Quality statement 5: Access to services for adults from minority ethnic backgrounds
Adults from minority ethnic backgrounds may experience difficulty and stigma accessing mental health services. Strategies to address variation in access to mental health services may include offering culturally appropriate access and pathways to care that deliver culturally appropriate and adapted treatments. By monitoring and comparing rates of access to mental health services among adults with depression by ethnicity, approaches to promoting and improving access to mental health services can be identified.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Evidence of action plans that identify strategies and measures to support adults from underrepresented groups to access treatment for depression where a need to improve and promote access has been identified from monitoring local data.
Data source: Evidence can be collected from information recorded locally by provider organisations and healthcare professionals, for example from local plans.
Data source: NHS England's Improving Access to Psychological Therapies (IAPT) data set records numbers of referrals received and referrals accessing services by ethnicity. NHS England's Mental Health Services Data Set records numbers of referrals and care contacts (including a group session or drop-in contact).
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records, for data on prescriptions for depression, by ethnicity.
Data on the number of referrals that finished a course of treatment is collected for NHS England's IAPT data set reports.
c) Time from first presentation with symptoms of depression to starting treatment for depression, by ethnicity.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations and healthcare professionals, for example from patient records.
NHS England's IAPT data set records data on referrals accessing services by ethnicity. NHS England's Mental Health Services Data Set records care contacts and collects data on diagnosis and ethnicity.
Service providers (such as GP practices, community health services, mental health services including NHS talking therapy services, charities and third-sector organisations) work with commissioners to develop local care pathways that promote access to mental health services tailored to the needs of the local population. They ensure that services are accessible and culturally appropriate to adults from minority ethnic backgrounds with depression. They also provide culturally adapted information about pathways into treatment, which is also available in different languages and formats. Services routinely collect ethnicity data to monitor, assess and support equity of access.
Healthcare professionals (such as GPs, specialist nurses and mental health professionals) give adults from minority ethnic backgrounds with depression information on how to access mental health services. They are aware of local pathways and have relevant culturally adapted information available in different languages. They offer different options for accessing services, ensuring that adults with depression from minority ethnic backgrounds can choose culturally appropriate services.
Commissioners work with providers to promote access to mental health services among adults from minority ethnic backgrounds with depression. Commissioners identify the needs of the local population and work with providers to develop local care pathways tailored to their needs. They also provide culturally adapted information about these pathways in different languages. They ensure that mental health services are provided in a variety of settings and that a range of support is available. They match access rates to local population and demographic data (collected, for example, by NHS talking therapy services) and monitor the extent to which providers reduce barriers to access in these groups.
Adults from minority ethnic backgrounds with depression are given a choice of ways to access mental health services that are culturally appropriate to them. They can access information about routes to treatment that has been adapted to their culture and beliefs, and written in a language that they can understand.
Depression in adults: treatment and management. NICE guideline NG222 (2022), recommendations 1.16.4 to 1.16.6
Depression in adults with a chronic physical health problem: recognition and management. NICE guideline CG91 (2009), recommendation 126.96.36.199
Commissioners and providers of mental health services should ensure pathways have the following in place for adults with depression to promote access, and increase uptake and retention:
services available outside normal working hours
a range of different methods to engage with and deliver treatments in addition to in-person meetings, such as text messages, email, telephone and online or remote consultations (where clinically appropriate, and for adults who wish to access and are able to access services in this way)
services provided in community-based settings, for example in a person's home, community centres, leisure centres, care homes, social centres and integrated clinics within primary care (particularly for older people)
services delivered jointly with charities or the voluntary sector
bilingual therapists or independent translators
procedures to support active involvement of families, partners and carers, if agreed by the person with depression.
Commissioners and providers of mental health services should also ensure that culturally adapted information about pathways to treatment is available. Examples include adaptations to reflect religion and spirituality, beliefs about mental illness, experience of stigma, and use of metaphor, stories and examples that are meaningful to the respective culture. The information should also be made available in different languages. [NICE's guideline on depression in adults, recommendations 1.16.4 and 1.16.5, and expert opinion]
The NICE guideline on depression in adults recognises that other groups also experience barriers to accessing mental health services and may benefit from interventions designed to improve access. Commissioners and providers should consider their local population and any unwarranted variation in access between adults with depression in groups such as:
lesbian, gay, bisexual and trans adults
adults experiencing homelessness, refugees and asylum seekers.
[Adapted from NICE's guideline on depression in adults, recommendation 1.16.6, and NICE's guideline on depression in adults with a chronic physical health problem, recommendation 188.8.131.52]