Guidance and an associated action plan to improve access to, and provision of, psychological interventions to people from Black, Asian and minority ethnic (BAME) communities: Summary Report of a Rapid Review

The aim of this rapid review is to identify research and professional guidance on the provision of psychological therapies for members of Black, Asian and minority ethnic (BAME) communities. These will be used to provide a set of good practice guidelines to inform the Matrics Cymru national standards for service delivery. The review process identified an initial body of 4,379 research papers and grey literature sources (e.g., professional guidelines, government reports). From these, 232 articles were identified as suitable for full text review and after this process was complete there were 19 papers included in this rapid review. The data suggested that clients from BAME communities may experience higher rates of mental health difficulties associated with certain socio-economic, contextual, historical, and systemic predisposing factors. In addition, despite the need and potential benefits of psychological therapies, clients from BAME communities tend to be underrepresented and have poorer access to interventions of this type. Furthermore, when they do access psychological therapies, there tend to be higher non-completion rates and poorer outcomes.

Research evidence indicates that poorer access and outcomes are related to a number of barriers;

Client-facing or community-facing barriers, such as individual or community-based stigma about mental health problems or community-based mistrust about mental health services, reluctance to engage with them, and concerns about the implications of engagement.

Organisational or service-based barriers, such as service pathways to referral being challenging to navigate, longer waiting times, or service policy models.

Therapist-facing barriers, such as therapists being avoidant or anxious about discussing pertinent aspects of the client's culture or identity or a lack of training in culturally adapted therapies, in part due to core training not addressing this topic or lack of CPD.

Therapeutic approach barriers, for example, the generic application of a Western, individualistic therapeutic approach without consideration of the client's culture, background, or identity.

A number of studies in this review have described attempts to address these issues with the development and piloting of culturally sensitive or culturally adapted psychological therapies;

Culturally sensitive psychological therapies tend to look much more like the psychological therapy provided to majority service users, but with adaptations made on a case-by-case basis by therapists, service users, or even interpreters. For instance, when helping a client increase their activity levels, including activities that are culturally appropriate and in keeping with their identity.

Culturally adapted psychological therapies involve retaining the active components of the psychological therapy while incorporating elements of the distinct and culturally mediated aspects of the way that mental health problems are expressed and understood. For instance, exploring and integrating cultural norms and behaviour into psychological therapy for a community group.

When appropriately modified, such psychological therapies have shown positive results in terms of accessibility, appropriateness, acceptability and outcomes. However, there is still limited research on the efficacy of such interventions across distinct cultural communities. In addition, access and outcome barriers need to be addressed with a more community based collaborative approach to service development. Furthermore, psychological therapists need support and guidance in adapting their practices to suit diverse cultural groups, and service level changes may also be needed in order facilitate this. We have developed several recommendations for research and practice, based on our review (see pages 35-38).