IAPT has proactively worked to increase access across the age spectrum and to meet the needs of diverse and underrepresented groups. Key information about these areas can be found below. Equality is essentially about creating a fairer society where everyone can participate and has the opportunity to fulfil their potential. It is underpinned by legislation designed to address unfair discrimination (past, present or potential) that is based on membership of a particular group. In some circumstances, positive action is encouraged to address discrimination. It is often summarised in terms of:
Equal access, Equal treatment, Equal outcomes, Equality of opportunity
Diversity is about the recognition and valuing of difference in its broadest sense, and creating a working culture and practices that recognise, respect, value and harness difference for the benefit of the organisation and the individual. The term describes the range of visible and non-visible differences that exist between people. Managing diversity harnesses these differences to create a productive environment in which everybody feels valued, where talents are fully utilised and in which organisational goals are met. Equality and diversity are not interchangeable but are interdependent. There is no advancement of equality if difference is not recognised and valued. The Department of Health published the "No Health Without Mental Health" Strategy in February 2011, which summarises actions on equality in chapter six and includes an analysis of the impact on equality. Human Rights and equality are inextricably linked, because they are derived from the same principles of, social justice, deferential treatment and dignity for every person. A human rights approach treats the individual as a whole person and strives to address their requirements holistically. At the heart of human rights is the belief that everybody should have autonomy, be treated fairly and with dignity - no matter what their circumstances. The Equality and Human Rights Commission identifies 15 rights protected by the Human Rights Act 1998. These can be summarised as follows:
Being treated fairly and with dignity; taking part in the community; living the life you choose; and being safe and protected from harm
In summary, this legislation places a requirement on public bodies to assess their current provision, identify the needs of their 'customer' base and then work with those people to develop the right services, anticipating needs and differentiating the interventions in order to achieve equity of access, experience and outcome. Recent public mental health work supports the Human Rights Act by highlighting the links between poor mental health and inequalities. We know that poor mental health can both be a consequence of inequality and result in social, economic and health inequality. For example, poor mental health is more common in areas of deprivation. It can lead to higher risk health behaviours (for example, smoking and drug misuse). This, combined with unequal access to quality healthcare, can result in poor health outcomes and shortened life expectancy. Talking Therapy Services support the Human Rights Act by expanding access to NICE approved psychological therapies across all communities, particularly for people that are at higher risk of developing poor mental health due to social, economic and health inequalities. The Public Sector Equality Duty is a specific duty, underpinning the general duties and came into force on 6 April 2011. The public sector equality duty covers all of the protected characteristics and public organisations are required to create equality objectives and publish information which enables the public to monitor the organisation's ability to promote equality, foster good relations and eliminate discrimination, harassment and victimisation. More information is available from the Equalities and Human Rights Commission website.
Equality and human rights in talking therapy is achieved through tackling barriers which adversely affect access to services, including self-referral pathways. Barriers to equal access to psychological therapies are well documented. Some groups that are at a higher risk of developing mental health problems are less likely to self-refer or be referred to psychological therapy services. Barriers to people using psychological therapies include:
- Lack of understanding of the value and effectiveness of therapy among the general population and the workforce
- Language, including the use of particular terms such as ‘talking therapies'. Some individuals can feel that they receive ‘talking therapies' from their friends or family
- Stigma of mental health problems and use of mental health services
- Individualist nature of some therapies, which can preclude family members or carers
- Religion or belief does not always form part of therapy
- Access and referral processes
- Accurate data collection and analysis of individuals using psychological therapies will identify gaps and help develop strategies that advance equality of opportunity
- Variable access throughout the life course.
Effectively challenging barriers to access involves establishing service standards which relate to:
- Access - care pathways and referral rates
- Experience - data from patient survey
- Outcomes - retention and recovery rates.
Focus on these areas will have the impact of tackling the under-representation of some communities and stigma that adversely affects help seeking behaviour. This is achieved through recognition and monitoring of variation among different groups. The following are key to achieving this:
- Service users are more inclined to drop out or fail to engage with therapy if their culture is neglected. The term culture is defined as a set of values that produces a perception of self and an understanding of one's place in the world
- Culturally adapted services focus upon data collection and analysis to identify and ensure inclusion of people of variable cultures
- Working with sensitive areas such as sexual orientation or religion and belief when exploring an individual's belief systems
- Responding to negative social identity about race, sexual orientation, gender and age to counter any stigma regarding the use and efficacy of psychological therapies
- Recognition that ethnic and gender matching can be a choice for some service users but does not automatically equate to culturally sensitive services
- Constructive and productive community engagement with different members of the community to help evidence service user inclusion in service design and planning. This remains a priority for the NHS Equality Delivery System that was implemented across the NHS in April 2011.
- Use of questioning during therapy to improve data collection, address information gaps and enable accurate recording
- Cultivate culturally responsive psychological therapies which is documented as more effective across all communities and groups
- Ethnic and gender matching has advantages but does not always translate to positive outcomes
- Therapists are ultimately responsible for providing culturally adapted services.
- Commissioning for the whole community
- Older People's Information
- Long Term Conditions and Medically Unexplained Symptoms Information
- Long Term Conditions Positive Practice Guide
- Antinatal and Perinatal Information
- Learning Disabilities Information
- BME Information
- Veteran's Information
- LGBT Information
- Drug and Alcohol Information
- Offenders Information
IAPT British Sign Language Information
Long term and Medically Unexplained Conditions Information
- Long term conditions positive practice guide
- IAPT long term conditions medically unexplained symptoms pathfinder evaluation project phase 1 final report
- Investing in emotional and psychological wellbeing for patients with long-term conditions
- A competence framework for psychological interventions with people with persistent physical health conditions
- Medically unexplained symptoms functional symptoms positive practice guide
Translated Outcome Measures
- Patient Health Questionnaire 9 and General Anxiety Disorder Rating Table 7
- General anxiety questionnaire Arabic
- General anxiety questionnaire Polish
- Patient health questionnaire 9 Polish
- Work and social adjustment scale Polish
- Patient Health Questionnaire 9 and General Anxiety Disorder Rating Table 7 clinical assessment tools in Punjabi
- Patient Health Questionnaire 9 and General Anxiety Disorder Rating Table 7 clinical assessment tools in Urdu
- Patient Health Questionnaire 9 and General Anxiety Disorder Rating Table 7 clinical assessment tools in Bengali
- Patient Health Questionnaire 9 Hindi
Translated Information for Patients
Having access to translated information for patients that can be accessed in a timely way is essential for IAPT practitioners and services. The Royal College of Psychiatry has a patient information leaflets available; including condition information and leaflets about what CBT is translated into a large range of languages and BSL. You can access these by visiting the Translations Index or by clicking straight to the translation you want to access:
British Sign Language
Translated Self Help Materials
To help improve accessibility, the following translated self help materials have been produced in the nine most common, non English languages spoken in London for use by IAPT services. These resources have been made publically available for services to use with kind permission from Camden & Islington NHS Foundation Trust and are available on the London Health Programmes NHS website.
Mind Over Mood by Greenberger & Padesky is available in a range of languages on their website.
A number of the Five Areas materials are available in language translations. Contact information can be found on their website.