NHS Talking Therapies for anxiety and depression (NHS TTad) were established in 2008 to increase and improve treatment for anxiety and depression, with the intention of reducing inequalities through being particularly responsive to individuals from marginalised groups. However, racially minoritised clients are under-represented within NHS TTad services, and are more likely to drop out of treatment. A service evaluation was carried out at a central London NHS TTad service to explore the experiences of clients from the ethnic group that was most likely to disengage. The aim was to find ways in which the service could be improved to enhance the experiences of this group and increase the rate of treatment completion. A service audit revealed that clients with a Black background, regardless of their specific ethnicity, had the highest drop-out rate and were significantly more likely to disengage than the White British group. The service evaluation involved interviewing six clients from this group who had recently dropped out of or declined treatment. Interviews were structured and analysed using narrative inquiry, and pattern coding was used to reduce large amounts of data into four main themes. Overall, participants found accessing support relatively easy but had limited knowledge on the service. A lack of choice and flexibility around appointments were highlighted as key factors in not completing therapy. Based on their experiences, participants recommended incorporating community and cultural learning into therapists’ training, and giving clients the option to request a therapist from a similar background. Recommendations are provided for service delivery.
Key learning aims(1) To identify which clients, based on ethnicity, are most likely to decline or discontinue treatment within an NHS TTad service in Central London.
(2) To increase understanding of the treatment experiences of clients from the ethnic group with the highest drop-out rates.
(3) To provide recommendations offered by these clients for service providers, aimed at improving engagement and treatment completion.
