Culturally responsive initiatives within IAPT services
Many IAPT services have been innovative in their approach in reaching out to ethnic minority groups to reduce the observed and reported disparity in access, experience and outcomes. We explored some of these approaches during our conversations with the services and have cited below some examples from London and other areas in England. We recommend that services consider these approaches and the examples below, when engaging with ethnic minority groups.
- Thrive LDN wellbeing support for black, Asian and minority ethnic communities can be found here
City & Hackney IAPT work with the Orthodox Jewish, Turkish Kurdish, African and Caribbean communities via the Psychological Therapies and Wellbeing Alliance to increase access to the service in these ethnic minority groups. As a result of this collaboration, ethnic minority access rates have increased for these communities to above 20% of prevalence. Access rates are now in line with national IAPT access rate targets and are close to or above access rates for the general population.
The four organisations within the Psychological Therapies and Wellbeing Alliance (Bikur Cholim, Talk Changes, Derman and IRIE Mind) achieved the four highest recovery rates out of London providers in 2019-20 (60%-70%) demonstrating that ethnic minority focused services can match and exceed services serving the general population. Please see City & Hackney case study for more details.
Haringey IAPT reviewed their IAPT data and identified that access and recovery rates were lower and drop-out rates were higher for ethnic minority service users compared to the White group of service users. People from ethnic minority backgrounds also experienced longer waiting times. To address these issues, the service has worked with Bridge Renewal Trust, and delivered joint work and outreach workshops with Haringey ethnic minority communities.
Hammersmith & Fulham, through a Farsi speaking therapist, have established a longstanding relationship with the Iranian Association. In interacting with this ethnic minority group, the IAPT service understood the challenges with shame and stigma faced by this community, which prevents them from seeking appropriate help for mental health issues. As a result of this understanding, the service decided to take IAPT to the community via the Iranian Association. The therapist runs regular culturally adapted workshops in Farsi at the Association’s office base, thus meeting the psychological and cultural needs of the group and increasing access to the IAPT service.
Bexley have increased engagement with the local Asian community who also have the stigmatising challenge around MH. Remote appointments (via zoom or phone) could help reduce that stigma. Some staff speak Punjabi and Hindi and the step 2 lead has established links within the local Asian communities.
Croydon IAPT partner with Certitude to increase their outreach to ethnic minority groups especially from the Black and Asian background. This is 2-way relationship whereby the IAPT service refer clients with psychosocial issues to Certitude who also spread the word about IAPT to ethnic minority groups at relevant forums.
Birmingham and Solihull Mental Health NHS Foundation Trust, through the local ‘Birmingham Healthy Minds’ initiative, has adapted their local service by developing a culturally sensitive treatment group where patients can feel that their ethnic, cultural and spiritual beliefs were understood by the group facilitator and where specific barriers to access for these communities are addressed. With this initiative, they have shown how CBT can be adapted and delivered in different languages in order to increase and maintain patient engagement in mental health services, whilst achieving good clinical outcomes.
Slough IAPT service noted low referrals from ethnic minority groups (comprising over 50% of the population) and developed a new targeted outreach strategy to improve access rates to the service. They produced language and patient appropriate communications, co-located services in GP surgeries, baby weigh-in clinics and other community settings. Targeted comms to GP surgeries has resulted in increased referrals to the service. Please see case study and additional information:
Camden & Islington have an active ethnic minority working group. The working group has focused on several different topics over the years, and looks at IAPT data, for example variation in access and outcomes for different ethnic groups in order to plan targeted interventions. This working group is also the main link with NAFSIYAT (an intercultural therapy centre) and triages referrals to them (for mother-tongue intercultural counselling – not CBT). NAFSIYAT also offer cultural competency training.
Furthermore, a Bengali-English speaking Clinical Psychologist working for Camden & Islington IAPT, worked with the Bangladeshi community to increase access to the IAPT service from this community. Please see this case study for more information.
Haringey IAPT also have a long-standing relationship with NAFSIYAT, a local organisation which delivers therapy in a number of different languages and offer culturally-sensitive interventions. The IAPT service will refer people to the NAFSIYAT service for culturally targeted interventions, and some of these interventions count towards IAPT targets. NAFSIYAT have also been providing bereavement sessions.
