How to increase BME access to psychological therapies

The Improving Access to Psychological Therapies Positive Practice Guide makes it clear that anybody accessing mental health services faces potential barriers. Ethnicity, culture, faith or language may all place additional barriers in the way of people from black and minority ethnic communities.

Having therapists who speak the same language and observe the same religious rites as their patients is good but it’s not the whole answer

As part of the improving access programme for these therapies, several demonstration, pathfinder and “second wave” sites have developed approaches that have begun to remove the barriers and show positive outcomes in the treatment of depression and anxiety among BME groups.

The London Borough of Newham has a 63 per cent BME population and is the most ethnically diverse borough in the country. Meeting the psychological needs of communities from South Asia, Eastern Europe, the Baltic States and other regions around the globe presents the programme demonstration site team working at Newham Primary Care Trust with a genuine challenge.

Nonetheless it now successfully provides a flexible and evolving service responsive to a range of language, faith and cultural needs (see box).

“We realise many people who have not been accessing our psychological services take their concerns related to anxiety or depression to their local religious leaders,” says interim service manager Julia Doe. “So we have been meeting with representatives from the local mosques and, through one of our senior therapists who speaks several community languages, have been explaining what services we can offer. The mosques have become a conduit for referrals to us.”

Local publicity

These steps have been backed up with interviews on local community radio stations and an article in the monthly local authority magazine.

Ms Doe continues: “We have also worked hard with religious leaders to overcome the stigma associated with mental illness. The results have been good and we have started to offer evening and Sunday clinics specifically for BME clients as a response to the increased uptake.”

In a borough with a BME population of over 70 per cent, Ealing PCT’s pathfinder site has increased its referrals from BME groups by 40 per cent. In the opinion mental health wellbeing service head Baljeet Ruprah-Shah, two things have particularly influenced this - a team of experienced practitioners who share cultural identity with the communities they serve and a huge publicity campaign.

“Having therapists who speak the same language and observe the same religious rites as their patients is good but it’s not the whole answer,” says Ms Ruprah-Shah. “Not all of our Punjabi speaking female clients for instance want to be seen by a practitioner from the same background. Within our team, however, we can share our insights into a wide range of cultural complexities and make sure that client is seen by someone who understands what she is going through.”

A strong understanding at the early stages of treatment is essential to the success of any intensive psychological therapy. It also keeps the did not attend rates down.

Multi-agency links

In Bristol PCT the local programme, a second wave site which went live this April, is provided by Turning Point’s Rightsteps service. The BME population of some city centre wards is perhaps as high as 50 per cent.

“Some of our team of therapists, of which 25 per cent are from the BME community, were recruited through adverts on local community radio,” says service manager Phil Harrison.

“Through links with the agencies, support groups and community development workers we have been able to build up an awareness of the service by word of mouth.”

Close involvement with the voluntary sector and the subsequent opportunities this provides for intelligence and workforce development could well feature in future commissioning intentions.

“The strength of the Improving Access to Psychological Therapies Positive programme is it embeds equal access through systems and processes,” says national head of delivering race equality in mental health Melba Wilson.