Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-28T11:11:53.472Z Has data issue: false hasContentIssue false

Not a cure, but helpful’ – exploring the suitability of evidence-based psychological interventions to the needs of Black, Asian and Minority Ethnic (BAME) communities

Published online by Cambridge University Press:  11 January 2023

Afsana Faheem*
Affiliation:
Department of Psychology, University of Bath, Bath, UK
*
Corresponding author. Email: af890@bath.ac.uk

Abstract

Individuals from Black, Asian and Minority Ethnic (BAME) groups experience profound disparities in accessing mental healthcare, show poorer treatment outcomes, and high attrition rates when compared to their White British counterparts. Despite the national rollout of Improving Access to Psychological Therapies (IAPT) services, research exploring service users’ recovery narrative has been scarce. The aim of this study was to explore whether evidence-based psychological interventions are suitable to the needs of BAME communities. Semi-structured interviews were conducted with nine BAME service users who received evidence-based psychological treatment(s) from IAPT services. Reflexive thematic analysis (RTA) was used to analyse the data which included a six-phase process to produce a robust pattern-based analysis. Overall, three themes were generated. The first theme highlighted the importance of recognising cultural dissonance within therapy, which considered patient therapeutic expectations, therapeutic guilt, and conflicting cultural identities. The second theme identified the need for therapists to develop cultural competency. This included the importance of building therapeutic trust and exploration of patient culture within therapy. The final theme considered the road to recovery and highlighted challenges with therapeutic engagement and evaluations of therapeutic effectiveness. Overall, BAME service users felt that therapy was not a cure, but found it helpful. Clinical implications and future recommendations are discussed.

Key learning aims

  1. (1) To briefly introduce cross-cultural theoretical models that may assist mental health professionals to think critically about whether Western notions of therapy are suited to the needs of ethnic minority communities.

  2. (2) To highlight cultural challenges that may impede therapeutic success for BAME communities.

  3. (3) For IAPT services and practitioners to consider cultural competency training needs that may enhance service user therapeutic experiences and outcomes.

  4. (4) To encourage IAPT services to enhance knowledge about psychotherapy and mental health by promoting culturally sensitive psychoeducation in ethnic minority communities.

Type
Original Research
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Bassey, S., & Melluish, S. (2012). Cultural competence in the experiences of IAPT therapists newly trained to deliver cognitive-behavioural therapy: a template analysis focus study. Counselling Psychology Quarterly, 25, 223–238.CrossRefGoogle Scholar
Christodoulou, V., Fortune, L., Arslan, G., & Canan, K. (2018). Turkish-speaking service-user experience of guided self-help in an improving access to psychological therapies service: using discovery interviews to improve services. Qualitative Report, 23, 2205–2221.CrossRefGoogle Scholar
Beck, A., & Naz, S. (2019). The need for service change and community outreach work to support trans-cultural cognitive behaviour therapy with Black and Minority Ethnic communities. the Cognitive Behaviour Therapist, 12.CrossRefGoogle Scholar
Hofstede, G. (2011). Dimensionalizing cultures: the Hofstede model in context. Online Readings in Psychology and Culture, 2, 8.CrossRefGoogle Scholar
Markus, H. R., & Kitayama, S. (1991). Culture and the self: implications for cognition, emotion, and motivation. Psychological Review, 98, 224.CrossRefGoogle Scholar

