8 Psychotherapy8.4 Service delivery and evaluation in psychotherapy
8.4.6 Access and choice in psychological therapy
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Finding barriers
Access is more than a place on a waiting list. The person must be able to reach an assessment, start a suitable treatment and keep going with it.
Choice means having a say in the treatment model, the format and the practical arrangements, within the options that are clinically appropriate.
Unequal uptake between groups may reflect language, cost, transport, caring duties, disability, stigma or previous harmful experiences of services.
Adapting the pathway
Barrier | Possible response |
|---|---|
Difficulty getting referred | Clear information, and self-referral where available |
Language or communication needs | Trained interpreters, accessible materials and adapted communication |
Travel or mobility problems | Accessible venues, remote appointments or outreach |
Work and caring responsibilities | Flexible scheduling and appointment times planned ahead |
Digital exclusion | In-person alternatives, and help with equipment or digital skills |
Fear of discrimination | Open discussion of past experiences of services, and culturally responsive care |
Remote therapy gives some people more options. It can also shut out people without privacy, reliable internet or accessible technology.
Reasonable adjustments meet needs that come from a disability. Do not assume that a diagnosis makes someone unsuitable for psychotherapy.
Shared decisions mean explaining the likely benefits, what therapy will ask of the person, what is uncertain and the alternatives. Use language the person understands.
Reviewing the service
Equity monitoring looks at referral, assessment, waiting, dropout and outcomes across patient groups. Counting referrals alone is not enough.
Patient involvement should include people who found the service hard to use, not only those who finished treatment successfully.
Continuity while waiting sets out who holds clinical responsibility, where the person can get support and how you will review them if their needs get worse.