Variations by ethnicity in referral and treatment pathways for IAPT service users in South London.

Hannah Harwood,Billy Gazard,Katharine A Rimes,Shirlee Maccrimmon,Luke Connor,Stephani L Hatch,Zoe Chui,Jheanell Hall,Rebecca Rhead,Ioannis Bakolis,Charlotte Woodhead

doi:10.1017/s0033291721002518

Abstract

The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise. This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis. Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated. Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.

Highlights

Common mental disorders (CMDs) such as depression and anxiety cause considerable burden to both individuals and the economy, with an estimated 72 million working days lost each year (Centre for Mental Health, 2017)
The majority of the sample identified as White British (52.4%), female (63.0%) and were referred to Improving Access to Psychological Therapies (IAPT) services in Lambeth (30.9%)
Our findings indicate 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

Summary

Introduction

Common mental disorders (CMDs) such as depression and anxiety cause considerable burden to both individuals and the economy, with an estimated 72 million working days lost each year (Centre for Mental Health, 2017). Racial and ethnic minority groups may have an increased vulnerability to CMDs through experiences of racism and discrimination (Hatch et al, 2016; Karlsen, Nazroo, McKenzie, Bhui, & Weich, 2005; Wallace, Nazroo, & Bécares, 2016), and being more likely to experience social inequalities that can contribute to mental ill-health (Allen, Balfour, Bell, & Marmot, 2014; Marmot & Bell, 2012). In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services.

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Discussion

Conclusion