References

Aggarwal, N. K., Pieh, M. C., Dixon, L., Guarnaccia, P., Alegria, M., & Lewis-Fernandez, R. (2016). Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: a systematic review. Patient Education and Counselling, 99, 198209.CrossRefGoogle ScholarPubMed
Allen, R. L., & Bagozzi, R. P. (2001). Consequences of the Black sense of self. Journal of Black Psychology, 27, 328.CrossRefGoogle Scholar
Al-Krenawi, A., & Graham, J. R. (2000). Culturally sensitive social work practice with Arab clients in mental health settings. Health & Social Work, 25, 922.CrossRefGoogle ScholarPubMed
Althubaiti, A. (2016). Information bias in health research: definition, pitfalls, and adjustment methods. Journal of Multidisciplinary Healthcare, 9, 211.CrossRefGoogle ScholarPubMed
Baker, C. (2018). Mental health statistics for England: prevalence, services and funding. Briefing paper 6988. House of Commons Library. Available at: https://researchbriefings.files.parliament.uk/documents/SN06988/SN06988.pdf Google Scholar
Bassey, S., & Melluish, S. (2012). Cultural competence in the experiences of IAPT therapists newly trained to deliver cognitive-behavioural therapy: a template analysis focus study. Counselling Psychology Quarterly, 25, 223238.CrossRefGoogle Scholar
Beck, A. (2016). Transcultural Cognitive Behavioural Therapy for Anxiety and Depression: A Practical Guide. London, UK: Routledge.CrossRefGoogle Scholar
Beck, A., & Naz, S. (2019). The need for service change and community outreach work to support trans-cultural cognitive behaviour therapy with Black and Minority Ethnic communities. the Cognitive Behaviour Therapist, 12.CrossRefGoogle Scholar
Beck, A., Naz, S., Brooks, M., & Jankowska, M. (2019). Improving Access to Psychological Therapies (IAPT) Black, Asian and Minority Ethnic service user positive practice guide. Available at: https://www.babcp.com/files/About/BAME/IAPT-BAME-PPG-2019.pdf Google Scholar
Bhullar, N., Schutte, N. S., & Malouff, J. M. (2012). Associations of individualistic-collectivistic orientations with emotional intelligence, mental health, and satisfaction with life: a tale of two countries. Individual Differences Research, 10.Google Scholar
Binnie, J. (2015). Do you want therapy with that? A critical account of working within IAPT. Mental Health Review Journal, 20, 7983.CrossRefGoogle Scholar
Boyd, L., Baker, E., & Reilly, J. (2019). Impact of a progressive stepped care approach in an improving access to psychological therapies service: An observational study. Plos One, 14, e0214715.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners. SAGE.Google Scholar
Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11, 589597.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2021a). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18, 328352.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2021b). To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Research in Sport, Exercise and Health, 13, 201216.CrossRefGoogle Scholar
Bricki, N., & Green, J. (2002). A guide to using qualitative research methodology. Available at: http://hdl.handle.net/10144/84230 Google Scholar
Bristow, K., Edwards, S., Funnel, E., Fisher, L., Gask, L., Dowrick, C., & Chew Graham, C. (2011). Help seeking and access to primary care for people from ‘hard-to-reach’ groups with common mental health problems. International Journal of Family Medicine, 2011, 110.CrossRefGoogle ScholarPubMed
Byrne, D. (2021). A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Quality & Quantity, 56, 13911412.CrossRefGoogle Scholar
Cardemil, E. V., & Battle, C. L. (2003). Guess who’s coming to therapy? Getting comfortable with conversations about race and ethnicity in psychotherapy. Professional Psychology: Research and Practice, 34, 278.CrossRefGoogle Scholar
Castillo, R. J., & Guo, K. L. (2011). A framework for cultural competence in health care organizations. The Health Care Manager, 30, 205214.CrossRefGoogle ScholarPubMed
Christodoulou, V., Fortune, L., Arslan, G., & Canan, K. (2018). Turkish-speaking service-user experience of guided self-help in an improving access to psychological therapies service: using discovery interviews to improve services. Qualitative Report, 23, 22052221.Google Scholar
Christopher, J. C. (2001). Culture and psychotherapy: toward a hermeneutic approach. Psychotherapy: Theory, Research, Practice, Training, 38, 115.CrossRefGoogle Scholar
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry, 23, 318327.CrossRefGoogle ScholarPubMed
