Empirically supported treatments for all: Realizing equitable coverage of care for trauma survivors globally

Global mental health is focused on reducing inequities in treatment access for mental health disorders. A core social determinant of mental health is trauma (e.g., violence, disasters, wars), contributing to myriad psychosocial outcomes such as posttraumatic stress disorder (PTSD), depression, anxiety, and functional impairment. Despite the development of numerous efficacious empirically supported treatments (ESTs), trauma survivors remain a particularly vulnerable group and rarely receive quality trauma-informed treatment. In this paper, we argue that in order to reduce global inequities in mental health treatment access, we need to fully embrace Chambless and Hollon's (1998) criteria for ESTs - that they be efficacious, effective in routine clinical contexts, feasible to deploy and scale up, and cost-effective. While the field of clinical science has made impressive strides in developing efficacious treatments, we argue that we ought to place greater emphasis on an EST being effective across contexts, feasible for delivery by a wide cadre of providers, and cost-effective to scale to improve equity. We discuss efforts in the field of global mental health that use innovative paradigms to fully realize the latter criteria, which have been under-appreciated in clinical science. We conclude with recommendations to improve EST access by applying an equity lens within and between contexts.