Mental health: the treatment gap
The Mental Health Challenge this year looked at the treatment gap – the difference between the prevalence of a mental health difficulty and the number of people accessing evidence based treatments. The challenge was to broaden understanding of the barriers to access mental health treatments, and how these could potentially be overcome.
To help with this, there were several external and internal speakers from a broad range of backgrounds that spoke with students throughout the week.
Students picked enquiry groups before the week, each with its own practical element in helping solve the treatment gap. On Monday, the group were introduced to the purpose of the week, how it would unfold, and what they could look to take away from it. They then broke into their chosen enquiry groups, where they met their facilitators, and conducted ice-breakers to get to know one another before deciding on their output idea. The common interest that brought the students to the challenge was a definite positive for the students: “The best thing was that we could come into the experience as a group of strangers, and through working with each other on a topic we were all passionate about, get to know each other fairly well and come together to create an output which could possible make some real change in the world.”
On the Tuesday there were several sessions with experts – some with a direct link to a specific enquiry group. James Woollard, from the NHS, spoke about online therapies, while Ursula James, also from the NHS, discussed patient level barriers. When referring to the talks, a student said: “I was impressed by the calibre of the external speakers.” Proceeding this, there were talks about both reading and physical activity on wellbeing. These talks laid a solid foundation from which the students could build, with the entirety of Wednesday and Thursday being dedicated to their work.
On the Friday, the groups presented their work to an expert panel and received feedback. This proved to be a rewarding part of the week for many students: “The presentation was the most challenging part for me but I also found it the most rewarding part as I had pushed myself out of my comfort zone. By the end of the week, I had managed to accomplish something which I was very anxious about beforehand.” Students then got to show their hard work at the showcase – a celebration of all of the students’ work, open to other challenge participants and their guests, as well as the University staff and general public. Then, exclusive to the Mental Health Challenge, all of the students met for a reflective session. Here the participants reflected on how they worked as individuals and in teams throughout the week and looked at how productive the week was.
The Mental Health Challenge saw many amazing outputs created, with several looking to become long-term projects. The ‘Mind Your Head Gets Active’ is hoping to expand the ‘Mind Your Head’ society and push to showcase the positives of physical activity on wellbeing, another group worked with Wellbeing Services to determine whether the language used in their promotions affected student’s utilising them. ‘Fresh Reads’ created a reading for wellbeing book club.
Enquiry groups are the subtopic of the challenge that students focus on for Grand Challenges Week:
This enquiry group will explore a range of factors that may reduce the likelihood of individuals seeking mental health support, or seeking intervention to improve their wellbeing. Whilst the focus will be upon patients in general, specific barriers that may affect university students seeking or accessing help to improve their wellbeing or to treat a mental health difficulty will also be explored to enable group members to draw upon their own knowledge and experiences. The understanding developed within this enquiry group may be used to inform the enquiry group output, developing an intervention to address patient level barriers.
The delivery of Cognitive Behavioural Therapy (CBT) through computer platforms is recognised by the National Institute of Clinical and Health Excellence (NICE) for the treatment of depression and specific anxiety disorders, as a low intensity therapy within a Stepped Care approach. Whilst computer based delivery is evidence based, offers greater flexibility in delivery, provides patients with increased choice and offers the potential for costs savings for the NHS, uptake amongst service providers is lower than anticipated. This has raised concerns within the NHS that prevalence targets set with respect to improving access to psychological therapies will not continue to be met. Developing a greater awareness regarding the availability and diversity of CBT approaches alongside appreciation of the costs and benefits associated with CBT may be used to help inform the enquiry group output; the development of a ‘pitch’ to encourage greater uptake of CBT by services commissioned through the IAPT programme.
The sheer number of people seeking treatment for mental health problems has placed the NHS and mental health service providers under immense pressure. Whilst the delivery of psychological therapies must be overseen by NICE, there remains potential to supplement evidence based therapies by considering other more innovative interventions that have the potential to improve wellbeing. This enquiry group will focus on a current innovation; reading fiction to maintain and enhance wellbeing at times of life transition, such as leaving home for the first time to go to university. There is the potential for student outputs to obtain data that can be used to inform the development and implementation of a reading based intervention to ease transition into university life, currently being led Dr Johanna Harris from the English Department.
Within England the IAPT programme has invested heavily in the delivery of evidence based psychological therapies through mainstream service providers. However, such a narrow focus is not suited to everyone and this is a limitation, especially when other evidence based approaches exist. For example, NICE recommends the use of physical activity programmes for the initial treatment of mild to moderate depression. The focus in this enquiry group will be upon examining the use of physical activity, not only for the treatment of depression but also as a way to maintain or enhance wellbeing. This will help to inform the enquiry group output focussing on ways to promote physical activity either amongst people to help maintain wellbeing, people with depression as a treatment or service providers.