A national survey of the infrastructure and IT policies required to deliver computerised cognitive behavioural therapy in the English NHS
Authors : Holly Andrewes, David Kenicer, Carrie-Anne McClay, Christopher Williams
Abstract
Objective
This study aimed to identify if patients have adequate access to Computerised Cognitive Behavioural Therapy (cCBT) programmes in all mental health trusts across England.
Design The primary researcher contacted a targeted sample of information technology (IT) leads in each mental health trust in England to complete the survey.
Setting Telephone, email and postal mail were used to contact an IT lead or nominated expert from each mental health trust.
Participants 48 of the 56 IT experts from each mental health trust in England responded. The experts who were chosen had sufficient knowledge of the infrastructure, technology, policies and regulations to answer all survey questions.
Results
77% of trusts provided computers for direct patient use, with computers in all except one trust meeting the specifications to access cCBT. However, 24% of trusts acknowledged that the number of computers provided was insufficient to provide a trust-wide service. 71% stated that the bandwidth available was adequate to provide access to cCBT sites, yet for many trusts, internet speed was identified as unpredictable and variable between locations. IT policies in only 56% of the trusts allowed National Health Service (NHS) staff to directly support patients as they complete cCBT courses via emails to the patients’ personal email account. Only 37% allowed support via internet video calls, and only 9% allowed support via instant messaging services.
Conclusions
Patient access to cCBT in English NHS mental health trusts is limited by the inadequate number of computers provided to patients, unpredictable bandwidth speed and inconsistent IT policies, which restrict patients from receiving the support needed to maximise the success of this therapy. English NHS mental health trusts need to alter IT policy and improve resources to reduce the waiting time for psychological resources required for patients seeking this evidence-based therapy.
Citation: Holly Andrewes, David Kenicer, Carrie-Anne McClay A national survey of the infrastructure and IT policies required to deliver computerised cognitive behavioural therapy in the English NHS
BMJ Open 2013;3:e002277 doi:10.1136/bmjopen-2012-002277
Received: 28 October 2012 Revised: 22 December 2012 Accepted: 10 January 2013 Published: 1 February 2013
Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
Acknowledgments
We wish to thank those in the various IT departments within the NHS Trusts in England who shared their expertise and experience to help inform the study.
Contributors
HA carried out data collection and results analysis and completed the writing of the Method, Results and Discussion sections. DK performed data collection and was the editor of the paper. CAM performed liaison for data-collection progress, and completed the writing of the Introduction section and editing comments on the whole paper. CW carried out the design, liaison for data collection and was the editor of the paper. All authors have approved the final published paper.
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing Interests
CW is an author of a variety of written and cCBT resources, which are licensed through Five Areas Ltd, a company that delivers free and licensed online life skills resources based on a CBT model in a variety of settings including the NHS in Scotland and England. CW was involved in the design and writing up of the study, but he was not involved in the data collection or analysis. CAM is completing a PhD with the University of Glasgow and was employed by both the University of Glasgow and Five Areas Ltd during the course of this research. CAM was neither involved in the design of the study nor the data collection and analysis.
