How equitable are psychological therapy services in South East London now? A comparison of referrals to a new psychological therapy service with participants in a psychiatric morbidity survey in the same London borough

Abstract

PurposePsychological therapy services are sometimes characterised as being small and inequitable, with an over-representation of white middle class women. The ‘Improving Access to Psychological Therapies (IAPT)’ initiative is a programme in England that attempts to make evidence-based therapies accessible to more people more equitably. The aim of this study is to assess whether an IAPT service is delivering an equitable service a London borough. Patients using services at the Southwark IAPT service (n = 4,781) were compared with a sub-group of participants in the South East London Community Health study (SELCOH) with diagnosable mental health problems and who were also resident in Southwark (n = 196).MethodsWe compared Southwark IAPT patients and SELCOH participants on equity criteria of age, gender, ethnicity, occupational status and benefits status. To investigate if referral pathways influenced equity, patients referred by their general practitioner (GP pathway) (n = 3,738) or who self-referred (self-referral pathway) (n = 482) were compared with SELCOH participants.ResultsSouthwark IAPT patients significantly differed from SELCOH participants on all our equity criteria and similar differences were found with GP pathway patients. However, self-referrals did not differ from the SELCOH group on age, gender, ethnicity and benefit status.ConclusionsWhen compared to a community sample with diagnosable mental disorders, health disparities were found with the overall Southwark IAPT service and with GP pathway patients. Although unemployed people did access IAPT, fewer disparities were found with the self-referral pathway patients, suggesting that the IAPT self-referral pathway may be important in reducing inequitable access to services.

Increasing access to psychological treatments for adults by improving uptake and equity: rationale and lessons from the UK

“…Referral methods within IAPT have been found to significantly affect equity [ 9 ]. A comparison of GP and self-referrals to IAPT in one London borough showed that self-referral led to greater equity on ethnicity as well as age, gender and social welfare status, when compared to the local population [ 9 ].…”

How can we successfully recruit depressed people? Lessons learned in recruiting depressed participants to a multi-site trial of a brief depression intervention (the ‘CLASSIC’ trial)

“…One discovery was that self-referrers were not just the ‘worried well’ and that 75% had diagnosable problems when psychiatrically interviewed using the CIS-R [26]. Secondly, a proportionally more representative group of the local population from black and ethnic minorities (BME) backgrounds (32%) came forward [22] compared to the GP referral rate of about 25% for the area [27]. This fits in with Gask’s model of access to mental health care [28]; this suggests that, as BME individuals can be reluctant to seek help from GPs [29], offering access to BME groups might not necessarily involve the GP.…”

Can a community-led intervention offering social support and health education improve maternal health?: a repeated measures evaluation of the PACT project run in a socially deprived London borough at 6 month follow-up

“…Further, PACT participants have a different profile compared with patients attending the local psychology service (Southwark IAPT) where approximately 60% identified themselves as "white British" [33]. In IAPT, patients are largely referred by their GPs whereas PACT participants are more similar to those who refer themselves, who do not go through their GP [34] and who are more likely to be more representative of the local population [35].…”