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Evidence-based psychological treatments for mental disorders: Modifiable barriers to access and possible solutions
Open accessAbstract
The prevalence of mental disorders is high and appears to be growing, yet the majority of individuals who meet diagnostic criteria for a mental disorder are not able to access an adequate treatment. While evidence-based psychological treatments (EBPTs) are effective single or adjunctive treatments for mental disorders, there is also evidence that access to these treatments is diminishing. We seek to highlight modifiable barriers to these problems at the patient, therapist, treatment, organization and government-levels of analysis. A range of solutions to each set of contributors is offered and domains for future research are highlighted. In particular, we focus on the need to continue to work toward innovation in treatment development while also solving the difficulties relating to the dissemination of EBPTs. Several relatively new concepts in the field will be discussed (implementation cliff, program drift, voltage drop and deployment treatment development) and we contrast America and England as examples of government-level processes that are in the process of major change with respect to EBPTs. We conclude that there is a need for people in our field to become more knowledgeable about, and get involved in, shaping public policy.
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“Overall, MAST-V helps to address patient-, therapist-, and treatment-level barriers to mental health care access (Harvey & Gumport, 2015).”
From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as Harvey & Gumport, 2015
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Although effective psychological treatments for depression and anxiety exist, they are difficult to access for many individuals [5,6].”
From Blended care-cognitive behavioral therapy for depression and anxiety in real-world settings: Pragmatic retrospective study (2020) · cites this paper as [5]
In the citing paper
“This is caused both by under-treatment of mental disorders such as depression (Demyttenaere et al., 2004, Harvey and Gumport, 2015) and therapist drift from evidence-based treatment protocols (Waller, 2009).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Harvey and Gumport, 2015
In the citing paper
“Research suggests that only a limited amount of patients in routine practise actually receives evidence-based treatment (Gyani et al., 2014, Harvey and Gumport, 2015).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Harvey and Gumport, 2015
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Citations
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Feasibility and Acceptability of the Primary Care Intervention for PTSD-Youth
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“35,36 Findings of the present study are promising with regard to increasing the scope of mental health interventions available in primary care settings, as PCIP-Y is the first proposed intervention to target trauma-related symptoms among school-aged children in integrated care.”
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“Adolescents are disproportionately affected by mental illness globally [22], yet access to therapy remains challenging due to resource gaps [22, 28, 57, 71].”
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“Clinical interventions include structured therapeutic approaches such as cognitive behavioral therapy, trauma‐informed care, or pharmacological treatment, usually delivered in individual or group formats (Han et al. 2021; Harvey and Gumport 2019).”
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“Understanding response signals is also an important step towards translating the findings from cohorts to a global comparison, as others’ access to treatment, types of therapy regimen, and characteristics of patients may influence the accuracy of prevalence and incidence [16].”
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“Individuals with depression and STBs often have low engagement rates with treatment due to a number of barriers including access to care, cost, lack of available providers, and personal beliefs about individual treatment (e.g., [35]).”
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Parent Perspectives on the Lights Out Online Program and Implications for Improvement.
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“EBTs are generally considered the gold standard of care and are highly effective at treating many prevalent mental health problems (Harvey & Gumport, 2015).”
A blended intervention for adjustment disorder: Results from a feasibility trial
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“Health systems more readily adopt treatments that are trainable, acceptable, affordable, supported, and adapt - able without losing their essential functions (Harvey & Gumport, 2015 ; McHugh & Barlow, 2010).”
Metadata
- Authors
- Harvey, A. G., & Gumport, N. B.
- Affiliations
- University of California, Berkeley (US)
- Corresponding author
- Harvey, Allison G.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 68
- Pages
- 1-12
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC4395546
- OpenAlex
- W2075286177
- Cited by
- 221
- References
- 149
- Citations by year
- 2026: 21 · 2025: 27 · 2024: 24 · 2023: 31 · 2022: 29 · 2021: 10 · 2020: 24 · 2019: 20 · 2018: 19 · 2017: 9 · 2016: 5 · 2015: 2
- FWCI
- 21.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (1 R01 MH105513-01)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- evidence-based psychotherapy, mental illness, access to mental health care, barriers to treatment access, voltage drop, mental health policy, public policy, mental health services
- MeSH terms
- Mental Disorders, England, Humans, Mental Health Services, Evidence-Based Medicine
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