Community mental health teams have been operating across each area over the past 10-20 years: specialist teams for early intervention, assertive outreach and crisis resolution and home treatment were similarly established by 2010 but in some areas are now being dismantled: IAPT for common mental disorders has also expanded to cover each area by 2012.
However availability of other evidence-based treatments is patchy:
- CQC found 39% overall had received psychological treatments in the past year94. This included those with common mental disorders therefore likely to considerably under-estimate availability for those with severe problems.
- In areas where provision of CBT for psychosis was made, referral may not occur because patients are ‘too well’ or ‘not likely to engage’ although the former may benefit from improved adherence and latter can be engaged by more flexible approaches95.
- Coverage of severe emotional difficulties (‘borderline personality disorder’) is also limited to certain areas.
Access to mental health services and available treatment options are even more limited for some groups:
- For older people, availability of psychological treatments has been limited but is now being extended through IAPT.
- For ethnic minorities8, the main barriers can be grouped into sociocultural difficulties (health beliefs and mistrust of services), systemic problems (lack of culturally competent interventions), economic issues and individual barriers (shame, stigma)96. Stigma is thought to be created and maintained due to a complex interplay of social-structural, interpersonal and psychological factors97.