Racial and ethnic differences in accessing NHS talking therapies

Written by: Nkasi Stoll and the Tackling Inequalities and Discrimination Experiences in health Services (TIDES) study team

What is this study about?

Did you know the NHS’s Improving Access to Psychological Therapies (IAPT) programme exists to make access to therapy for depression and anxiety equal for all? This is how IAPT works:

  • Referral – There are multiple ways to be referred to IAPT, people can refer themselves, or be referred by their GP, community services etc.
  • Assessment – Those referred to IAPT are usually assessed to establish the nature of their mental health problems and the most appropriate course of treatment.
  • Treatment – After being assessed, if deemed that IAPT can provide a suitable course of treatment, treatment should begin.
Elderly black man in counselling, sitting on a couch and talking to a woman who has their back to the camera.
Black man in counselling, sitting on a couch and talking to a woman who has their back to the camera.

Even though IAPT should make it easier for everyone to get help for mental illness, this may not be happening. Individuals from racially and ethnically minoritized backgrounds who could benefit from IAPT services appear to not be accessing or receiving IAPT mental health treatments in the same way as White British people in South East London (an ethnically diverse area of London with a greater number of Black Caribbean residents than other parts of London).

Read this summary and you can learn about the ethnic differences in how people access IAPT and what happens after people access IAPT.

How did they do the study? 

Researchers looked at anonymised (not personally identifiable) data from 85,800 people referred to South London and Maudsley (SLaM) NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Researchers wanted to know how racial and ethnic minority people were referred to IAPT (if they referred themselves or if they were referred by their gp or social services), and after they were referred, how many were assessed and then treated through the IAPT programme.

 To do this, researchers looked at the relationship between race/ethnicity and:

  1. How people were referred to IAPT.
  2. After referral, did they receive an assessment?
  3. After assessment, did they receive a treatment?

What did they find? 

Compared to the White British group:

Referral

  • Black African, Asian and Mixed ethnic groups were less likely to refer themselves to IAPT services.
  • Black Caribbean, Black Other and White Other groups were more likely to be referred to IAPT through community services (such as employment agencies, voluntary organisations, education providers as well as prison and probation services).

Assessment

  • Almost all racially and ethnically minoritised groups were less likely to receive an IAPT assessment after they had been referred.

Treatment

  • Among service users assessed through IAPT, all racial and ethnic minority groups were less likely to receive mental health treatment via IAPT.

Why is this important? 

Findings from this study suggest that ethnic minorities are not referring themselves for treatment as much as White British people in South East London. Instead, it could be that for many, their mental health is being allowed to deteriorate until they are referred by community services.

When ethnic minorities are referred, they are less likely to get the assessment and treatment they need compared to White British people. This could be because they are not offered an assessment/treatment, or, are offered assessment/treatment but decline or drop out. This lack of equity in healthcare provision can jeopardise and/or lengthen recovery for service users from ethnic minority groups. More needs to be done to address the cultural and structural barriers in place that lead to these inequalities. 

This study also shows that access to electronic IAPT records can help us identify ethnic inequalities in referral, assessment, and treatment. This will help us work towards making IAPT equal for all individuals, regardless of their race or ethnicity.

Blocks with facial expressions.
Blocks with facial expressions.

What can I do with this?

I would like to refer myself to IAPT: For more information about IAPT please go to: https://www.nhs.uk/service-search/find-a-psychological-therapies-service/  

I work for IAPT: Work on facilitating more racial and ethnic minority IAPT referrals by building trust with the local community; consider the barriers specific to your racial and ethnic minority service users; ask your service users why they decline or drop out of assessments and treatments; adapt the service and psychometric measures to a culturally diverse population. 

I work with the electronic IAPT records: Record country of origin data so that services and researchers can better understand the intersections of ethnicity and migration status. Find ways to encourage colleagues/other IAPT clinicians to record ethnicity data and highlight the importance of doing so. 

I am a policy maker: You can use these study findings to justify the prioritisation of resources to address ethnic inequality in IAPT services, for the benefit of all. 

I am a researcher: You can use this study to justify conducting research on the IAPT referral, assessment, and treatment experiences of people from all ethnicities to further understand what and how racial and ethnic inequalities affect people who need mental health support. You could also take this research a step further by looking at racial and ethnic inequalities in treatment outcomes. 

I am a student:  You can use this study to reference in your essays or assignments (please see citation below). To highlight the importance of looking at racial and ethnic inequalities in mental health services (and the relative lack of research in this area for IAPT). 

I want to know more!

Read the paper here: 

Harwood, H. & Rhead, R., Chui, Z., Bakolis, I., Connor, L., Gazard, B., Hall, J., Rimes, K. A., Woodhead, C., & Hatch, S. (2021). Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychological Medicine, 1-12. doi:10.1017/S0033291721002518