Skip to main content Accessibility help
×
×
Home

Addressing issues of race, ethnicity and culture in CBT to support therapists and service managers to deliver culturally competent therapy and reduce inequalities in mental health provision for BAME service users

  • Saiqa Naz (a1), Romilly Gregory (a2) and Meera Bahu (a3)

Abstract

Conversations around improving access to psychological therapies for BAME (Black, Asian and minority ethnic) service users have been ongoing for many years without any conclusion or resolution. BAME service users are often under-represented in primary care mental health services, and often have worse outcomes, leading to them being portrayed as ‘hard to reach’, and to deterioration in their mental health. They are over-represented in secondary care mental health services. The authors of this article argue that more resources are required in order to understand the barriers to accessing mental health services, and improve both access and recovery for BAME service users. This paper examines concepts such as race, ethnicity and culture. It aims to support service managers and therapists to develop their confidence to address these issues in order to deliver culturally competent psychological therapies to service users from BAME communities, with a focus on primary care. It is based on our experiences of working with BAME communities and the feedback from our training events on developing cultural competence for CBT therapists. The paper also discusses the current political climate and the impact it may have on service users and the need for therapists to take the wider political context into consideration when working with BAME service users. Finally, the paper stresses the importance of addressing structural inequalities at a service level, and developing stronger ethical guidelines in the area of working with diversity for CBT therapists in the UK.

Key learning aims

  1. (1)To examine concepts such as race, ethnicity and culture and to provide a shared understanding of these terms for CBT therapists.
  2. (2)To assist CBT therapists and supervisors to develop their confidence in addressing issues of race, ethnicity and culture with BAME service users within the current political climate and to deliver culturally competent therapy.
  3. (3)To assist service managers to promote equality of access and of outcomes for service users from BAME communities.
  4. (4)To understand how unequal expectations of therapists in services impacts on CBT therapists from BAME communities.
  5. (5)To widen understanding of some of the structural inequalities at service level which the CBT community needs to overcome, including recommending stronger ethical guidelines around working with diversity in the UK.

Copyright

Corresponding author

*Corresponding author. Email: saiqa.naz@shsc.nhs.uk

Footnotes

Hide All
§

All three authors are committee members for the BABCP’s Equality and Culture Special Interest Group. Saiqa Naz is Chair, Romilly Gregory is Treasurer and Meera Bahu is Secretary.

