Beyond the barriers: South Asian women’s experience of accessing and receiving psychological therapy in primary care

Abstract

Purpose A number of initiatives have been developed to ensure easy access to mental health services for Black and Asian Minority Ethnic (BAME) communities. Improving Access to Psychological Therapies (IAPT) is a service that delivers first line interventions for South Asian women; however, little is known about what makes IAPT accessible for this population. This paper aims to explore South Asian women’s experiences of accessing psychological therapy and whether therapy within IAPT helps individuals to re-frame their experiences within their own cultural context. Design/methodology/approach A qualitative approach was used. Semi-structured interviews were carried out with South Asian women who accessed an IAPT service. Ten participants took part in the study and interviews were analysed using thematic analysis. Findings Six themes were identified; access, experience, cultural framework, therapist characteristics, expectations and “sticking with it”. Having a good therapeutic relationship with the therapist was key. While cognitive behavioural therapy (CBT) enabled clients to manage their symptoms, manualised CBT led to a sense of dissatisfaction for some. Clients spoke of having to make a forced choice to either deny their culture or leave their culture at the door to access therapy. Cultural and religious exclusion had a negative impact on therapy particularly for those whose difficulties were related to their cultural or religious context. Practical implications Culture and religion continues to be excluded from psychological therapy for South Asian Women. A cultural shift is required from within IAPT services to maintain engagement for this group. Further clinical implications are discussed. Originality/value While the experiences of Black and Asian ethnic minority groups accessing secondary mental health services has been explored, this study explores and highlights the experiences of South Asian Women accessing therapy in primary care, and uniquely identifies the processes that enable women to engage in therapy.

A scoping review to identify opportunities and challenges for communities of South Asian (SA) origin in accessing mental health services and support in high- income countries

“…Acceptability refers to the cultural and social factors that impact on whether an individual accepts the service and the appropriateness to seeking care (32). Mental health stigma (including, personal, interpersonal and intergenerational) was evident across many studies, leading to shame, internalised discrimination, trivialisation of MH and denial (39)(40)(41)(42)(43)(45)(46)(47)(48)50,52,(54)(55)(56)(57)(58)(59). Fears of stigmatising experiences with healthcare professionals, exacerbated by overly clinical environments, encouraged MH care avoidance or pressure to distort relationships between culture and MH, to evade cultural stereotyping (41,60,61).…”

“…SA culture and stigma informed dominant MH beliefs, negative attitudes (questioning e cacy of socially stigmatised HCPs -psychiatrists), treatment acceptability (i.e. discordance with rigid care models like CBT even when ethnically-matched), poor MH self-acceptance and limits suitable alternatives (religious or cultural constraints) (43,44,(47)(48)(49)54,56,58).…”

“…However, services fostering privacy and safe disclosure, encouraged open patient-provider discussions (43,49,54). Additionally, health care professionals were dismissive of concerns about familial shame, lacking cultural training and withholding referrals even if patient-requested (40, 47,48,58). Accessibility challenges included provider's preconceived notions and limited research on CALD people causing pathologisation of cultural experiences, in exible and untailored practice and limited recognition of MH-associated co-morbidities (i.e.…”

“…Accessibility challenges included provider's preconceived notions and limited research on CALD people causing pathologisation of cultural experiences, in exible and untailored practice and limited recognition of MH-associated co-morbidities (i.e. eating disorder) resulting in poor self-acceptance of illnesses (44,47,48,50,58). These experiences foster mistrust and internalised stigma, compromise patient safety, amplify the burden on support networks and delay MH care (40,44,54,56,58) (40, 44,54,56,58).…”

“…eating disorder) resulting in poor self-acceptance of illnesses (44,47,48,50,58). These experiences foster mistrust and internalised stigma, compromise patient safety, amplify the burden on support networks and delay MH care (40,44,54,56,58) (40, 44,54,56,58). SA service users felt expected to become "cultural experts" to assist healthcare staff, which was associated with cultural and language challenges (43,50,56,58).…”