Ethnic differences in receipt of psychological interventions in Early Intervention in Psychosis services in England: a cross-sectional study

Abstract

Background There is some evidence of inequitable psychosis care provision by ethnicity. We investigated variations in the receipt of CBTp and family intervention across ethnic groups in Early Intervention in Psychosis (EIP) teams throughout England, where national policy mandates offering these interventions to all. Methods We included data on 29,610 service users from the National Clinical Audit of Psychosis (NCAP), collected between 2018 and 2021. We conducted mixed effects logistic regression to examine odds ratios of receiving an intervention (CBTp, family intervention, or either intervention) across 17 ethnic groups while accounting for the effect of years and variance between teams and adjusting for individual- (age, gender, occupational status) and team-level covariates (care-coordinator caseload and mental health inequalities strategies). Findings Compared with White British people, every minoritized ethnic group, except those of mixed Asian-White and mixed Black African-White ethnicities, had lower adjusted odds of receiving CBTp (aOR 0.39, 95%CI 0.32-0.47 to 0.80, 0.64-1.00). People of Black African (0.61, 0.53-0.69), Black Caribbean (0.67, 0.56-0.81), non-African/Caribbean Black (0.63, 0.51-0.79), non-British/Irish White (0.73, 0.64-0.84), and of "any other" (0.66, 0.54-0.81) ethnicity also experienced lower adjusted odds of receiving family intervention. Interpretation Pervasive inequalities in receiving CBTp for first episode psychosis exist for almost all minoritized ethnic groups, and family intervention for many groups. Investigating how these inequalities arise should be a research priority, allowing co-produced development and testing of approaches to address them. Funding Independent research commissioned and funded by the National Institute for Health Research Policy Research Programme.