Importance of culturally sensitive and responsive services
The Equality Act (2010), states a clear legislative duty on the part of mental health services to provide equality of access for all communities within their catchment area. In order to really improve access to psychological therapies, IAPT services need to be inclusive for all ethnic groups in the local area. However, in England, members of ethnic minority groups with mental health problems are currently more likely to see mental health services as hard to access, less likely to access therapy, less likely to have good outcomes and more likely to report negative experiences in therapy compared to White majority service users. For example, in 2019/20, the average IAPT access rate across London was 1.9% and 2.2% in people identifying as ethnic minorities and White respectively.
There is a clear need for mental health services to provide care, which is accessible, safe and culturally responsive if we are to truly advance equalities in care. A lot has been done and is still being done since the inception of IAPT in 2008. For example, an early finding in the Newham demonstration site was that people from ethnic minority backgrounds were under-represented in referrals using conventional primary care routes. To help overcome this problem, IAPT was opened up to self-referral. While this is likely to have helped to improve access in this group of individuals, more needs to be done.
The IAPT Black Asian and Minority Ethnic Service User Positive Practice Guide, co-developed by IAPT clinicians and ethnic minority service users and published by the British Association for Behavioural & Cognitive Psychotherapies (BABCP), provides a framework for IAPT commissioners, service managers, supervisors and clinicians to work towards better access and outcomes to achieve equity for all. The guide concludes with a helpful audit tool for IAPT teams to complete to aid the development of an overall strategy to increase access and improve outcomes for ethnic minority communities. The tool can be used to establish the degree to which services are culturally responsive and develop action plans to improve the work they do with these communities. ‘Please also see The Advancing Mental Health Equalities Strategy.
Furthermore, NHS England and NHS Improvement have has committed to developing a Patient and Carers Race Equality Framework (PCREF) to support organisations to identify and build core competencies in delivering culturally responsive care for ethnic minority patients and carers. PCREF aims to improve the experience of people from ethnic minority backgrounds in contact with mental health services in England to ensure equality across all ethnic groups. Development of the framework began in 2019/20 and is expected to be rolled out across all Mental Health Trusts by 2022. The PCREF is expected to complement the BABCP positive practice guide. You can find out more on the PCREF proposal here. South London and Maudsley Trust (SLAM) is one of the four national pilot sites for the PCREF and you can find out more on the progress of their work here.
SLaM recognises that the PCREF presents a crucial opportunity to radically transform its relationship and reputation with their Black community and over the medium to long term aim to support the reduction in inequalities in access, experience, and outcome. The work of the PCREF contributes to SLaM’s work to become an anti-racist organisation. Read a recent blog by Zoe Reed on Piloting a route to race equity in Mental Health