Understanding ethnic minority differences in access to and outcomes of psychological therapies for first episode psychosis and severe mental illness

Context: Prevalence rates of severe mental illnesses (SMI) such as psychosis differ between ethnic groups disproportionately. Disparities also exist when exploring access and outcomes to psychological therapies based on ethnicity. The literature suggests that individuals from ethnic minority groups with SMI are less likely to be offered a psychology therapy. Methods: The broad aim of the thesis was to explore the effectiveness and accessibility of psychological therapies for ethnic minority groups who experience a SMI. A systematic review explored the effectiveness of psychological therapies for ethnic minority groups who experienced a SMI. Secondly, an empirical paper investigated whether sociodemographic factors, including ethnicity, influenced the offer and uptake of psychological therapies in a sample of service users who experienced first episode psychosis. Results: Our systematic review included nine studies for analysis, with seven reporting significant improvements in SMI symptom severity. Seven studies made cultural adaptations which led to a reduction in SMI symptom severity compared to treatment as usual. However the quality and risk of bias varied between studies, reducing the strength of the findings. In our empirical paper we found that service users in ‘White Other’ and ‘Other’ ethnic minority groups were less likely to be offered a psychological therapy compared to the white British reference group (‘White other’ OR = .48, CI .26 – .89, p = .04, ‘Other’ OR = .38, CI .17- .87, p = .02). Presenting to Early Intervention Services increased the likelihood being offered a psychological therapy. Conclusions: Our evidence highlights that whilst psychological therapies may be useful for ethnic minority groups with SMI, the availability is mixed depending on the service accessed. Future research is needed to explore the frequency and use of culturally adapted therapies in clinical settings. Research is needed that allows comparisons to be made between culturally adapted and standard therapies