Addressing the treatment gap: A key challenge for extending evidence-based psychosocial interventions

doi:10.1016/j.brat.2016.06.004

Behaviour Research and Therapy

Volume 88, January 2017, Pages 7-18

https://doi.org/10.1016/j.brat.2016.06.004 Get rights and content

Highlights

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Most individuals in need of mental health services receive no treatment.
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The dominant model of delivering treatments will need to be complemented by models that can be scaled to reach larger numbers of individuals.
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Criteria for models of delivery and illustrations of models are provided.
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A key priority will be to deliver are well studied treatments in new ways.

Abstract

Remarkable progress has been made in developing psychosocial interventions for a broad range of psychiatric disorders for children, adolescents, and adults. In addition many efforts are well underway to address the research-practice gap, which refers to the dissemination evidence-based treatments from controlled settings to clinical care. The present article focuses on the treatment gap, which refers to the discrepancy in the proportion of the population in need of services and the proportion that actually receives them. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services receive no treatment. Although there are many reasons, the dominant model of delivering psychosocial interventions in both research and clinical practice makes it difficult to scale treatment to reach the large swaths of individuals in need. That model includes one-to-one, in person treatment, with a trained mental health professional, and provided in clinical setting (e.g., clinic, private practice office, health-care facility). The article discusses the development of delivery models that would permit reaching more individuals in need, highlights criteria for developing such models, and illustrates novel models already available. The article proposes that our next challenge is to reach individuals in need with the many excellent interventions we have developed but through a diversified set of delivery models.

Section snippets

Overview of the problem

The treatment gap refers to the difference in the proportion of people who have disorders or a particular disorder (prevalence) and the proportion of those individuals who actually receive care (Kohn et al., 2004, Patel et al., 2010a). In the context of mental health, considerable evidence has addressed each component of the gap to outline the nature of the problem (Andrade et al., 2014, Becker and Kleinman, 2013, Merikangas et al., 2011, Steel et al., 2014, Whiteford et al., 2013). In the

Overview

There are many impediments or barriers that stand in the way of people receiving mental health interventions (e.g., Andrade et al., 2014, Corrigan et al., 2014, Hinshaw and Stier, 2008). These include primarily system issues (e.g., out of pocket costs, proximity to mental health services and health professionals) and attitudinal issues (e.g., stigma, mental health literacy). I return to the topic later because extending treatment on a large scale requires addressing multiple barriers. Yet, for

Characteristics of treatment that would help reach individuals in need

Typically, as we develop treatments, we begin with a focus on a clinical disorder, a model of how that disorder may come about, how treatment can address key components of the disorder, and what we might draw from the human and nonhuman animal research in the way of principles or techniques. We then begin tests of treatment. If one considers cognitive therapy for depression and prolonged or graduated exposure for anxiety, for examples, many of these steps have been critical for developing these

Barriers to mental health care: context and considerations

The impediments to providing and receiving care do not hinge or completely fall to the model of delivering treatment. There are of course many reasons the vast majority of individuals in need of psychological services receive no treatment. To begin, receiving services for psychological dysfunction encompasses multiple steps that include experiencing symptoms or some form of dysfunction, identifying those as symptoms or something in need of help, deciding whether action is needed to do something

Conclusions

EBPIs represent an enormous research advance. The comments of the present article are designed to build on these gains. We are now at the first point in history where behavioral and social sciences have established a large set of treatments with rigorous scientific evidence on their behalf. This accomplishment has to be savored as an evolutionary leap that allows us to consider what is needed for the next set of breakthroughs. The vast majority of EBPIs rely on a model of providing services

Author note

Many facets of this article have been directly influenced by Terry Wilson. Our collaboration on evidence-based treatments began in 1976 as we spent a year together (Center for Advanced Studies in the Behavioral Sciences, Stanford, California) along with luminaries in research whose contributions were well established (W. Stewart Agras, Nathan Azrin, Walter Michel, Jack Rachman). The group was charged with the task of evaluating research on behavioral therapies. Terry and I collaborated on a

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Addressing the treatment gap: A key challenge for extending evidence-based psychosocial interventions

Highlights

Abstract

Section snippets

Overview of the problem

Overview

Characteristics of treatment that would help reach individuals in need

Barriers to mental health care: context and considerations

Conclusions

Author note

Critical Reviews in Oncology/Hematology

Transactions of the Royal Society of Tropical Medicine and Hygiene Journal

Cognitive and Behavioral Practice

Preventive Medicine

Journal of the American Academy of Child & Adolescent Psychiatry

Journal of Pediatrics

Lancet

Lancet

Clinical Psychology Review

Lancet

Evidence-based practice in psychology

American Psychologist

Barriers to mental health treatment: Results from the WHO World Mental Health surveys

Psychological Medicine

Matching markets in the digital age

Science

Videoconferencing psychotherapy: A systematic review

Psychological Services

Blogging as a social tool: A psychosocial examination of the effects of blogging

Cyberpsychology & Behavior

Acute air pollution exposure and risk of suicide completion

American Journal of Epidemiology

The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India

BioMed Central Health Services Research

Neonatal and infant mortality in the 10 years (1993-2003) of the Gadchiroli field trial: Effect of home-based neonatal care

Journal of Perinatology

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Journal of Technology in Human Services

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Studies in hysteria

Asynchronous teleneurology: A systematic review of electronic provider-to-provider communications (P3. 400)

Neurology

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Psychological treatments: Evidence-based practice and practice-based evidence

InPsych

Cost of scaling up mental healthcare in low- and middle-income countries

British Journal of Psychiatry

Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: Mathematical modelling study

British Medical Journal

The innovator’s solution: Creating and sustaining successful growth

The innovator’s prescription: A disruptive solution for health care

Paraprofessionals, partners, peers, paraphernalia, and print: Expanding mental health service delivery

Professional Psychology

Grand challenges in global mental health: Integration in research, policy, and practice

PLoS Medicine

The impact of mental illness stigma on seeking and participating in mental health care

Psychological Science in the Public Interest

The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: Executive summary of an American College of Physicians Position paper

Annals of Internal Medicine

Exercise and mental health: Many reasons to move

Neuropsychobiology

What if? A letter from the CEO of the bill and linda gates foundation

Evidence-based psychotherapy: Where practice and research meet

A second life for eHealth: Prospects for use of 3-D virtual worlds in clinical psychology

Journal of Medical Internet Research

Self-help in mental health: A critical review

Health professional shortage areas: Mental health designated populations

Stigma as related to mental disorders

Annual Review of Clinical Psychology

An action plan for behavioral health workforce development