Reducing Barriers to Mental Health Care: Bringing Evidence-Based Psychotherapy Home

Abstract

Objectives: Barriers to treatment for depression and anxiety are prevalent among older adults and caregivers living in the community. We designed and implemented an evidence-based psychotherapy program to reduce obstacles to care.

Design: A practice improvement initiative providing no-fee evidence-based mental health care at home in clients' primary languages.

Setting: Independence at Home, a community service of SCAN Health Plan in Southern California.

Participants: Diverse older adults and adult caregivers of older people with age-related disability (mainly dementia).

Intervention: Redesign of an existing supportive counseling program to improve access to validated models of psychotherapy for depression and anxiety.

Measurements: We describe program content, phases of development, equity in participation from referral to program completion, clinical outcomes, and estimated direct program delivery costs.

Results: Insights successfully served demographically diverse clients experiencing a broad range of barriers to mental health care. A total of 211 clients completed therapy using one of three evidence-based approaches in the first 33 months of operation (2015-2018). Clinical efficacy was high and equivalent across demographic groups and therapy models. Depression, anxiety, quality of life, self-rated disability, and patient activation all improved significantly. We supported therapists' transition to the new model, modified workflows, and used clinical outcome data and therapist focus groups to improve referral, selection, and enrollment processes and simplify treatment assignment. With program maturation, treatment duration and direct costs both declined.

Conclusion: The Insights model could add value to healthcare organizations seeking to provide effective, equitable mental health services for older adults and caregivers who have difficulty accessing care for depression, anxiety, or difficult life challenges. J Am Geriatr Soc 67:2174-2179, 2019.

Keywords: access; depression; geriatrics.