City and Hackney is richly diverse with almost half of the borough’s population from ethnic minority backgrounds, with the largest communities being African / Caribbean Heritage, Charedi Jewish and Turkish and Kurdish. These groups are over-represented in mental health inpatient services and mental health related A&E admissions but under-represented earlier in the pathway in primary care in NHS Talking Therapy (formally IAPT) services. Because of the cultural barriers these groups face, before our redesign, access rates and recovery rates were amongst the lowest in London.

Under the guidance and governance of the lead NHS provider (Homerton NHS Talking Therapies) and City and Hackney Psychological Therapies and Wellbeing Alliance, a programme was designed to commission small culturally focused voluntary sector organisations to deliver NHS Talking Therapies. 

Typically, most referrals to NHS Talking Therapies start through a discussion with the GP even if the person then self-refers online. However, language barriers, feelings of stigma and the belief that their GP will not understand because they are not from the same community means that many people do not discuss their mental health with their GP and face a barrier to accessing the support they need. Furthermore, feedback from cultural communities shared that individuals often felt NHS provider led Talking Therapies was patronising and culturally alien.

Our innovative approach removed these barriers by embedding NHS Talking Therapies services in each cultural community. Our providers link directly to the community and focal points, like places of worship, community centres, barber shops and betting shops. VCSE providers offered treatments by members of the same community able to speak Turkish, Yiddish, Hebrew, Yoruba and adapted the treatments using narrative, role models and new techniques to create a closer cultural fit. 

I worked with Mind (ACH & LGBTQI+ communities), Bikur Cholim (Charedi  Jewish community) & Derman (Turkish & Kurdish speaking communities) and clinical leads from NHS England to integrate IAPT compliant therapies into the VCSE services, supporting each to ensure their offer was culturally appropriate for their community while meeting NICE Guidance & NHS IG. Each provider ensured that the qualifications of therapists met clinical requirements (BACP / BABCP accreditation) & supported each provider to secure IAPT accredited training in the appropriate modality for each therapist.

I also resolved their digital integration to NHS dataflows, supporting each provider to complete the NHS IG Toolkit, and connect to NHS England (previously NHS Digital) via HSCN connections, enabling real time reporting and contribution to national datasets. This model significantly improved uptake from historically underserved populations, addressing systematic inequalities and supporting long-term recovery.