An Evaluation Of Improving Access To Psychological Therapies (IAPT) Services Offered To Culturally And Ethnically Diverse (CED) Communities: A Mixed-Methods Approach

Clarke-Jeffers, Paige (2026) An Evaluation Of Improving Access To Psychological Therapies (IAPT) Services Offered To Culturally And Ethnically Diverse (CED) Communities: A Mixed-Methods Approach. Doctoral thesis, Birmingham City University.

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Abstract

Purpose. Previous literature has outlined that Black, Asian and Mixed/Dual-Heritage groups have lower recovery rates with the Improving Access to Psychological Therapy (IAPT) service compared to white service users in the United Kingdom. The research rationale is to understand and address mental health disparities between the two groups. The aims are to explore both clinicians' and service users' perspectives on their IAPT experiences. Also, the aim is to investigate variables such as autonomy, religious affiliation and referral pathways on clinical outcomes. The purpose of these aims is to explore what factors are contributing towards the health inequality gap and lower recovery amongst Black, Asian and Mixed/Dual-Heritage groups.

Methods. A mixed methods approach was used, which included 1) Clinicians' IAPT Experiences (qualitative), 2) CED service users' IAPT Experience (qualitative), 3) Effects of Autonomy and Ethnicity on Mental Health Outcomes (quantitative, primary data) and 4) Ethnicity and Recovery Determinants (quantitative, secondary data).

Findings. Study one highlighted that IAPT clinicians (N = 14) want to feel confident to make psychological adaptations if needed to enhance the therapeutic alliance and aid recovery for CED service users in particular. Also, participants denoted that cultural competency training needs to be improved, although caution was expressed regarding not getting burnt out. Study two was interviews with current IAPT service users (N = 12). Similarly to study one, participants expressed the importance of diversity, representation within healthcare and accessibility (knowing what the IAPT service is, what the service does and how they can be referred to the IAPT service). As well as considering how sessions are delivered (one-to-one and group sessions), which can aid their IAPT trajectory to recovery. Study three (N = 203) highlighted that autonomy and more specifically self-awareness and capacity to manage new situations were linked with better outcomes for anxiety, depression and functional impairment. Specifically, self-awareness reduced anxiety and depression, especially for CED groups. Lastly, study four showed that the effect of receiving IAPT therapy was comparable between white and CED participants (n = 28,793), though CED groups revealed higher pre- and post-outcome scores for anxiety, depression and functional impairment. Additionally, when exploring what determinants helped or hindered recovery, it was suggested that religious affiliation could have acted as a protective barrier, and those referred by ‘other’ routes showed the worst recovery outcomes for anxiety and depression compared to GP and self-referral routes.

Conclusion. Though study four showed no significant (pre- and post-scores) differences between CED and white individuals for recovery, the findings did reveal that CED groups have a higher severity of anxiety and depression when they enter the IAPT services. Thus, the combination of all the findings demonstrates that when addressing mental health disparities among CED individuals, a multi-faceted approach is required. Exploring an individual’s autonomy (SA, CNS and SO), religious affiliation, the referral pathway, fostering inclusivity and enhancing clinicians’ cultural competency are all factors that should be considered to ensure that CED groups are receiving appropriate treatment to aid recovery. Considerations and implications are discussed in each relevant chapter in the context of future research, policy and practice.

Item Type:	Thesis (Doctoral)
Dates:	Date Event 6 February 2026 Accepted
Uncontrolled Keywords:	Mental Health, IAPT Service, Recovery, Health Disparity, Intersectionality, Culturally Competency, Mixed-Methods
Subjects:	CAH04 - psychology > CAH04-01 - psychology > CAH04-01-01 - psychology (non-specific) CAH04 - psychology > CAH04-01 - psychology > CAH04-01-04 - psychology and health
Divisions:	Doctoral Research College > Doctoral Theses Collection Life and Health Sciences > Psychology
Depositing User:	Louise Muldowney
Date Deposited:	07 Apr 2026 13:47
Last Modified:	07 Apr 2026 13:47
URI:	https://www.open-access.bcu.ac.uk/id/eprint/16955

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