Mental health: the treatment gap

Campus: Exeter

Press Release: Professor Paul Farrand has been quoted in the Daily Mail talking about men's mental health, as part of the #headstogether campaign championed by Prince Harry. Paul's comments relate to Stephen Fry's new video in which he discusses his mental health breakdown with his psychiatrist, as well as the importance of talking openly about mental health.

Grand Challenges

This challenge is now being developed by Professor Paul Farrand. Available to all undergraduates interested in mental health, this will be a fascinating and impactful challenge broadening your understanding of the barriers to accessing mental health treatments, and how these could potentially be overcome.

The mental health treatment gap represents the difference between the prevalence of a mental health difficulty and the number of people accessing evidence based treatments (Kohn, 2004). With the prevalence of mental health difficulties increasing across the world (Steel et al, 2014), the treatment gap is having an increased impact on the individual, their families, society and the economy and places general levels of wellbeing under threat.

Within this grand challenge you will work with peers in small ‘enquiry groups’, each focusing on a particular barrier contributing to the mental health treatment gap. In doing so it is hoped you will develop a better appreciation of the barrier being focussed on in the enquiry group and will be encouraged to consider potential solutions to help improve access to psychological therapies to enhance wellbeing.

You will have the opportunity to network with a range of external stakeholders to share their perspectives on barriers contributing to the treatment gap, including mental health and health professionals, service users and community groups and organisations making contributions to this area, You will also be exposed to the work of clinical researchers and training academics within the Clinical Education, Development and Research (CEDAR) group within Psychology. Members of the CEDAR group have national roles within the NHS Improving Access to Psychological Therapies (IAPT) programme and are helping to improve access to psychological therapies across the world in countries such as Canada, Hong Kong, Japan and New Zealand.

Enquiry groups

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.

Flickr gallery from Mental Health 2017