Geographic inequity in the availability of cognitive behavioural therapy in England and Wales

Delivery of cognitive behavioural therapy (CBT) is limited by a scarcity of resource. In England and Wales, there are not enough practitioners appropriately trained in CBT to meet the needs of those who might benefit from treatment. In addition, there are reasons to believe that available therapists are inequitably distributed across the country. We investigated the distribution of British Association of Behavioural and Cognitive Psychotherapies (BABCP) members, accredited CBT practitioners, and BABCP members who are nurses or clinical psychologists in England and Wales by postal code. This analysis demonstrated a 20-fold discrepancy in availability of accredited CBT practitioners between the best and least well-served population deciles. Despite limitations, these findings are highly indicative of "postcode availability" of the best qualified CBT practitioners. We discuss possible strategies to remedy this inequity, which further challenges the ability of conventional methods of CBT delivery to meet public health requirements.