Clark, D. M. (2018). Realizing the mass public benefit of evidence-based psychological therapies: the IAPT program. Annual Review of Clinical Psychology, 14.CrossRefGoogle ScholarPubMed
Clarke, V., & Braun, V. (2013). Teaching thematic analysis: overcoming challenges and developing strategies for effective learning. The Psychologist, 26, 120123.Google Scholar
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rusch, N., Brown, J. S. L., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45, 1127.CrossRefGoogle ScholarPubMed
Cohen, A. B., Wu, M. S., & Miller, J. (2016). Religion and culture: individualism and collectivism in the East and West. Journal of Cross-Cultural Psychology, 47, 12361249.CrossRefGoogle Scholar
Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6, 579585.CrossRefGoogle Scholar
Fernando, S. (2010). Mental Health, Race and Culture. UK: Palgrave Macmillan.CrossRefGoogle Scholar
Fernando, S. (2012). Race and culture issues in mental health and some thoughts on ethnic identity. Counselling Psychology Quarterly, 25, 113123.CrossRefGoogle Scholar
Frese, F. J. III, Stanley, J., Kress, K., & Vogel-Scibilia, S. (2001). Integrating evidence-based practices and the recovery model. Psychiatric Services, 52, 14621468.CrossRefGoogle ScholarPubMed
Good, M. J. D., & Hannah, S. D. (2015). ‘Shattering culture’: perspectives on cultural competence and evidence-based practice in mental health services. Transcultural Psychiatry, 52, 198221.CrossRefGoogle ScholarPubMed
Gordis, L. (2014). Epidemiology (5th edn). Canada: Elsevier Saunders Inc.Google Scholar
Gushue, G. V., & Constantine, M. G. (2003). Examining individualism, collectivism, and self-differentiation in African American college women. Journal of Mental Health Counseling, 25, 115.CrossRefGoogle Scholar
Harwood, H., Rhead, R., Chui, Z., Bakolis, I., Connor, L., Gazard, B., … & Hatch, S. L. (2021). Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychological Medicine, 112.CrossRefGoogle ScholarPubMed
Hofstede, G. (1980). Culture’s Consequences: International Differences in Work-Related Values. CA, USA: Sage.Google Scholar
Hofstede, G. (2011). Dimensionalizing cultures: the Hofstede model in context. Online Readings in Psychology and Culture, 2, 8.CrossRefGoogle Scholar
Hong, J. J., & Woody, S. R. (2007). Cultural mediators of self-reported social anxiety. Behaviour Research and Therapy, 45, 17791789.CrossRefGoogle ScholarPubMed
Horrell, L., Goldsmith, K. A., Tylee, A. T., Schmidt, U. H., Murphy, C. L., Bonin, E. M., … & Brown, J. S. (2014). One-day cognitive–behavioural therapy self-confidence workshops for people with depression: randomised controlled trial. British Journal of Psychiatry, 204, 222233.CrossRefGoogle ScholarPubMed
Jacob, K. S., Bhugra, D., & Mann, A. H. (2002). A randomised controlled trial of an educational intervention for depression among Asian women in primary care in the United Kingdom. International Journal of Social Psychiatry, 48, 139148.CrossRefGoogle ScholarPubMed
Jacobs, L., & Pentaris, P. (2021). Factors affecting the help-seeking behaviour of Black Asian Minority Ethnic (BAME) groups for mental health services in the UK: a literature review. Greenwich Social Work Review, 2, 156170.CrossRefGoogle Scholar
Lamb, J., Bower, P., Rogers, A., Dowrick, C., & Gask, L. (2012). Access to mental health in primary care: a qualitative meta-synthesis of evidence from the experience of people from ‘hard to reach’ groups. Health, 16, 76104.CrossRefGoogle ScholarPubMed
Laungani, P. D. (2007). Understanding Cross-Cultural Psychology: Eastern and Western Perspectives. London, UK: Sage Publications Ltd.CrossRefGoogle Scholar
Lawton, L., McRae, M., & Gordon, L. (2021). Frontline yet at the back of the queue–improving access and adaptations to CBT for Black African and Caribbean communities. the Cognitive Behaviour Therapist, 14.CrossRefGoogle Scholar
Loewenthal, D. (2018). IAPT: also promoting individualism at the expense of the common good? European Journal of Psychotherapy & Counselling, 20, 249256.CrossRefGoogle Scholar
Loewenthal, D., Mohamed, A., Mukhopadhyay, S., Ganesh, K., & Thomas, R. (2012). Reducing the barriers to accessing psychological therapies for Bengali, Urdu, Tamil and Somali communities in the UK: some implications for training, policy and practice. British Journal of Guidance & Counselling, 40, 43.CrossRefGoogle Scholar
Mantovani, N., Pizzolati, M., & Edge, D. (2017). Exploring the relationship between stigma and help-seeking for mental illness in African-descended faith communities in the UK. Health Expectations, 20, 373384.CrossRefGoogle ScholarPubMed
