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Geographic Inequity in the Availability of Cognitive Behavioural Therapy in England and Wales: A 10-Year Update

  • Kate Cavanagh (a1)

Background: Improving access to psychological therapies, and in particular cognitive behavioural therapy (CBT), has been a health service priority in England and Wales over the past decade. The delivery of CBT has been limited by a scarcity of resources and further limited by the inequitable geographic distribution of CBT therapists. Aims: The current study replicates and extends our previous analysis of the geography of British Association of Behavioural and Cognitive Psychotherapies (BABCP) membership (Shapiro, Cavanagh and Lomas, 2003) 10 years later in order to evaluate the progress made in improving equitable access to CBT. Method: This paper presents the absolute and comparative geographic distribution of current BABCP members, accredited CBT practitioners, and BABCP members who are nurses or clinical psychologists in England and Wales. Results: Efforts to improve the availability of CBT in England and Wales are reflected in the doubling of total membership, and a 4.5 fold increase in accredited membership over the last 10 years. There is evidence that the magnitude of inequity in the geographic availability of CBT therapists has decreased, but that inequity is still evident. Limitations of using BABCP membership data as a proxy measure of CBT availability are acknowledged. Conclusions: A five-fold discrepancy in accredited CBT practitioners between the best and least well-served population decile indicates ongoing “postcode availability” of the best qualified CBT practitioners. Possible strategies to improve the availability of CBT and remedy this inequity are discussed.

Corresponding author
Reprint requests to Kate Cavanagh, University of Sussex, School of Psychology, Falmer, East Sussex BN1 9QH, UK. E-mail:
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Brugha, T. S., Bebbington, P. E., Singleton, N., Melzer, D., Jenkins, R., Lewis, G., et al. (2004). Trends in service use and treatment for mental disorders in adults throughout Great Britain. British Journal of Psychiatry, 185, 378–84.
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry, 23, 375384.
Department of Health (2011). Talking Therapies: a four year plan. London: Department of Health.
Department of Health (2012). IAPT Three-Year Report: the first million patients. London: Department of Health.
Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., et al. 2009). Mind the gap: improving the dissemination of CBT. Behaviour Research and Therapy, 47, 902909.
Shapiro, D. A., Cavanagh, K. and Lomas, H. (2003). Geographic inequity in the availability of cognitive behavioural therapy in England and Wales. Behavioural and Cognitive Psychotherapy, 31, 185192.
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Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
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