Inequalities in mental health services:An intersectional approach to examining ethnicity, gender and socio-economic status in relation to psychological therapy treatment outcomes

Background: Mental health inequalities remain a major public health issue in the United Kingdom (UK). Inequalities such as poorer treatment outcomes are consistently associated with individual characteristics such as ethnicity, gender and socio-economic status. These disparities are complex and interrelated, yet few studies have employed a detailed approach to understand how these characteristics are jointly associated with mental health treatment outcomes. This study aimed to employ an intersectional approach to examine mental health inequalities in UK psychological therapy services.Method: Data from 46,684 patients who completed treatment in Improving Access to Psychological Therapies (IAPT) services in four South London boroughs were analysed. Regression models were used to identify inequalities in treatments indicators and outcomes, predicted by individual characteristics (ethnicity, gender, employment status) and at their intersection. Treatment indicators included treatment allocation (high versus low intensity) and number of treatment sessions attended (up to 12 sessions indicating lower level treatment provision versus more than 12 sessions indicating higher level treatment provision). Treatment outcome referred to recovery and symptom reduction following treatment.Results: White Other patients had decreased odds of being allocated to a high intensity intervention compared to White British patients. With the exception of the Asian ethnic group, all other ethnic groups had increased odds of being allocated to a high intensity intervention compared to the White British ethnic group, after adjusting for confounders. Asian and Black (African, Caribbean, Other) ethnic groups were less likely to attend more than 12 treatment sessions compared to the White British ethnic group after adjusting for confounders. Reliable recovery was more likely for female and White British patients. Ethnic minority women showed greater reduction in depression scores compared to White British women, with no significant interaction effect with employment status. Ethnic minority men only showed a greater reduction in depression scores when employment status was considered.Conclusions: Using an intersectional approach revealed disparities in depression change scores based on intersections between ethnicity, gender and employment status. Future studies should utilise intersectional approaches to ascertain inequalities in mental health treatment outcomes not previously identified.<br/

Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross-sectional study.

BACKGROUND: The unfair treatment of individuals with severe mental illness has been linked to poorer physical and mental health outcomes. Additionally, anticipation of discrimination may lead some individuals to avoid participation in particular life areas, leading to greater isolation and social marginalisation. This study aimed to establish the levels and clinical and socio-demographic associations of anticipated and experienced discrimination amongst those diagnosed with a schizophrenia and comparator severe mental illnesses (bipolar and major depressive disorders). METHODS: This study was a cross-sectional analysis of anticipated and experienced discrimination from 202 individuals in South London (47% with schizophrenia, 32% with depression and 20% with bipolar disorder). RESULTS: 93% of the sample anticipated discrimination and 87% of participants had experienced discrimination in at least one area of life in the previous year. There was a significant association between the anticipation and the experience of discrimination. Higher levels of experienced discrimination were reported by those of a mixed ethnicity, and those with higher levels of education. Women anticipated more discrimination than men. Neither diagnosis nor levels of functioning were associated with the extent of discrimination. Clinical symptoms of anxiety, depression and suspiciousness were associated with more experienced and anticipated discrimination respectively. CONCLUSIONS: The unfair treatment of individuals with severe mental illnesses remains unacceptably common. Population level interventions are needed to reduce levels of discrimination and to safeguard individuals. Interventions are also required to assist those with severe mental illness to reduce internalised stigma and social avoidance

Health, mental health and housing conditions in England

APMS 2007 included a structured clinical assessment of mental health that allowed for the reliable diagnosis of common mental disorders such as anxiety and depression. The questionnaire also covered aspects of housing conditions and financial strain related to domestic fuel use, including presence of mould, cutting back on fuel usage, lack of central heating and double-glazing, being cold at home, and fuel-related problem debt or utility disconnection. This report presents the prevalence of different aspects of poor housing in the English population and identifies which types of household are at greatest risk. It also explores how poor housing conditions and fuel related debt relate to other indicators of poverty, and goes on to examine associations with mental and physical health and disability