Markus, H. R., & Kitayama, S. (1991). Culture and the self: implications for cognition, emotion, and motivation. Psychological Review, 98, 224.CrossRefGoogle Scholar
Marshall, D., Quinn, C., Child, S., Shenton, D., Pooler, J., Forber, S., & Byng, R. (2016). What IAPT services can learn from those who do not attend. Journal of Mental Health, 25, 410415.CrossRefGoogle Scholar
Mclean, C., Campbell, C., & Cornish, F. (2003). African-Caribbean interactions with mental health services in the UK: experiences and expectations of exclusion as (re)productive of health inequalities. Social Science & Medicine, 56, 657669.CrossRefGoogle ScholarPubMed
Memon, A., Taylor, K., Mohebati, L. M., Sundin, J., Cooper, M., Scanlon, T., & de Visser, R. (2016). Perceived barriers to accessing mental health services among Black and Minority Ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open, 6, e012337.CrossRefGoogle ScholarPubMed
Miller, E., Bosun-Arjie, S. F., & Ekpenyong, M. S. (2021). Black and ethnic minority carers perceptions on mental health services and support in the United Kingdom: a systematic review. Journal of Public Mental Health, 20, 298311.Google Scholar
Mofrad, L., & Webster, L. A. (2012). The treatment of depression and simple phobia through an interpreter in the North-East of England: a case study. the Cognitive Behaviour Therapist, 5, 102111.CrossRefGoogle Scholar
Mohamed, A. D., & Loewenthal, D. (2009). Is it possible to ethically research the mental health needs of the Somali communities in the UK. Journal of Ethics in Mental Health, 4, 16.Google Scholar
Moller, N. P., Ryans, G., Rollings, J., & Barkham, M. (2019). The 2018 UK NHS Digital annual report on the Improving Access to Psychological Therapies programme: a brief commentary. BMC Psychiatry, 19, 252.CrossRefGoogle ScholarPubMed
Naz, S., Gregory, R., & Bahu, M. (2019). Addressing issues of race, ethnicity and culture in CBT to support therapists and service managers to deliver culturally competent therapy and reduce inequalities in mental health provision for BAME service users. the Cognitive Behaviour Therapist, 12.CrossRefGoogle Scholar
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16.CrossRefGoogle Scholar
Omylinska-Thurston, J., McMeekin, A., Walton, P., & Proctor, G. (2019). Clients’ perceptions of unhelpful factors in CBT in IAPT serving a deprived area of the UK. Counselling and Psychotherapy Research, 19, 455464.CrossRefGoogle Scholar
Pawson, R., & Tilley, N. (1997). Realistic Evaluation. London, UK: Sage Publications.Google Scholar
Pope, C., & Mays, N. (2006). Qualitative Research in Health Care (eds). John Wiley & Sons Ltd.CrossRefGoogle Scholar
Prajapati, R., & Liebling, H. (2021). Accessing mental health services: a systematic review and meta-ethnography of the experiences of South Asian Service users in the UK. Journal of Racial and Ethnic Health Disparities, 9, 598619.CrossRefGoogle ScholarPubMed
Ryan, T., & Pritchard, J. (2004). Good practice in adult mental health. London, UK: Jessica Kingsley Publishers.Google Scholar
Sainsbury Centre for Mental Health (2007). Mental Health at Work: Developing the Business Case. Available at: http://www.scmh.org.uk/pdfs/mental_health_at_work.pdf Google Scholar
Sue, D. W. (1991). A conceptual model for cultural diversity training. Journal of Counseling and Development, 70, 99105.CrossRefGoogle Scholar
Sue, D. W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist, 29, 790821.CrossRefGoogle Scholar
Sue, S. (2006). Cultural competency: from philosophy to research and practice. Journal of Community Psychology, 34, 237245.CrossRefGoogle Scholar
Triandis, H. C. (1995). Individualism & Collectivism. Oxford, UK: Westview Press Inc.Google Scholar
Tse, S., & Ng, R. M. (2014). Applying a mental health recovery approach for people from diverse backgrounds: the case of collectivism and individualism paradigms. Journal of Psychosocial Rehabilitation and Mental Health, 1, 713.CrossRefGoogle Scholar
Williams, C. H. J. (2015). Improving Access to Psychological Therapies (IAPT) and treatment outcomes: epistemological assumptions and controversies. Journal of Psychiatric and Mental Health Nursing, 22, 344351.CrossRefGoogle ScholarPubMed
Supplementary material: File

Faheem supplementary material

Faheem supplementary material

Download Faheem supplementary material(File)
File 48.1 KB
Submit a response

Comments

No Comments have been published for this article.