This report was first published on Mad In America September 3rd 2024
A recent study published in the International Journal of Social Psychiatry sheds light on the barriers minority women in the UK face when seeking mental health treatment. The research highlights the importance of cultural sensitivity and flexibility in therapy services to improve outcomes for this underserved population.
The study, led by Laura-Louise Arundell of University College London, involved interviews with 12 minority women receiving NHS talking therapies. While common mental health issues (such as anxiety and depression) are more prevalent for women than men, and women are more likely to seek treatment, there is a disparity in access and utilization of mental health services for minority women in the UK.
The authors write:
“The study emphasizes the importance of culturally sensitive care and identifies some of the challenges and facilitators associated with the delivery of treatment to minoritized communities. Most importantly, the study outlines improvements that services could make at the treatment delivery, treatment content, and wider organization levels to optimize experiences and outcomes.”
Participants reported facing significant hurdles, including long wait times, limited treatment options, and a lack of cultural understanding from therapists. To address these issues, the authors advocate for a more diverse mental health workforce, reduced wait times, and services tailored to the unique cultural and personal needs of minority women.
The authors recruited 12 participants who were receiving NHS talking therapies for anxiety and depression (NHSTTad) in north London to take part in semi-structured interviews about their experience of the treatment. To be included in the present research, participants had to belong to a minority ethnic group, be between 18 and 65 years old, identify as female or as a woman, have attended at least two NHSTTad sessions, and have to speak English.
The authors developed a draft of interview questions that were then refined after review by an NHS Black, Asian, and Minority Ethnic Staff Working Group and a Service User Advisory Group. Potential participants who had agreed to be contacted about research opportunities were reached via email and telephone after the authors consulted their named clinician about any concerns about the service users’ participation.
Interviews were conducted between February and April 2022. Each interview lasted 40 minutes to one hour and was recorded and transcribed. The researchers then coded the transcripts and identified overarching themes in the interviews.
Out of the twelve participants, six were between 25 and 34 years old, four were between 18 and 24 years old, one was between 35 and 44, and one was between 55 and 64. All participants had attended at least six therapy sessions, with seven having attended ten or more, including two who had attended more than 20 sessions. The ethnicities represented in the group included Asian, Indian, Black, African, Caribbean, Arab, Irish, Chinese, Pakistani, and Mixed.
The researchers identified four overarching themes from the interviews: cultural identity and experiences of mental health and treatment, challenges associated with treatment, facilitators of good treatment experiences and outcomes, and improvements for women from minoritized ethnic groups.
Cultural Identity and Experiences of Mental Health and Treatment
This theme included how culture could affect the way people viewed mental health, seeking help for mental health issues, and treatment, as well as the importance of culturally sensitive treatment. While some participants reported that cultural awareness and sensitivity were critical in therapy, others did not view cultural adaptations as necessary in their treatment. Some participants reported that their culture could be dismissive of mental health and stigmatize people with mental health struggles. One participant said:
“I think, you know, even admitting that you. . . have mental health issues. It’s just such a stigma. You are seen as weak and it took me a long time accept. . . to accept my mental health status and, and then you know and even till today like you know my extended family didn’t accept it. . .Why is this such a scary thing for people in my culture?”
Challenges Associated with Treatment
Participants reported three main challenging areas associated with treatment: access, limitations of NHSTTad treatments, and personal issues that affected participation in treatment. Participants commonly reported issues with wait times. Some endured long waits for assessment followed by shorter waits for treatment, while others were assessed quickly and then had a long wait for treatment. Sessions were often seen as too short, and the number of sessions was insufficient. Participants also reported that it was personally challenging to speak about their own mental health problems and unpleasant memories.
Facilitators of Good Treatment Experiences and Outcomes
The therapist’s temperament and ability to establish trust were necessary for the participants. Service users favored non-judgemental and open-minded therapists. Open-mindedness was particularly important when the therapist was from a culture different from that of the service user. Some participants could better relate to therapists who shared personal identity characteristics (age, gender, ethnicity) with them. Having a female therapist was particularly significant for women who had reported bad experiences with men. Flexibility in scheduling, number of sessions, length of sessions, and treatment format (remote or face-to-face) was viewed by many participants as necessary.
Improvements for Women from Minoritised Ethnic Groups
Participants pointed to 5 areas that could help improve mental health services for minority women: cultural sensitivity, waiting times, service availability and delivery, workforce, and outreach/uptake/engagement. Participants expressed that therapists should have knowledge of minority cultures and ensure that materials and resources used in treatment are culturally relevant.
Dissatisfaction with waiting times was common among participants. Service users often recommended offering options for increasing the number of sessions and for the format of sessions (remote or face-to-face) as a possible improvement. While some participants expressed a desire to work with a therapist from their own culture, others did not view it as essential and some said they would prefer not to work with someone from a similar cultural background. Generally, participants believed that more diversity in the mental health workforce could improve services. Some participants also expressed that mental health services should be promoted in minority communities along with education about mental health issues.
The authors acknowledge several limitations to the current work. The low number of participants and the fact that most of them were between 18 and 34 years old limits generalizability to other populations. The participants came from areas with large ethnic minority populations. Minority women from areas with smaller ethnic minority populations may have different experiences of mental health services. Participants were required to speak English, and none of them required explicit cultural adaptations in treatment, further limiting generalizability to non-English speaking populations.
Many participants reported the number of sessions they had had in the past rather than just the number of NHSTTas sessions. While participants were invited to give input around the themes identified by researchers, none did. This means the service users did not verify the themes. Interviews were conducted remotely. Face-to-face interviews may have yielded different results. One limitation not acknowledged by the authors was that service user clinicians were contacted before the service users to assess their fitness for participation in the interviews. This could have biased the research towards participants that clinicians felt would paint them in the best light.
The authors conclude:
“The study outlines improvements that services could make at the treatment delivery, treatment content, and wider organization levels to optimize experiences and outcomes. There was consensus that taking service user preferences into account, in terms of therapist gender and treatment format, is key. This necessitates a stronger focus on workforce diversity and flexibility of service delivery.”
Psychiatry has a long history of oppressing women and minorities. One expert has argued that an unacknowledged role of doctors is the suppression of women. Research has shown that racial and gender stereotypes can affect psychiatric diagnosis in both children and adults. Black and multiracial service users are more likely to be restrained in psychiatric settings and have negative descriptors in their patient health records.