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

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Access to healthcareTable 10: Clinical review protocol for the review of service developmentsComponentReview questionObjectivesDescriptionIn adults (18 years and older) at risk of depression or anxietydisorders* (in particular, BME groups and older people), doservice developments and interventions that are specificallydesigned to promote access increase the proportion of peoplefrom the target group who access treatment, when comparedwith standard care?To perform a narrative synthesis of the evidence that assessesthe effectiveness of service developments specificallydesigned to promote accessSubquestions • Do new service developments targeted at changing thebehaviour of the individual or the practitioner improveaccess to healthcare services?• Do service developments targeted at the healthcaresystem improve access to healthcare services?• Do specific treatments or interventions developed forvulnerable groups improve access to healthcare services?Population Adults (18 years and older) identified as at risk of depression oranxiety disorders* (in particular, BME groups and older people)Intervention(s) • Service developments that are specifically designed topromote access• Specific models of service delivery (that is, communitybasedoutreach clinics, clinics or services in non-healthcaresettings)Comparison • Standard careCritical outcomes • Proportion of people from the target group who accesstreatment• Uptake of treatmentSecondary • Satisfaction, preferenceoutcomes • Anxiety about treatment• Individual/practitioner communicationElectronic 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.77
Access to healthcareBEACH2006 [Beach et al., 2006], FISHER2007 [Fisher et al., 2007], FLORES2005[Flores, 2005], MEGHANI2009 [Meghani et al., 2009], VANCITTERS2004 [VanCitters & Bartels, 2004]) met the eligibility criteria for inclusion in the review. Allincluded reviews were published in peer-reviewed journals between 2003 and 2009,and included a total of 148 studies identified from searches ranging from databaseinception to 2008. The characteristics of the reviews included in the narrative synthesiscan be found in Table 11 and Table 12, with further information in Appendix 14.In addition, ten studies were excluded from the narrative synthesis. Of these,seven were excluded because they were outside the scope (Bhui et al., 2003; Gruenet al., 2003; Jimison et al., 2008; Ploeg et al., 2005; Powell, 2002; Skultety & Zeiss,2006; Warrilow & Beech, 2009) and three were excluded because they did notprovide data on outcomes which evaluated access to healthcare (Bouman et al., 2008;Cuijpers, 1998; Moffat et al., 2009).Of the six systematic reviews included, only one (VANCITTERS2004) wasfocused on improving access to mental healthcare services. All other included reviewswere not specifically focused on mental health. However, BEACH2006 andFLORES2005 reported sub-analyses that focused on mental health. Four reviewsfocused on improving access for BME groups (ANDERSON2003, BEACH2006,FISHER2007, MEGHANI2009), one evaluated improving access for people withlimited English proficiency (FLORES2005), and one review assessed interventions toimprove access for older people (VANCITTERS2004).ANDERSON2003 assessed individual-/practitioner-level interventions (culturalcompetency training, and use of interpreters and bilingual practitioners) as well assystem-level interventions (a programme to recruit and retain staff who reflected theculture of the community served), compared against a control condition with noexposure to the intervention. BEACH2006 evaluated a number of interventions at theindividual/practitioner level (for example, practitioner education), the system level(for example, tracking/reminder systems, culturally-specific healthcare settings, andlinguistically- and culturally-appropriate health education materials) as well astreatment-level interventions (for example, culturally-tailored and multifaceted interventions)compared against a control condition with no exposure to the intervention.FISHER2007 reviewed interventions that were grouped into individual-levelinterventions, access interventions, and healthcare interventions compared against acontrol condition with no exposure to the intervention. FLORES2005 compared theeffect of not using an interpreter when one was needed with the use of a trained or adhoc translator, and the use of bilingual practitioners. MEGHANI2009 focused on theeffectiveness of patient-practitioner ‘race-concordance’ 8 , that is, the individual inneed of healthcare and the practitioner are the same race. VANCITTERS2004 evaluatedoutreach methods designed to improve access for older people, as compared withtraditional methods.8 Race is used in this context to describe the biological heritage of the individual and not their ethnicity,which refers to learned cultural behaviours and practices through geographical location.78
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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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Common mental health disordersto ho
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Common mental health disordersManua
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Common mental health disordershighe
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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 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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