Study finds ethnic disparities in access to early psychological interventions for psychosis in England

People experiencing a psychotic episode for the first time are less likely to receive early psychological interventions in England if they are from an ethnic minority background, finds a new study led by UCL researchers.

Some groups were only half as likely to receive early treatment, which is important for improving outcomes later in life for people with psychotic disorders such as schizophrenia, according to the findings published in Psychiatry Research and led by the National Institute for Health and Care Research (NIHR) Mental Health Policy Research Unit at UCL.

Early intervention is very important for people with psychosis, as treatment early on can greatly improve the long-term prognosis. Offering early intervention, including treatments that are known to be effective such as Cognitive Behavioural Therapy and family interventions, to everyone who needs it is now a policy-mandated goal in England.

Unfortunately, we found there are stark, pervasive ethnic inequalities in who gets these early interventions for psychosis, both for talk therapy and for family interventions.”

Merle Schlief, Lead Author, PhD Candidate, UCL Psychiatry

The researchers reviewed three years of data from the National Clinical Audit of Psychosis, commissioned by the Healthcare Quality Improvement Partnership, including data on 29,610 people with first-episode psychosis who were in contact with Early Intervention in Psychosis services in England. They were reviewing whether people were offered, and whether they received, two of the key non-pharmacological treatments for early psychosis: tailored talk therapy – Cognitive Behavioural Therapy for psychosis (CBTp) – and family interventions, which support families in helping people with psychosis.

They found that across all ethnic groups, only 47% of people experiencing a first episode of psychosis in the study received CBTp and only 21% received family intervention.

Nearly all ethnic minority groups were less likely to receive CBTp compared to white British patients. South Asian, Chinese and Black people were close to half as likely as white British people to receive CBTp, with Bangladeshi people being the least likely to receive CBTp. Some ethnic groups, particularly Black adults, were also less likely to receive family intervention services.

While this research did not investigate causes of the disparities, the study authors say there are likely multiple factors on the service and staff side, such as misperceptions of appropriateness of treatments or lack of interpreters, as well as service users from some groups being less engaged with mental health services or perceiving treatments that have not been tailored to their own needs as of limited relevance to them. Some ethnic groups are more likely to experience coercive pathways to care such as involuntary hospital admissions, which can reduce trust of healthcare professionals and services.

Professor Sonia Johnson (UCL Psychiatry), Director of the Mental Health Policy Research Unit, said: “Despite a national service model intended to ensure all are offered effective treatment, many people are still missing out on much-needed early treatment for psychosis.

“Mental health care providers need to be aware of such disparities between ethnic groups and be culturally sensitive. More research is also needed, ideally involving service users themselves, to better understand the complex reasons behind such disparities and the best ways to address them, including making sure that treatments are helpful and relevant across the whole population.”