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Barriers to accessing talking therapies for service users from racial and ethnic minority groups

Dr Rebecca Rhead & the TIDES Team

06 October 2021

The theme for the 2021 World Mental Health Day is 'Mental Health in an Unequal World'. This is a vital topic because, as the world re-emerges from the COVID-19 pandemic, it is essential to ensure that mental health treatments are available for everyone. The pandemic has taken its toll on the mental health of many in the UK and more must be done to ensure equity in mental health services, particularly for those from racial and ethnic minority backgrounds who have been disproportionately affected by the pandemic and must be able to access the treatment they need.

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Depression is one of the most common mental illnesses worldwide, affecting approximately 280 million people globally (WHO). Depression is also something that affects many adults in the UK, with ONS data finding an estimated one in five adults reporting some form of depression during the COVID-19 pandemic (more than double that observed before the pandemic).

The National Health Service’s (NHS) Improving Access to Psychological Therapies (IAPT) programme exists to make access to cognitive and behavioural based talking therapies, including guided self-help, for depression and anxiety related disorders equally available for all. It is a national mental health treatment programme that lets people refer themselves for care in addition to GP referral.

Unfortunately, even though IAPT should make it easier for everyone to get help with difficulties in their mental health, this may not be happening.

Barriers to access

New research from the Health Inequalities Research Group at the Institute of Psychiatry, Psychology & Neuroscience has found that people from racial and ethnic minority backgrounds experience greater barriers when engaging with IAPT than people from White British backgrounds.

Research was conducted using data taken from the South London and Maudsley (SLaM) NHS Foundation Trust, one of largest mental health trusts serving one of the most racially and ethnically diverse communities in the UK. SLaM provides access to psychological therapies across four South London boroughs; Croydon, Lambeth, Lewisham and Southwark. Each borough implements their own IAPT services, with most referrals coming from GPs or via self-referral.

The study, published in Psychological Medicine, analysed data from 85,800 people referred to SLaM IAPT services between 1st January 2013 and 31st December 2016. Researchers found that racial and ethnic minority groups were less likely to self-refer to IAPT than the White British group and were more likely to be referred via community services (such as government agencies and criminal justice services). This indicates a lack of awareness, capacity or willingness to self-refer, and potentially that their mental health needs have been unmet for some time.

The study also found that most racial and ethnic minority groups were less likely to receive the required IAPT mental health assessment after being referred, and that those who were assessed by IAPT were less likely to receive treatment than White British service users. This indicates that ethnic minority IAPT service users are more likely to be discharged, referred elsewhere, or drop out of treatment.

Looking ahead

Further research is needed to examine how IAPT referrals differ by ethnicity and to understand why racial and ethnic minority service users are less likely to receive assessment and treatment in IAPT. Clinicians also need to be made aware of this issue and to develop a programme of targeted initiatives that are designed to:

  • raise awareness about IAPT services in local racial and ethnic minority communities
  • monitor and improve the way service users engagement with IAPT therapy
  • identify the factors that prevent people from referring themselves.

The pandemic has taken its toll on the mental health of many in the UK and more must be done to ensure equity in mental health services, particularly for those from racial and ethnic minority backgrounds who have been disproportionately affected by the pandemic and must be able to access the treatment they need.

IAPT must make it easier for ethnic minority service users to refer themselves to and receive care. They could do this by emphasising culturally sensitive and anti-racist professional practices that focus on identifying reasons for racial inequities within their service, including how depression and anxiety symptoms among racial and ethnic minority groups are perceived by health professionals and how this influences clinical decision making.

Addressing barriers to treatment are incredibly important - treatment delay can lead to worsened mental health symptoms such that the level of severity becomes too high for the scope of IAPT practice.

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Find out more

You can read the full research paper here, or read our research summary for a breakdown of findings and information on what you can do to help.

This research was conducted as part of the Tackling Inequalities and Discrimination in Healthcare Services (TIDES) study. TIDES is an ongoing investigation into racial and ethnic inequalities experienced in healthcare. This work was from TIDES Phase 1, funded by the Wellcome Trust.

 For more information on TIDES please go to: https://tidesstudy.com/

In this story

Rebecca Rhead

Rebecca Rhead

Research Associate

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