‘It’s been quite a poor show’ – exploring whether practitioners working for Improving Access to Psychological Therapies (IAPT) services are culturally competent to deal with the needs of Black, Asian and Minority Ethnic (BAME) communities

Abstract

Cultural competency is a core clinical skill. Yet, psychological therapists may be inadequately trained to deal with the needs of service users from Black, Asian and Minority Ethnic (BAME) backgrounds. This can lead to dissatisfaction with mental health services, disengagement from therapy, and poorer treatment outcomes when compared to the White British population. The aim of this study was to explore whether practitioners working for Improving Access to Psychological Therapies (IAPT) services are culturally competent to deal with the needs of diverse communities. Semi-structured interviews were carried out with a range of practitioners, from early career psychological wellbeing practitioners (PWPs) to senior cognitive behavioural therapists (n=16). Reflexive thematic analysis (RTA) was used to analyse the data, guided by a six-phase process to produce a robust pattern-based analysis. Overall, three themes were generated: (1) encountering cultural dissonance within therapy; (2) challenges in making cultural adaptations to therapy; and (3) identifying cultural competency needs. Out of sixteen participants, only nine therapists received one-day formal training throughout their therapeutic career, whilst seven reported receiving no cultural competence training at all. Overall, it appears that there is an urgent need and desire for therapists to be offered cultural competency training so that they can better serve BAME communities. Clinical implications and future recommendations are made. Key learning aims (1) To briefly introduce cross-cultural theoretical models that may assist mental health professionals to think critically about Western notions of therapy and whether they are suited to the needs of ethnic minority communities. (2) To consider challenges IAPT practitioners encounter during therapy and identify examples of good practice. (3) To explore to what extent IAPT practitioners feel culturally competent to deal with the needs of BAME communities. (4) To encourage IAPT services and decision makers (e.g. training bodies and commissioners) to enhance cultural competence training so that practitioners can better serve ethnic minority communities.

Psychological wellbeing practitioners’ experiences of improving access to psychological therapies (IAPT) services cultural competency training

“…Research shows that ethnic matching can be an effective approach for tailoring therapy (Arundell et al , 2021) as it enables practitioners to identify the needs of service users from ethnic minorities by improving communication and facilitating rapport (Alegría et al , 2013; Granek et al , 2020). Similar to the findings of Faheem (2023b), BAME therapists were better able to empathise with their patients if they shared an ethnic identity because they were familiar with their family dynamics and upbringing. Although PWP participants of the current study did not raise any issues of ethnic matching, recognizing if a BAME service user prefers seeing a non-BAME therapist due to fear of judgement or due to discussing sensitive topics is also a crucial cultural competency skill (Faheem, 2023b).…”

“…Due to the ethnic differences, PWPs felt compelled to hear and address service users’ experiences of being part of ethnic minorities, to prove that they are unbiased and objective in their practice. This contrasts Faheem (2023b), where White therapists are reported to have been reluctant to see BAME patients because they felt afraid to deal with individuals from different ethnic backgrounds. Similarly, previous research has also shown that White therapists feel uncomfortable with BAME service users, particularly because they lack the training needed to equip them to address cultural differences in therapy (Knox et al , 2003; Patel, 2014).…”

“…Given that most cultural competency training packages consist of a minimum of two days of mandatory training, one day training offered by IAPT services was insufficient to instil cultural competency skills (Clegg et al , 2016). Similarly, seven out of 16 IAPT practitioners in Faheem (2023b) also reported one day of cultural competency training, which focused on diverse communities in general. In addition, Clegg et al (2016) reported that specific models of cultural competence may enhance the depth and structure of the training, however, the IAPT manual does not reveal whether such models are incorporated in PWP training (NCCMH, 2018).…”

“…Therefore, IAPT can consider incorporating PWPs’ personal initiatives and experiences to enhance cultural competency training. However, engaging in additional methods to improve cultural competency may also be disadvantageous, as PWPs would spend time outside of work hours to undergo such initiatives, leading to increased pressure and potential burnout (Faheem, 2023b).…”

“…Critics argue whether being culturally competent is enough, and whether practitioners should embrace cultural humility as a lifelong commitment to address power imbalances inherent in clinical practice (Greene-Moton and Minkler, 2020; Tervalon and Murray-Garcia, 1998). However, it appears that there are inconsistencies in how cultural competency training is offered as part of clinical training programmes in the UK, including those working for Improving Access to Psychological Therapies (IAPT) services (Clegg et al , 2016; Faheem, 2023b).…”