CBT and the challenge of primary care: developing effective, efficient, equitable, acceptable and accessible services for common mental health problems
| Pages | 32-41 |
| Published date | 01 August 2008 |
| DOI | https://doi.org/10.1108/17465729200800006 |
| Date | 01 August 2008 |
| Author | Jim White |
| Subject Matter | Health & social care |
Recent guidelines suggest that cognitive behavioural therapy (CBT) has a pivotal role to play in the
treatment of common mental health problems (CMHPs). There is a danger that we simply ask for
‘more of the same’ instead of looking at all the current limitations preventing individuals from accessing
appropriate help. Doing this leads us to aim for a more radical and innovative approach to the
CMHPs. This paper suggests that progress in primary care mental health has been much more limited
than mental health workers and, in particular, researchers often acknowledge.It looks at the major
obstacles barring the way to the development of services that could meet the needs of the very lar ge
number of people in our communities with CMHPs.
CBT and the challenge
of primary care: developing
effective, efficient, equitable,
acceptable and accessible
services for common mental
health problems
Jim White
Consultant Clinical
Psychologist,STEPS Pr imary
Care Mental Health Team
South-East Community
Health Care Partnership
Glasgow and Clyde Primary
Care NHS Trust,Scotland
Correspondence to:
Dr Jim White
Consultant Clinical
Psychologist
STEPS primary care
mental health team
South-East Community
Health Care Partnership
Glasgow and Clyde
Primary Care NHS Trust
Govanhill Workspace
69 Dixon Road
Glasgow G42 8AT
0141 433 4934
jim.white@ggc.scot.nhs.uk
RESEARCH
32 journal of public mental health
vol 7 • issue 1
In Britain, with services increasingly delegated
to the primary care setting and in line with
World Health Organization recommendations
(WHO, 2001), there is a pressing need for
clinicians to develop more clinically effective,
efficient, equitable, acceptable and accessible
services (Department of Health, 2004).
However there is a danger that CBT therapists,
in particular, use the recent NICE guidelines for
anxiety and depression (National Institute for
Clinical Excellence, 2004a; 2004b) to demand
more resources for ‘more of the same’ instead of
taking this opportunity for a roots and branch
change in the way they, and others, approach
common mental health problems (CMHPs). This
more traditional approach seems evident with the
Improving Access to Psychological Therapies
programme. In a speech Lord Layard, describing
mental health as Britain’s biggest social problem,
suggested that Britain would need an additional
10,000 therapists delivering 10 sessions of CBT to
1,000,000 individuals each year (Sainsbury Centre
for Mental Health, 2005). No one appears to be
asking why, instead of focusing on individuals, we
are not focusing on the toxic factors in a society
that can produce such a high casualty rate.
Indeed, the recent significant increase in
funding through Improving Access to Psychological
Therapies (IAPT) focuses on condition-specific
approaches for all the common mental health
problems and seems to pay scant regard to social
factors (eg. Department of Health, 2008). The
rationale for the almost exclusive focus on CBT
models comes from academic research centre studies
with little concern about how well these results can
generalise to populations using NHS services. It is
© Pavilion Journals (Brighton) Ltd
Keywords
CBT
primary care
common mental health
problems
stepped-care
To continue reading
Request your trial