Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions.
BACKGROUND
In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities.


METHODS
Narrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care.


RESULTS
The narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a) community engagement (b) addressing the quality of interactions in primary care and (c) the development and delivery of tailored psychosocial interventions.


CONCLUSIONS
The model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model.
Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK. linda.gask@manchester.ac.uk
Linda
L
Gask
Peter
P
Bower
Jonathan
J
Lamb
Heather
H
Burroughs
Carolyn
C
Chew-Graham
Suzanne
S
Edwards
Derek
D
Hibbert
Marija
M
Kovandžić
Karina
K
Lovell
Anne
A
Rogers
Waquas
W
Waheed
Christopher
C
Dowrick
D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration*; D017146:Models, Organizational; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration; D006113:United Kingdom