Advancing mental health equalities in NHS Talking Therapies for anxiety and depression services

Addressing health inequalities has been a priority in mental health for years, as highlighted in the Five Year Forward View for Mental Health and the NHS Long Term Plan.

The NHS Talking Therapies team’s work on advancing mental health equalities forms part of NHS England’s commitments to reduce mental health inequalities, and builds on the wider Advancing Mental Health Equalities Strategy, which was published in October 2020.

The NHS Talking Therapies programme’s work to advance equalities includes actions to reduce inequalities in access, experience and outcomes for different groups and communities in NHS Talking Therapies services.

1. Inequalities in access: Different groups access services differently, with underrepresentation in some services and overrepresentation in others. In NHS Talking Therapies, for example, older people are underrepresented across the country.

2. Inequality in experience: Different groups report having different levels of satisfaction with the healthcare they receive.

3. Inequality in outcomes: Different groups receiving the same treatment also have different recovery outcomes but over the years, there has been progress on ethnic minority outcomes. In 2021/22, the recovery target was met for seven ethnic groups: Indian, Black African, Black Caribbean, Chinese, White British, White Irish and Other White Background. However, the data also shows that there is much more to do to enable all ethnic communities to achieve equitable access and outcomes. 

Workstream 1: Supporting local systems to advance equalities

This means equipping systems with the tools and enablers they need to bridge the inequality gaps.

1. Developing and using NHS Talking Therapies Positive Practice Guides (PPG)

NHS Talking Therapies for Anxiety and Depression PPGs have been developed to support commissioners and providers to improve equity of experience, access and outcomes for a number of specific underrepresented groups. Current guidance available are listed below, some of which are currently being refreshed and additional guides are currently being developed for other underrepresented groups.

2. Translating Step 2 low-intensity resources

For guided self-help interventions, step 2 materials are often utilised by PWPs. There is sometimes a barrier to the interaction between patient and clinician for non-English patients. In 2022/23, the national team worked with providers of high quality Step 2 resources and translated these resources into 10 languages including Arabic, Bengali, Pakistani Punjabi, Persian Farsi, Polish, Portuguese, Russian, Spanish, Ukrainian and Urdu.

Example resources include:

All resources can be accessed through our Futures webpage: NHS Talking Therapies, for Anxiety and Depression – FutureNHS Collaboration Platform (this platform requires a log in).

Workstream 2: Improving the quality and use of data

This means developing insight, raising the profile of inequalities and informing action within NHS Talking Therapies.

1. Improving the quality of outcomes data by ensuring outcome measures are available in multiple languages

In 2020/21, the national team translated 14 of its recommended patient reported outcome measures and 2 patient experience questionnaires into 17 languages. Ukrainian was added in 2022. This has allowed patients, whose first language is not English, to accurately record their symptoms without misinterpretation which further enables clinicians to give the most appropriate treatment.

The National Clinical Content Repository have obtained permission from outcome measure tool owners for their use across the NHS. This has reduced burden for individual providers who can now, in one form, request permission to use outcome measures in 19 languages (including English). Please use the following link to obtain permissions National Clinical Content Repository (Copyright Licensing Service) – NHS Digital

2. Signalling to systems that improving outcomes for ethnic minorities is a priority

In 2021/22, the national team introduced a support metric to close the outcomes gap between ‘White British’ and all other ethnicities. This metric is reported via performance dashboards and through the programme delivery board on an ongoing basis. This data is also available quarterly and annually in the NHS Talking Therapies publications.

In 2022/23, the recovery rate gap between ‘White British’ and all other ethnicities has reduced to 1.8% (from 4% in 2020/21).

Workstream 3: Workforce

This means educating and supporting therapists and other staff working in NHS Talking Therapies Services.

1. Developing training opportunities for staff

Training opportunities are reviewed regularly, to ensure that NHS Talking Therapies clinicians have the skills, knowledge and confidence to advance equalities. In 2022/23, the national team revised the core curriculum for HITs and PWPs, to ensure there was a more detailed introduction to equality, diversity, and inclusion. For the existing workforce, there is an ongoing review of national webinars and new training content being designed and developed, to provide clinicians with a better grounding for culturally sensitive and diverse practices in clinical delivery.

2. Supporting Leadership Development of those from Ethnic Minority Communities

It is known that under-representation of minoritised groups becomes more pronounced in more senior psychological professions roles. In 2021/22, NHS England commissioned the RISE mentoring scheme to deliver leadership mentoring opportunities for ethnic minority psychological professionals (AfC Bands 5 – 8a) who aspire to lead. This will support the creation of more diverse, inclusive leadership in the psychological professions. Improving equity and inclusion for people to access psychological professions training | Health Education England (