67% clients improvised, recovery improved (43-51%)

C: only half of referred to onto treatment, unclear if interventions tailored enough to meet complexity, unclear if IAPT prevents need for onward referral to secondary care

Question 19

What did Amos et al find about low intensity IAPT interventions?

Answer 19

Participants received low intensity, therapists who adapted approach to individual needs were perceived as more effective