Black, Asian and minority ethnic people experience longer waiting times and are less likely to recover after treatment when accessing NHS mental health services than their white counterparts, a report has found.
The research looked at 10 years of anonymised patient data from NHS Talking Therapies, formerly known as Improving Access to Psychological Therapies – an NHS programme launched in 2008 to improve patient access to NHS mental health services. A total of 1.2 million people used 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 access treatment.
The report, Ethnic Inequalities in Improving Access to Psychological Therapies, commissioned by the NHS Race and Health Observatory and carried out by the National Collaborating Centre for Mental Health, found that people from black and minority ethnic backgrounds were less likely than their white counterparts to attend at least one treatment session, despite being referred by their GP.
People from minority ethnic backgrounds were also more likely to have poorer outcomes after treatment, meaning they had lower rates of recovery. These poorer outcomes were most common for people from a South Asian background. For example, in 2021-22, 51% of people from a white British background recovered after treatment – the only ethnicity to have a recovery rate of over 50% – compared to just 35.1% of people from a Pakistani background.
The NHS offers a range of treatments for different mental health conditions, including generalised anxiety disorder, post-traumatic stress disorder and specific phobias. Types of therapy offered include cognitive behavioural therapy (CBT), counselling for depression and interpersonal therapy.
The research also found that people from ethnic minority backgrounds experienced longer waiting times for initial assessment and between treatments, and were less likely to be referred for treatment after assessment.
The inequalities found in the programme were also associated with people from these backgrounds living in areas with higher levels of deprivation and unemployment.
Dr Lade Smith, President of the Royal College of Psychiatrists, said: “For far too long we’ve known that people from minority ethnic groups don’t get the mental health care they need. This review confirms that while there have been some improvements, there is still an urgent need to improve access, experience and outcomes of talking therapies, particularly for Bangladeshi people.
“There is progress, particularly for people from black African backgrounds, when they can get into therapy, but getting into therapy in the first place remains difficult. This review makes clear recommendations on how to build on the improvements we have seen. I hope that policy makers, system leaders and practitioners will act on these findings.
The report suggests that those in leadership roles in mental health services should focus on understanding the needs of ethnic minority groups in their care, and look at resources and funding.
Dr Habib Naqvi, chief executive of the NHS Race and Health Observatory, said: “We know that there are still critical gaps in access and outcomes when it comes to mental health support and talking therapies for different ethnic groups. There are many people from black and minority ethnic communities who are struggling with their mental health, yet they are less likely to be referred to talking therapies and have poorer experiences and outcomes once referred. It’s vital that we take a serious look at the findings of this review – reflecting on what has worked in the past and looking at how services can be more inclusive and equitable across all communities.”
An NHS spokesperson said: “The NHS is committed to making these services as accessible as possible for patients, 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 than 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 descent, has received several rounds of NHS therapy for trauma.
The structure of the NHS Talking Therapies model is not fully equipped to deal with the sensitivities of patients from minority backgrounds, she says. “I would say there was a lack of cultural competence and the fact that 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 in this country, and I’m not sure that the [NHS Talking Therapies] model in itself is equipped for that – because it’s a six to eight week programme, which is quite superficial and not as effective as it could be.
“With the trauma that many of us bring with us, a six- to eight-week session doesn’t even touch the tip of the iceberg.”
Awojobi-Johnson added: “We try to fix it with cultural interventions, which are very helpful, but if the model itself is flawed, no amount of intention is ever going to make it really fit for purpose.
Despite this, Awojobi-Johnson said her more recent experience of NHS treatment had been more positive, with shorter waiting times. “With my previous two cycles, there were longer waiting times,” she said. “But with the cycle I had last year it was quicker because things had improved, and things like fluid availability.
“Before that, my experience was quite negative, including long waiting lists and then having to deal with people who had no cultural awareness or unconscious bias.”
Awojobi-Johnson, who contributed to the report as a representative of lived experience, said the findings that people from ethnic minority backgrounds had worse outcomes were “disappointing”.
She said: “It’s quite complex, but it’s not really surprising if there’s a long waiting list or cultural misunderstandings and difficulties in understanding these conditions.”
Satwinder Kaur, 55, who also contributed to the report as a lived experience representative and has received psychotherapy on the NHS, said that while her experience had positive aspects, the cultural sensitivities were something that needed to be addressed.
“I had this really fantastic clinician, and I didn’t have short sessions, I had a 12-week programme, which helped,” Kaur said. “But then there’s the cultural divide, there’s the stigma, and there’s also trusting people who don’t know anything about you.”