Footnotes

References

Hide All
Beck, A (2016). Transcultural Cognitive Behavioural Therapy for Anxiety and Depression: A Practical Guide. London, UK: Routledge.
Mir, G, Meer, S, Cottrell, D, McMillan, D, House, A, Kanter, JW (2015). Adapted behavioural activation for the treatment of depression in Muslims. Journal of Affective Disorders, 180, 190199.
Joint Commissioning Project on Mental Health (2014). Guidance for commissioners of mental health services for black and minority ethnic service users. London: Joint Commissioning Project on Mental Health. Available at: http://www.jcpmh.info/good-services/black-minority-ethnic-communities/
American Counselling Association (2014). Code of Ethics. Available at: https://www.counseling.org/knowledge-center/ethics
BACP (2016). Ethical Framework for the Counselling Professions. Available at: https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/
BABCP (2017). Standards of Conduct, Performance and Ethics. Available at: http://www.babcp.com/About/Documents.aspx
BBC (2018). Beckton birthday acid attacker John Tomlin jailed for 16 years (20 April 2018). Available at: https://www.bbc.co.uk/news/uk-england-london-43838476
BBC (2018). Lincoln man admits sending ‘Punish a Muslim Day’ letters (12 October 2018). Available at: https://www.bbc.co.uk/news/uk-england-45838506
Beck, A (2016). Transcultural Cognitive Behavioural Therapy for Anxiety and Depression: A Practical Guide. London, UK: Routledge.
Brown, B (2008). I Thought it was Just Me. New York: Random House.
Butt, J, Clayton, K, Gardner, Z, Huijbers, K et al. (2015). Better practice in mental health for black and minority ethnic communities. Race Equality Foundation. Available at: raceequalityfoundation.org.uk/wp-content/…/10/Better-practice-in-mental-health.pdf
Carter, L (2018). Evidence and Ethnicity in Commissioning. Available at: http://www.ethnicitycommissioning.group.shef.ac.uk/
Castillo, G et al. (2007). The influence of multicultural training on perceived multicultural counselling competencies and implicit racial prejudice. Journal of Multicultural Counselling and Development, 35, 243254.
Dearden, L (2018). Religious hate crime rises 40% in England and Wales – with more than half directed at Muslims. The Independent (16 October 2018). Available at: https://www.independent.co.uk/news/uk/crime/uk-hate-crime-religious-muslims-islamophobia-police-racism-a8585846.html
Equality Act (2010). See HM Government (2010).
Equality and Human Rights Commission (2016). Race Discrimination. Available at: https://www.equalityhumanrights.com/en/advice-and-guidance/race-discrimination
Francis, R (2013). Mid Staffordshire NHS Foundation Trust Public Inquiry. Available at: http://webarchive.nationalarchives.gov.uk/20150407084231/http://www.midstaffspublicinquiry.com/report
Gilbert, P (2010). The Compassionate Mind: A New Approach to Facing the Challenges of Life. London, UK: Constable Robinson.
Gong, T (2010). Exploring the roles of major forms of cultural transmission in language evolution. Available at: https://doi:10.1142/9789814295222_0022
Greenwald, AG, Kriege, LH (2006). Implicit bias: scientific foundations. California Law Review, 94, 945.
GQ Magazine (2018). In Praise of David Lammy (19 April 2018). Available at: http://www.gq-magazine.co.uk/article/david-lammy-speech-windrush
Gurpinar-Morgan, A, Murray, C, Beck, A (2014). Ethnicity and the therapeutic relationship: views of young people accessing cognitive behavioural therapy. Mental Health, Religion and Culture, 17, 714725.
HM Government (2010). Equality Act 2010. London: HMSO.
Jandt, F (2013). An Introduction to Intercultural Communication: Identities in a Global Community, 7th edn. Thousand Oaks, CA, USA: SAGE Publications
Jandt, F (2017). An Introduction to Intercultural Communication: Identities in a Global Community, 9th edn. Thousand Oaks, CA, USA: SAGE Publications
Lago, C, Thompson, J (2002). Counselling and race. In Palmer, S (ed), Multicultural Counselling: A Reader. London: Sage
Loue, S (2006). Transcultural Cognitive Behavioural Therapy for Anxiety and Depression: A Practical Guide, Beck, Andrew (2016). London, UK: Routledge.
Maddox, L (producer) (2018). Let’s Talk About CBT: Outreach Event [audio podcast, 18 October 2018]. Available at: http://letstalkaboutcbt.libsyn.com/website
Metro (2018). Man arrested for ‘Punish a Muslim day’ letters (12 June 2018). Available at: https://metro.co.uk/2018/06/12/man-arrested-punish-muslim-day-letters-7626272/