Lewisham IAPT service identified that there were poorer outcomes for the local Asian communities – particularly, the local Tamil population, many of whom are refugees. The service has begun a project with the Tamil population and with local Tamil GPs. They have identified some issues with stigma and that it is a fairly closed community. The IAPT service has a Tamil speaker within its workforce and has set up mindfulness sessions for Tamil women within the GP surgery. It also has a project for the Tamil population with Sydenham Gardens.
Lewisham IAPT have also adapted Step 2 resources and protocols to produce culturally sensitive workshops co-produced with community partners and service users and are more relevant to different communities. In addition to translating materials, the service has amended the examples used within the resources to be more relevant to the local ethnic minority population groups. Amending the materials is an ongoing ‘live’ process, to ensure that the material is relevant to issues within the borough, but also world events such as Covid – case study
Greenwich IAPT have an ethnic minority workstream, which conducts outreach work at mosques and churches for example; the workstream lead worked at weekends in order to attend during mosque and church worship services.
One member of staff in Bromley IAPT service is focussed on outreach work to local ethnic minority communities, and they will develop tailored materials and literature targeted at different communities.
Good Thinking have produced guides, videos and podcasts for specific faith and belief communities. They have co-produced with Faith Leaders the ‘5 Ways to Wellbeing workbooks’ for different faiths and in different languages:
Camden & Islington service occasionally has members of staff who can speak other languages such as Sylheti, Somali, Bengali and Turkish. Outreach work to these communities is most successful when there is a speaker of that language on the IAPT staff, as they can run same language workshops, for example a Step 2 workshop with the Bangladeshi community. In order to encourage a culturally diverse workforce representing the ethnic diversity of the local area, job advertisements state that applications are welcome from various ethnic communities.
Haringey IAPT use a variety of methods for interpreting but have found it can be hard to arrange this remotely. They have some IAPT therapists who speak other languages such as Turkish, Polish, Spanish and Portuguese.
In Lewisham IAPT, everyone within the workforce has an objective on diversity and equality within their Personal Development Plan (PDP) – the emphasis of the service is to keep this as an ongoing priority.
Newham IAPT looks at the ethnic profile of those accessing IAPT services every month, and it generally matches the ethnic profile of the local population (two thirds come from an ethnic minority background). This suggests that there is some equality in access for all ethnic groups. Some of the therapists speak other languages and can deliver therapy in those languages to clients who require this.
Hillingdon IAPT has developed a new Band 8a Public and Partnership lead role (job description) which involves innovative and active outreach to people in the community who were identified during Covid as being hard to reach / engage with and are therefore more vulnerable. The role will also develop new links with partner organisations in the voluntary, social and health sectors. The postholder will devise and oversee the outreach and groups programmes; supporting existing groups as well as developing new ones as part of the new outreach programme.
Lewisham IAPT has received training in ‘adaptive practice’ with the ethnic minority community, from one of the co-authors of the IAPT Black Asian and Minority Ethnic Service User Positive Practice Guide.
Leeds IAPT were commissioned to work with refugees and the Roma & Traveller communities alongside continuing to broaden access for other ethnic minority groups. The service convened a diversity inclusion working group to look at how diversity is considered in key decisions, training and how the service recruits. The staff have been trained in providing adapted CBT work with ethnic minority communities and also worked with a health inequalities expert who developed an approach for a depression recovery group for the Islamic faith, to develop a step 2 group based in the local mosque.
Hillingdon IAPT service is planning to commission training on site to look at in-built assumptions on race and equality, as requested from ethnic minority colleagues in the service.
Greenwich IAPT developed psycho-educational training for religious settings and did workshops with them – although these were paused due to Covid-19. The service also plans to do cultural intelligence training with the IAPT workforce that will educate the staff on what it’s like to experience racism and undertake consultation and peer support with staff members.
As part of a quality improvement (QI) project led by the community IAG (Independent Advisory Group) with SLAM, Lewisham IAPT identified that ethnic minority access for IAPT was lower, and outcomes were poorer when compared to the White population. The findings from this QI project led to the development of a 3-year Diversity, Equality & BAME Engagement Strategy for the IAPT service. Please refer to the strategy for full details.