The availability of therapy and therapists: the stepped care model as a possible solution
| Date | 01 October 2006 |
| Published date | 01 October 2006 |
| DOI | https://doi.org/10.1108/17556228200600012 |
| Pages | 16-22 |
| Author | Kevin Gournay |
| Subject Matter | Health & social care |
16
The availability of therapy and
therapists: the stepped care model
as a possible solution
Kevin Gournay CBE
Emeritus Professor, Institute of Psychiatry, Kings College London
The Journal of Mental Health Workforce Development Volume 1 Issue 2 October 2006 © Pavilion Journals (Brighton) Ltd
Abstract
This article sets out to provide information
regarding the evidence base for psychological
treatments and to demonstrate that the number of
mental health professionals who are available and
competent to deliver these treatments is very small
compared with the numbers of people who might
benefit. The article also considers the prevalence of
conditions that are amenable to psychological
treatment and then explores how ‘stepped care’
may be one solution for providing available
treatment resources in a way that is fairest and
most effective for the population at large.
Key words
psychological therapy; Layard; stepped care models;
mental health treatment
Introduction
Anyone glancing at this edition of the journal will see
that there is now an enormous effort being made to
deliver effective psychological therapies to all those in
need. In the last decade we have seen a growing
awareness that, while psychological therapies may
produce enormous benefits, there is also a need to be
much more discriminating when it comes to selecting
which therapies to provide. It is true to say that 20 years
or so ago the average local NHS psychology department
largely provided dynamic and analytical psychotherapy
and that these therapies were often used on the same
patients for years at a time. The advent of evidence-based
medicine and the accompanying awareness not only by
mental health professionals, but also the general public,
of the need to see evidence of effectiveness, has led us to
concentrate our efforts on providing therapies that
largely come under the rather broad umbrella of the
cognitive behavioural. It is true that cognitive
behavioural therapies are not the only psychological
treatments with evidence of effectiveness; however it
needs to be said that other effective therapies such as
interpersonal therapy are simply not available because
there are very few practitioners adequately trained in
these methods.
Today therefore, the general public and the mental
health community are well aware that many mental
health problems are amenable to psychological
treatments. The need to provide such treatments is
enshrined in countless policy documents issued by the
Department of Health and government more generally.
However,while all of this sounds encouraging there is
also a realisation that the delivery of psychological
therapies to people, presenting in their general
practitioner’ssurgery or in community mental health
teams, is problematic to say the least. It is not uncommon
to see people who have presented with quite serious
mental health problems to be referred to a psychological
therapy service and then find that they wait many
months for an assessment, are then put on to a treatment
waiting list and then eventually receive, after several
more months of waiting, a ‘capped’ treatment package of
six to ten sessions. In some areas of the country mental
health professionals openly say that one needs to accept
that the days of reasonable availability of psychological
therapies are in the past and the only realistic way
forward for most patients is to ‘go private’. Self-help
organisations such as No Panic (www.nopanic.org.uk)
and OCD Action (www.ocdaction.org.uk) receive many
thousands of calls per month to their help lines and hits
to their websites, by people with mental health problems
who cannot access psychological therapies and the
market for self-help material has never been so profitable.
While the growth of self-help is, for many reasons,
commendable and to be encouraged, this growth
should take place alongside robust psychological
therapy services.
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