Mental Health Treatment & Access Barriers

• Many individuals who meet the diagnostic criteria for mental disorders cannot access adequate treatment.
• Evidence-based psychological treatments (EBPTs) are effective for mental disorders but access to them is diminishing.
• There's a need to identify EBPT providers and increase the number of trained providers.
• Modifiable barriers to EBPTs exist at patient, therapist, treatment, organization, and government levels.
• Solutions should be geared toward innovation in treatment development and dissemination of EBPTs.
• Implementation cliff, program drift, voltage drop, and deployment treatment development are relatively new concepts in the field.
• Public policy involvement is crucial for people in the mental health field.

Prevalence of Mental Disorders

• The National Comorbidity Study (NCS) in 1990-1992 surveyed 8,098 individuals aged 15-54 in the USA.
• The NCS replication (NCS-R) in 2001-2003 surveyed 9,282 individuals aged 18+ in the USA.
• According to NCS-R (Kessler et al., 2005), 30% of those surveyed met the criteria for a mental disorder over a 12-month period.
• 50% of the population met diagnostic criteria for a mental disorder over their lifespan.
• SAMHSA estimated in 2007 that fewer than half of individuals needing mental health care were receiving it (SAMSHA, 2007).
• Wang et al. (2005) reported that about 60% of individuals with a mental disorder do not receive treatment.
• Only 32% of the treatments received were considered "at least minimally adequate" (Wang et al., 2005).
• Psychosocial interventions have arguably more encouraging results than pharmacological treatments (Insel, 2009).
• Progress in establishing EBPTs for most mental disorders has been excellent.

Shifts in Mental Health Service Provision

• Analyses indicate a shift away from EBPTs in mental health services from 1998 to 2007,
• An analysis of service use data compared outpatient mental health care in 1998 (n = 22,953) and 2007 (n = 29,370) (Olfson & Marcus, 2010).
• The number of people affected by mental disorders is large and growing, yet the majority are not receiving treatment.

Cognitive Behavioral Therapy (CBT)

• Cognitive-behavioral therapy is the empirically supported treatment of choice for mental and behavioral health problems.
• Emerging technologies might offer novel solutions to bridge the treatment gap.
• Internet-based and smartphone-based cognitive-behavioral therapy are examples of technology-enabled solutions.

Blended Cognitive Behavioral Treatment (bCBT)

• Research indicates that only a limited number of patients in routine practice receive evidence-based treatment.
• Therapist drift from evidence-based treatment protocols contributes to this issue.
• Providing CBT in a web-based format can improve therapist adherence to protocols.
• Blended care combines face-to-face treatment with web-based components.
• Blended treatment may improve patient participation and lower costs by reducing treatment duration and/or therapist contact.
• A blended CBT (bCBT) protocol was developed based on recommendations from depressed patients and e-health experts.
• An initial evaluation of integrated high-intensive bCBT was conducted with depressed patients in specialized mental health care.
• Seven out of nine patients engaging with bCBT completed ≥ 90% of treatment.
• System usability was evaluated as above average, and patients were mostly satisfied with bCBT.
• Patients reported improvements in depression, health-related quality of life, and anxiety.
• Therapists found the structured blended treatment helpful in providing evidence-based treatment to complex patients.
• bCBT approach might shorten treatment duration and be valuable for patients with severe depression.
• Effectiveness of the bCBT protocol warrants further exploration through a randomized controlled trial.

Many individuals with mental disorders can't access adequate treatment. Evidence-based psychological treatments are effective, but access is diminishing. Addressing barriers at various levels and public policy involvement are crucial for improving mental health care.