Cognitive-Behavioural Therapy for Adults With Mental Health Problems

Working to improve access in BC

Jamie Livingston, Mark Lau, Dolores Escudero, Eric Ochs, Gayle Read, Pam Whiting, Maureen Whittal and Chris Wilson

Reprinted from "CBT" issue of Visions Journal, 2009, 6 (1), p. 25

Accessing cognitive-behavioural therapy (CBT) is not easy for many adults in British Columbia who have mental health problems. Because of this, BC Mental Health & Addiction Services (BCMHAS), an agency of the Provincial Health Services Authority, formed the BC Cognitive Behaviour Therapy Network in late 2008. The intent is to improve access to CBT across the province and to strengthen province-wide collaboration.

The BC CBT Network is made up of clinical and administrative representatives from BCMHAS, the Ministry of Health Services (MoHS), the Ministry of Children and Family Development and each of the five regional health authorities. These representatives meet regularly to advise and coordinate initiatives to build CBT capacity throughout BC.

The work of the BC CBT Network is guided in part by a provincial CBT service framework that was drafted by BCMHAS and MoHS in early 2009.1 This framework outlines a broad-based plan for strengthening CBT services in BC.

The vision of the BC CBT Network is that every person in BC will have equal access to high-quality CBT, no matter where they live. This will lead to better care and treatment for people with mental health problems.

What do we know about CBT services for adults in BC?

We know that CBT is an effective psychotherapy for treating a wide range of mental health problems. For many mental health problems, CBT is as effective as medications and more cost-effective over the long term.2-3

However, we also know that BC doesn’t have enough professionals trained in CBT to meet the needs of the people. Therefore, medications continue to be the primary or sole method for treating mental health problems in BC. Since some people don’t want to take psychiatric medications and some can’t afford to, the result is high rates of untreated mental health problems in the province.

BC does not currently have a system in place to train, supervise and accredit mental health professionals in CBT. And the CBT expertise that is available in BC is unequally distributed across the province, as services tend to be concentrated in urban areas. This creates countless missed opportunities to intervene with adults before mental health problems become severe, debilitating and costly. We know that we need to work hard across BC to improve the availability, accessibility and affordability of CBT services for adults who have mental health problems.

What is low-intensity CBT and how do you access it?

People often think of CBT as face-to-face, one-on-one counselling. However, low-intensity CBT emphasizes self-help and can be highly effective for many people who experience mild to moderate levels of distress. There are two types of low-intensity CBT: pure self-help and guided self-help.

Pure self-help refers to people managing their mental health problems on their own. They learn about coping skills and strategies through books, workbooks, DVDs, computer software or Internet-based programs.

Guided self-help refers to people learning about and using CBT strategies with the guidance and support of a trained professional, such as a general practitioner (GP) or community coach. Bounce Back: Reclaim Your Health is one example of a BC program that uses a guided self-help approach.*

In BC, you may be able to obtain information about low-intensity CBT resources through your GP. Efforts are underway to provide BC physicians with CBT training and resources so that they can identify, guide and support patients with mental health problems.4 The Antidepressant Skills Workbook5 and the Cognitive Behavioural Interpersonal Skills Manual6 are examples of self-help CBT resources that some physicians are using. At present, however, many GPs may be unaware of low-intensity CBT resources. You can also get information from either a non-profit mental health agency (such as the Canadian Mental Health Association) or through the Internet.

Internet based examples of low-intensity CBT that can be accessed at no cost include the self help resources listed in the sidebar. The BC CBT Network is currently working with several non-profit mental health agencies (e.g., AnxietyBC, Canadian Mental Health Association’s BC Division) to increase awareness of and access to low-intensity CBT resources in BC.

What about high-intensity CBT?

High-intensity CBT refers to formal, face-to-face services delivered by a trained therapist, such as a clinical psychologist or counsellor. These services are generally suited to people with moderate to severe levels of distress related to mental health problems.

In BC, high-intensity CBT for adults is provided in either the public or private health care sectors. As mentioned earlier, high-intensity CBT services in the public health sector are difficult to access in BC. You can contact your local GP, nurse practitioner or mental health service provider to ask how to get information about these services, whether high-intensity CBT services are available in your area and, if so, whether you qualify to access these services. A long-term goal of the BC CBT Network is to dramatically increase the number of practitioners in the public health sector who are appropriately trained to provide high-intensity CBT.

You can also find out more about the cost and availability of high-intensity CBT in the private health sector through your workplace employment assistance program or by contacting a local psychotherapist through a professional organization (see sidebar).

Choosing a CBT practitioner

When choosing a practitioner in BC, it’s important to know that it’s unlikely they will be accredited in CBT. In fact, no Canadian province or territory has established standards for accrediting CBT practitioners. Only a small number of trained CBT practitioners in BC are accredited through the US-based Academy of Cognitive Therapy, which is the only registry of accredited CBT practitioners in North America.

The BC CBT Network is working towards establishing standards for accrediting practitioners that provide CBT services in BC. But for now, there is no easy way for people who are seeking treatment to find out how qualified or skilled a particular practitioner is in CBT.

Some useful background questions to ask before you decide to receive CBT from a particular practitioner may include whether they’ve received specialized training in CBT, how long they’ve been providing CBT and how much experience they’ve had treating people similar to yourself with CBT. It’s also important to check how much financial coverage your workplace employee assistance program or extended health plan provides for CBT.

* For more information on the Bounce Back program, see the article "Bounce Back: Reclaim Your Health"

 
About the authors

The contributing authors are all founding members of the BC Cognitive Behaviour Therapy Network.

Jamie Livingston, BC Mental Health & Addiction Services (BCMHAS), Provincial Health Services Authority (PHSA), Mark Lau, BCMHAS, PHSA, Dolores Escudero, Ministry of Health Services, Eric Ochs, Vancouver Island Health Authority, Gayle Read, Ministry of Children and Family Development, Pam Whiting, BCMHAS, PHSA, Maureen Whittal, Vancouver CBT Centre, and Chris Wilson, Interior Health Authority

Footnotes:
  1. BC Mental Health & Addiction Services. (2009, January). Provincial cognitive behaviour therapy (CBT) service framework. BC Ministry of Health Services, limited circulation document.

  2. Butler, A.C., Chapman, J.E., Forman, E.M. et al. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31. www.ncbi.nlm.nih.gov/pubmed/16199119.

  3. Myhr, G. & Payne, K. (2006). Cost-effectiveness of cognitive-behavioural therapy for mental disorders: Implications for public health care funding policy in Canada. Canadian Journal of Psychiatry, 51(10), 662-670. www.ncbi.nlm.nih.gov/pubmed/17052034.

  4. Impact BC, Practice Support Program, Mental Health: www.impactbc.ca/node/399.

  5. Bilsker, D. & Patterson, R. (2005). Antidepressant skills workbook (2nd ed.). Burnaby: Centre for Applied Research in Mental Health and Addictions, Simon Fraser University. www.comh.ca/antidepressant-skills/adult.

  6. Vancouver Island Health Authority. (2009). Cognitive behavioural interpersonal skills manual. www.impactbc.ca/files/documents/Mental_H_-_CBIS_Manual.pdf.

 

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