How equitable are psychological therapy services in South East London now? A comparison of referrals to a new psychological therapy service with participants in a psychiatric morbidity survey in the same London borough.

S. L. Hatch,L. Aschan,J. S. L. Brown,J. Wingrove,M. Hotopf,H. Ferner

doi:10.1007/s00127-014-0900-6

Abstract

PurposePsychological therapy services are sometimes characterised as being small and inequitable, with an over-representation of white middle class women. The ‘Improving Access to Psychological Therapies (IAPT)’ initiative is a programme in England that attempts to make evidence-based therapies accessible to more people more equitably. The aim of this study is to assess whether an IAPT service is delivering an equitable service a London borough. Patients using services at the Southwark IAPT service (n = 4,781) were compared with a sub-group of participants in the South East London Community Health study (SELCOH) with diagnosable mental health problems and who were also resident in Southwark (n = 196).MethodsWe compared Southwark IAPT patients and SELCOH participants on equity criteria of age, gender, ethnicity, occupational status and benefits status. To investigate if referral pathways influenced equity, patients referred by their general practitioner (GP pathway) (n = 3,738) or who self-referred (self-referral pathway) (n = 482) were compared with SELCOH participants.ResultsSouthwark IAPT patients significantly differed from SELCOH participants on all our equity criteria and similar differences were found with GP pathway patients. However, self-referrals did not differ from the SELCOH group on age, gender, ethnicity and benefit status.ConclusionsWhen compared to a community sample with diagnosable mental disorders, health disparities were found with the overall Southwark IAPT service and with GP pathway patients. Although unemployed people did access IAPT, fewer disparities were found with the self-referral pathway patients, suggesting that the IAPT self-referral pathway may be important in reducing inequitable access to services.

Highlights

High quality care should ideally be both effective and provide equitable access for the population based on need [1]
Southwark Improving Access to Psychological Therapies (IAPT) patients significantly differed from SELCOH participants on all our equity criteria and similar differences were found with general practitioners (GPs) pathway patients
Self-referrals did not differ from the SELCOH group on age, gender, ethnicity and benefit status

Summary

Introduction

High quality care should ideally be both effective and provide equitable access for the population based on need [1]. Access to services is poor worldwide, with only about 30–40 % of individuals with mental disorders consulting their general practitioners (GPs) [2,3,4]. GPs often fail to recognise mental disorders in patients [5]; may lack resources to manage them effectively [6, 7]; and individuals may be reluctant to consult GPs about emotional problems [8, 9]. Epidemiological data indicate that up to 50 % of all adult mental health problems start by the mid-teens and 75 % by the mid-20s [13]. GPs have been shown to be less likely to detect common mental health problems in black people compared to white people [10]. South Asians are less likely to consult, even after controlling for severity [2]

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