Lecture 1 - Interventions/Services in Global/UK Context Flashcards
What is the prevalence of mental disorders globally?
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
What is the treatment gap?
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
What proportion of people receive treatment in the UK?
35% moderately severe cases, 65% severe cases
What are some barriers to accessing mental health care for low income countries?
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)
What are some barriers to accessing mental health care for high income countries?
Increased uptake of treatment
Treatment still not adequate standards
Not reaching those in population that need it most (minorities/young people)
What is stigma?
When someone views individual affected by mental health difficulties in negative way bc of it
What is discrimination?
Someone treats individual in negative way bc of it
What does stigma lead to?
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
What can contribute to reducing help-seeking behaviours?
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
What are mental health interventions?
Methods of:
Providing treatment/support to individuals experiencing mental health difficulties
Reduce risk of mental health difficulties/build resilience/establish supportive enviros
What types of interventions are there?
Pre-emptive treatment, evidence-based interventions
What is pre-emptive treatment?
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
What is the social-ecological model?
(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
What are evidence-based interventions?
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)
What are some things evidence based interventions need to consider?
Clinical characteristics (eg. Severity)
Evidence base remains under-developed especially w/ co-occurring disorders + underserved populations
Ethnoracial/ethnocultural minorities not well represented in RCTs
What is Improving Access to Psychological Therapies? (IAPT)
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)
What are the 4 steps of IAPT?
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
What are the benefits/criticisms of IAPT?
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
What did Amos et al find about low intensity IAPT interventions?
Participants received low intensity, therapists who adapted approach to individual needs were perceived as more effective
