How equitable are psychological therapy services in South East London now? A comparison of referrals to a new psychological therapy service with participants in a psychiatric morbidity survey in the same London borough

Soc Psychiatry Psychiatr Epidemiol. 2014 Dec;49(12):1893-902. doi: 10.1007/s00127-014-0900-6. Epub 2014 Jun 14.


Purpose: Psychological therapy services are sometimes characterised as being small and inequitable, with an over-representation of white middle class women. The 'Improving Access to Psychological Therapies (IAPT)' initiative is a programme in England that attempts to make evidence-based therapies accessible to more people more equitably. The aim of this study is to assess whether an IAPT service is delivering an equitable service a London borough. Patients using services at the Southwark IAPT service (n = 4,781) were compared with a sub-group of participants in the South East London Community Health study (SELCOH) with diagnosable mental health problems and who were also resident in Southwark (n = 196).

Methods: We compared Southwark IAPT patients and SELCOH participants on equity criteria of age, gender, ethnicity, occupational status and benefits status. To investigate if referral pathways influenced equity, patients referred by their general practitioner (GP pathway) (n = 3,738) or who self-referred (self-referral pathway) (n = 482) were compared with SELCOH participants.

Results: Southwark IAPT patients significantly differed from SELCOH participants on all our equity criteria and similar differences were found with GP pathway patients. However, self-referrals did not differ from the SELCOH group on age, gender, ethnicity and benefit status.

Conclusions: When compared to a community sample with diagnosable mental disorders, health disparities were found with the overall Southwark IAPT service and with GP pathway patients. Although unemployed people did access IAPT, fewer disparities were found with the self-referral pathway patients, suggesting that the IAPT self-referral pathway may be important in reducing inequitable access to services.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Ethnicity / psychology
  • Ethnicity / statistics & numerical data
  • Female
  • General Practitioners*
  • Health Services Research
  • Health Surveys
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • London / epidemiology
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / therapy*
  • Mental Health Services*
  • Middle Aged
  • Referral and Consultation / statistics & numerical data*
  • Socioeconomic Factors
  • Young Adult