Patients from minority ethnic backgrounds wait longer for, and have worse outcomes from, referrals than white counterparts
Black, Asian and minority ethnic people experience longer waiting times, and are less likely to be in recovery after treatment, when accessing NHS mental health services compared with their white counterparts, a report has found.
The research looked at 10 years’ worth of anonymised patient data from NHS Talking Therapies, formerly known as Improving Access to Psychological Therapies – an NHS programme that launched in 2008 to improve patient access to NHS mental health services. A total of 1.2 million people accessed NHS Talking Therapies services in 2021-22, and by 2024 the programme aims to help 1.9 million people in England with anxiety or depression to access treatment.
The report, Ethnic Inequalities in Improving Access to Psychological Therapies, commissioned by the NHS Race and Health Observatory and undertaken by the National Collaborating Centre for Mental Health, found that people from black and minority ethnic backgrounds were less likely to go on to have at least one treatment session, despite having been referred by their GP, than their white counterparts.
People from minority ethnic backgrounds were also more likely to have worse outcomes after treatment, meaning that they had lower rates of recovery. These poorer outcomes were most experienced by people from a south Asian background. For example, in 2021-22, while 51% people from white British backgrounds were in recovery after treatment, the only ethnicity to have a recovery rate of over 50%, the figure was only 35.1% for people from a Pakistani background.
The NHS offers a range of treatments for treating various mental health conditions, which includes generalised anxiety disorder, post-traumatic stress disorder, and specific phobias. The forms of therapy offered include cognitive behavioural therapy (CBT), counselling for depression, and interpersonal therapy.
The research also found that people from minority ethnic backgrounds experienced longer waiting times for an initial assessment and between treatments, and were less likely to be referred for treatment after being assessed.
The inequalities found within the programme were also linked to people from these backgrounds living in areas with higher levels of deprivation and with higher rates of unemployment.
Dr Lade Smith, the president of the Royal College of Psychiatrists, said: “For far too long we have known that people from minoritised ethnic groups don’t get the mental healthcare they need. This review confirms, despite some improvements, it remains that access, experience and outcomes of talking therapies absolutely must get better, especially for Bangladeshi people.
“There is progress, particularly for people from black African backgrounds, if they can get into therapy, but getting therapy in the first place continues to be difficult. This review provides clear recommendations about how to build on the improvements seen. I hope that decision-makers, system leaders and practitioners will act on these findings.”
The report suggested that those in leadership roles in mental health services should focus on understanding the needs of minority ethnic groups within their care, and look at resources and funding.
Dr Habib Naqvi, the chief executive of the NHS Race and Health Observatory, said: “We recognise there are still critical gaps in access and outcomes when it comes to mental health support and talking therapies, across different ethnic groups. There are many people from black and minoritised ethnic communities struggling with their mental health, and yet they are less likely to be referred to talking therapies and have poorer experiences and outcomes once they are referred. It’s vital that we take a serious look at the findings of this review – reflect on what has been effective in the past, and address how service provision can be more inclusive and equitable across all communities.”
An NHS spokesperson said: “The NHS is committed to ensuring that these services are as accessible as possible for patients, and so if you or someone you know is struggling with their mental health you can refer yourself to NHS talking therapy services online or by contacting your GP.
“NHS talking therapy services treated 15,000 more people from ethnic minority backgrounds last year compared [with] the year before, thanks to an NHS campaign to raise awareness of the service, and guidance has been issued to local health systems on how they may need to adapt therapies to improve outcomes for ethnic minority communities.”
‘The model is flawed’
Abiola Awojobi-Johnson, 56, of Nigerian heritage, has had several rounds of therapy from the NHS in regards to trauma.
The structure of the NHS Talking Therapies model is not entirely equipped to deal with the sensitivities that patients from minority backgrounds, she says. “I would say there has been a lack of cultural competency, and that the fact I went back three times is a story in itself,” Awojobi-Johnson said.
“I’m not sure that [NHS Talking Therapies] always works for people from [diverse] cultural backgrounds because we often come with so much trauma just by being diverse people existing in this country and I’m not sure if the [NHS Talking Therapies] model is in itself equipped for that – because it’s a six- to eight-week programme, which is quite superficial and is not as effective as it could be.
“With the trauma a lot of us bring, a six- to eight-week session isn’t even going to touch the tip of the iceberg.”
Awojobi-Johnson added: “We’re trying to fix it by making cultural interventions which are very helpful, but if the model itself is flawed, no matter the intention is not ever going to make it really fit for purpose.
But despite this, Awojobi-Johnson said her more recent experiences with NHS therapy had been more positive given the shorter waiting times. “With my previous two cycles there were longer waiting times,” she said. “But with the cycle I had last year because things had improved it was swifter, and things like fluid availability.
“Prior to that my experiences had been quite negative, including long waiting lists and then being faced with people who had no cultural awareness or had unconscious bias.”
Awojobi-Johnson, who was involved in the report as a lived experience representative, said the results showing people from ethnic minority backgrounds experienced worse outcomes was “disappointing”.
She said: “It’s quite complex, but it’s not surprising really, when there’s a long waiting list or cultural misunderstandings and difficulties when it comes to understand about these conditions.”
Satwinder Kaur, 55, who also worked on the report as a lived experience representative and who has had psychotherapy on the NHS, said that although her experience had had positive aspects, the cultural sensitives were something that needed to be addressed.
“I had this really fantastic clinician, and I didn’t have short sessions but had a 12-week programme which helped,” Kaur said. “But then there’s the cultural disconnect, there’s the stigma, and there’s also trusting people who don’t know anything about you.”