CG123 Common mental health disorders - National Institute for ...

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Access to healthcaresuch as making and obtaining appointments, problems with scheduling and longwaiting-times can also affect access to healthcare (DIXONWOODS2005).COCHRANE2007, DIXONWOODS2005, and SCHEPPERS2006 identified that forsome groups (such as BME groups and older people) poverty can have an effect onthe ability to attend appointments with a GP, due to physical access limitations suchas lack of access to a car or funds for public transportation.4.3 ADAPTING MODELS OF SERVICE DELIVERY ANDTHERAPEUTIC INTERVENTIONS4.3.1 IntroductionOne approach to improving access to services has been to focus on the systems for theorganisation and delivery of interventions. These approaches have fallen into two broadcategories; first, attempts to alter the configuration of services, for example by deliveringa service in a community centre away from traditional healthcare settings (Powell,2002), or by using novel methods of service delivery, for example computers (Gullifordet al., 2007); second, to alter the nature of the intervention provided, for example bychanging the structure and content of a psychological intervention in the light of informationabout the cultural beliefs or presentations of a disorder within a particular ethnicgroup (Bernal, 2006; Bernal & Domenech Rodriguez, 2009; Griner & Smith, 2006).4.3.2 Clinical review protocolThe aim of this review was to perform a narrative synthesis of the evidence thatassesses the effectiveness of adapting existing models, methods, services and interventions,with the aim of improving access to healthcare. The review protocol, includingthe review question, information about databases searched and the eligibilitycriteria used in this section of the guideline can be found in Table 8. A search forsystematic reviews published since 1995 was conducted. The GDG decided thatsystematic reviews conducted before 1995 would not be useful in evaluating accessto healthcare and so these were excluded. Furthermore, due to the large volume ofliterature retrieved from the search, the GDG decided to evaluate papers from the last7 years alone. The GDG conducted an additional search for RCTs published between2004 and 2010 with the aim of identifying studies that may not have been capturedby the included systematic reviews (searching for RCTs published in the last 6 yearswould identify the studies included in the majority of systematic reviews). Furtherinformation about the rationale for the method employed here can be found inChapter 3 and information about the search strategy can be found in Appendix 6.Where possible, the evidence was grouped and synthesised by the subquestions, thatis, those that evaluated interventions for the general population, for mental healthcareservices specifically and for identified hard-to-reach groups (for example, BMEgroups and older people).69
Access to healthcare70Table 8: Clinical review protocol for the review of models of service deliveryComponentReview questionObjectivesDescriptionIn adults (18 years and older) at risk of depression or anxietydisorders* (in particular, BME groups and older people), dochanges to services and interventions (that is, community-basedoutreach clinics, clinics or services in non-health settings),increase the proportion of people from the target group whoaccess treatment when compared with standard care?To perform a narrative synthesis of the evidence, whichassesses the effectiveness of adapting or changing existingmodels, methods, services and interventions, with the aim ofimproving access to healthcareSubquestions • Do adaptations to existing services improve access tomental healthcare for all individuals?• Do adaptations improve access to mental healthcare forvulnerable groups (for example, older people and peoplefrom BME groups)?Population Adults (18 years and older) identified as at risk of depressionor anxiety disorders* (in particular, older people and peoplefrom BME groups)Intervention(s) • Service developments or changes that are specificallydesigned to promote access• Specific models of service delivery (that is, community-basedoutreach clinics, clinics or services in non-health settings)• Methods designed to remove barriers to access, includingstigma (both cultural and self and stigmatisation), misinformationor cultural beliefs about the nature of mental disorderComparison • Standard careCritical • Proportion of people from the target group who accessoutcomestreatment• Uptake of treatmentSecondary • Satisfaction, preferenceoutcomes • Anxiety about treatmentElectronic Systematic reviews: CDSR, CINAHL, DARE, EMBASE,databases MEDLINE, PsycINFORCTs: CENTRALDate searched Systematic reviews: 1 January 1995 to 10 September 2010RCTs: 1 January 2004 to 10 September 2010Study design Systematic review and RCT*Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias and PTSD.
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Commonmental healthdisordersTHE NIC
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© The British Psychological Societ
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Contents6 FURTHER ASSESSMENT OF RIS
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Guideline development group members
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Preface1 PREFACEThis guideline has
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Prefacecollaborative manner using t
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PrefaceThe experience of people wit
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Common mental health disorders2.2 T
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Summary of recommendations8.1.1.6 S
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Summary of recommendationsFigure 12
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Summary of recommendations●Genera
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Summary of recommendations8.4 STEPS
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Summary of recommendations●●a g
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Summary of recommendationsDiscuss w
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Summary of recommendationsinclude p
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Appendices9 APPENDICESAppendix 1: S
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Appendix 1of a depressive disorder
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Appendix 1b) Assessment of anxiety
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Appendix 2APPENDIX 2:DECLARATIONS O
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Appendix 2Mr Mike BessantEmployment
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Appendix 2Personal non-pecuniary in
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Appendix 2Actions takenMr Rupert Su
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Appendix 2Personal family interestN
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Appendix 3APPENDIX 3:STAKEHOLDERS A
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Appendix 4ClinicalpopulationPeople
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Appendix 4Case identificationNo. Pr
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Appendix 5APPENDIX 5:REVIEW PROTOCO
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Appendix 7APPENDIX 7:METHODOLOGY CH
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Appendix 9APPENDIX 9:METHODOLOGY CH
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Appendix 92.10 Are all important pa
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Appendix 9case also excludes costs
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Appendix 9For consistency, the EQ-5
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Appendix 9Answer ‘yes’ if the a
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Appendix 9Answer ‘yes’ if the e
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Appendix 9Answer ‘yes’ if appro
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Appendix 10APPENDIX 10: EVIDENCE TA
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Appendix 11APPENDIX 11:HIGH PRIORIT
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Appendix 11discussion of options bu
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Appendix 13APPENDIX 13:GENERALIZED
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ReferencesAndlin-Sobocki, P., Jöns
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ReferencesBower, P., Gilbody, S., R
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ReferencesCooper, S., Smiley, E., M
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ReferencesEhlers A., Gene-Cos N. &
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ReferencesGiles, D. E., Jarrett, R.
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ReferencesHorowitz, M. J., Wilner,
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ReferencesKnapp, M. & Ilson, S. (20
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ReferencesMarks, J., Goldberg, D. P
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ReferencesNCCMH (forthcoming) Self-
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ReferencesOzer, E. J., Best, S. R.,
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ReferencesSartorius, N. (2002) Eine
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ReferencesTiemens, B. G., Ormel, J.
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ReferencesWilkinson, M. J. B. & Bar
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Glossarybeliefs and interpretations
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Glossaryto learn to become more awa
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Abbreviations12 ABBREVIATIONSADDADS
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AbbreviationsOASISOCDONSORPHQ (-A,
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