1. Self-referral
Self-referral essentially encourages individuals to decide to enrol for a particular intervention that is publicized, without having to go through a health professional. Given problems of stigma and the low level of knowledge about treatment effectiveness, the publicity needs to be eye-catching, non-stigmatising and informative about the benefits of attending the workshop.
Referral methods within IAPT have been found to significantly affect equity [
9]. A comparison of GP and self-referrals to IAPT in one London borough showed that self-referral led to greater equity on ethnicity as well as age, gender and social welfare status, when compared to the local population [
9].
With respect to Gask et al. access model [
5], self-referral essentially focuses on community engagement (Stage 1) and to some extent on Psychosocial Intervention (Stage 3) but misses out the Primary Care Quality stage (Stage 2). Interestingly, Gask et al. [
6] suggest that this combination could be more effective in attracting different minority ethnic groups, who often are reluctant to consult their GPs.
2. Non-diagnostic titles of interventions
These are very important, given our experience with the Self-confidence workshops. The social marketing of interventions needs to relate to ‘normal’ problems that people understand rather than diagnostic terms. Information needs to be relevant to what people are experiencing and also give ‘hope’ [
8]. The titles used in the workshops have been ‘Stress’ and ‘Self-confidence’ for adults. Non-diagnostic labels and explanatory models that emphasise social rather than biomedical constructions are important in reducing anticipated stigma from potential participants.
3. Non-mental health locations
Locations need to be carefully chosen. Libraries and leisure centres have been used as these may be viewed as more ‘normal’ and less stigmatising.
4. Face to face presentation
There is evidence that face-to-face interventions are preferred to computerised interventions because they are more credible, are motivational, and offer personal support [
10].
Psychosocial intervention (Stage 3)
5. Brief CBT group intervention
Evidence-based CBT principles have been used in the programmes—and which have been evaluated to ensure effectiveness of the interventions. Participants are taught coping skills and techniques which are demonstrated in a very practical way during the workshop using a “psycho-educational” format. Participants are encouraged to identify personal goals and use the methods taught. While community interventions may sometimes be delivered by non-professional leaders, these community CBT workshops have been delivered by clinical psychologists with help from assistant psychologists.
6. Acceptable format
The interventions have been designed to be acceptable and convenient; day-long sessions at the weekend are often easier to attend than weekly sessions during the week. The programmes have been designed to be very interactive and the language used is normalised.