People from ethnic minority backgrounds who also live with a long-term physical health condition are less likely to get effective talking therapy for depression or anxiety, and more likely to drop out early. This matters because these patients face a double disadvantage: their physical illness worsens their mental health, yet standard NHS Talking Therapies services often fail to reach or help them. The research team will analyse national treatment data and hospital records to pinpoint exactly which groups—defined by specific ethnicities and conditions like diabetes or heart disease—are worst affected. They will then interview patients and therapists to understand why current care pathways fall short. If successful, the project will produce new, co-designed care pathways tested in GP practices linked to two Talking Therapies services. The goal is a practical NHS toolkit that helps clinicians adapt treatment for these underserved groups, improving both access and recovery rates. The findings will directly inform NHS England’s Talking Therapies team, potentially reshaping how mental health support is delivered to millions of patients with combined physical and mental health needs.
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Research question: How can we improve access to and outcomes from Talking Therapies services for people from ethnic minority backgrounds with long-term physical health conditions seeking mental health support? Background: Analyses of routinely delivered psychological treatment for people with common mental disorders show that people of ethnic minority backgrounds as well as those with long-term physical health conditions (LTCs) have both poorer access to care and outcomes from treatment. Ethnic minority people with LTCs report particularly poor mental health, yet face additional barriers to accessing care. Aims and Objectives: We will synthesise findings across a set of studies to generate new care pathways that improve access to and outcomes from talking therapies for ethnic minority people with LTCs. Specific objectives for each Work Package (WP) are as follows: WP1-Identify which service user groups, described by the intersections of specific ethnic minority backgrounds and physical health conditions, are at most risk of poor access and outcomes from Talking Therapies services. WP2-Develop a programme theory identifying potential generative mechanisms that impact care pathways for service users from underserved groups identified in WP1 WP3-Explore perspectives on the perceived barriers and potential ways to improve outcomes for these underserved groups. WP4-Consolidate findings from WP1-3 to co-create and implement new care pathways that can enhance mental health care provision for people from ethnic minority groups with LTCs. Methods: To meet our objectives, the following methods will be employed: WP1: Quantitative analysis of linked national Talking Therapies data and hospital records, employing causal inference methods to isolate the effects of specific ethnicities and physical health conditions associated with poorer access and outcomes. WP2: Realist synthesis of the existing literature on access, engagement, and pathway modifications to services for the identified underserved groups. WP3: Utilise both primary qualitative data collection using interviews and secondary analysis of an existing qualitative dataset, to develop a framework to refine new care pathways. WP4: Co-production of new care pathways for the identified underserved groups, with experts by experience and a community of practice group. Implement the new care pathways in general practices linked to two Talking Therapies services, and evaluate the changes in access and outcomes for ethnic minority groups with LTCs. Timelines for delivery: WP1 (national analysis) will run until month six, and WP2 (realist review) will operate until month 17 to provide an initial programme theory to guide the in-depth qualitative work (WP3 qualitative study) taking place between months 1 to 15. WP4 (co-design and implementation of pathway) will synthesise evidence through a series of workshops and thus will commence in the middle of the second year for 12 months, with the final months dedicated to the final analyses and reporting. Anticipated Impact and Dissemination. Initial impact will be for ethnic minority groups with LTCs seeking talking therapies for common mental disorders, as well as services and the broader NHS. The findings will support NHS England’s Talking Therapies team, who will support implementation and dissemination. Plans and results will be shared widely through service user networks, stakeholders and through academic publications and conferences
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