McIntosh, P (1989). White Privilege: Unpacking the Invisible Knapsack. Peace and Freedom Magazine, July/August 1989, pp. 10–12. Available at: https://nationalseedproject.org/white-privilege-unpacking-the-invisible-knapsack
Mir, G, Kanter, JW, Meer, S, Cottrell, D, McMillan, D, House, A (2012). BA-M Treatment Manual: Addressing Depression in Muslim Communities. Available at: http://medhealth.leeds.ac.uk/info/615/research/327/addressing_depression_in_muslim_communities
Mir, G, Meer, S, Cottrell, D, McMillan, D, House, A, Kanter, JW (2015). Adapted behavioural activation for the treatment of depression in Muslims. Journal of Affective Disorders, 180, 190199.
Modood, T, Beishon, S, Virdee, S (1994) Changing Ethnic Identities. London: Policy Studies Institute.
Mueller, M, Kennerley, H, McManus, F, Westbrook, D (2010). The Oxford Guide to Surviving as a CBT Therapist. Oxford, UK: Oxford University Press.
Nazroo, J (1999). Ethnicity and Mental Health: Findings for the National Community Survey 1999. London: Policy Studies Institute.
NHS (2018). Psychological Therapies: Annual Report on the use of IAPT services England, further analyses on 2016–17. Available at: http://www.digital.nhs.uk/catalogue/PUB30232
NICE (2009). National Institute for Health and Care Excellence. Depression in adults: recognition and management. Published 2009, last updated April 2016. Available at: https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#care-of-all-people-with-depression
Palmer, S (1999). In search of effective counselling across cultures. In Palmer, S, Laungani, P (eds), Counselling in a Multicultural Society. London, UK: Sage Publications.
Pennine Care NHS Foundation Trust (2016). Mental health support for minorities wins top prize (7 October 2016). Available at: https://www.penninecare.nhs.uk/news-and-events/news/2016/10/mental-health-support-for-minorities-wins-top-prize/
Persons, JB, Davidson, J (2001). Cognitive-behavioral case formulation. In Dobson, K (ed), Handbook of Cognitive-Behavioral Therapies (pp. 86110). New York: Guilford Press.
Shabbir, M, Mir, G, Meer, S, Wardak, W (2012) One step at a time. Available at: https://medhealth.leeds.ac.uk/download/734/ba-m_client_self_help_booklet
Tangney, JP, Miller, RS, Flicker, L, Hill, D (1996). Are shame, guilt, and embarrassment distinct emotions? Journal of Personality and Social Psychology, 70, 12561269.
The Guardian (2017). Acid attack on two Muslim cousins in London being treated as hate crime (30 June 2017). Available at: https://www.theguardian.com/uk-news/2017/jun/30/acid-attack-victim-says-he-and-cousin-targeted-because-they-are-muslim-beckton-london
The Guardian (2017). Anxious Poles in the UK ‘won’t report hate crimes’ (7 January 2017). Available at: https://www.theguardian.com/society/2017/jan/07/poles-lin-uk-scared-to-speak-up-on-hate-crimes
The Guardian (2017). Manchester mosque left gutted after suspected arson attack (17 July 2017). Available at: https://www.theguardian.com/uk-news/2017/jul/17/manchester-mosque-left-gutted-after-suspected-arson-attack
The Guardian (2017). Poles in UK fear spike in hate crimes when Brexit process begins (10 January 2017). Available at: https://www.theguardian.com/society/2017/jan/10/poles-in-uk-fear-spike-in-hate-crimes-when-brexit-process-begins
The Guardian (2018). Antisemitic incidents in UK at all-time high (1 February 2018). Available at: https://www.theguardian.com/society/2018/feb/01/antisemitic-incidents-in-uk-at-all-time-high
The Guardian (2018). It’s inhumane: the Windrush victims who have lost jobs, homes and loved ones (20 April 2018). Available at: https://www.theguardian.com/uk-news/2018/apr/20/its-inhumane-the-windrush-victims-who-have-lost-jobs-homes-and-loved-ones
The Guardian (2018). Londoner denied NHS cancer care: ‘It’s like I’m being left to die’ (10 March 2018). Available at: https://www.theguardian.com/uk-news/2018/mar/10/denied-free-nhs-cancer-care-left-die-home-office-commonwealth
The Guardian (2018). Man jailed for life after running over Muslim woman in Leicester (24 March 2018). Available at: https://www.theguardian.com/uk-news/2018/mar/27/man-jailed-life-running-over-muslim-woman-leicester-paul-moore-zaynab-hussein
The Independent (2018). Armed police deployed in counterterror operation to protect synagogues during Jewish holidays (9 September 2018). Available at: https://www.independent.co.uk/news/uk/crime/jewish-holidays-rosh-hashanah-police-terror-attack-operation-armed-synagogues-hate-crime-london-a8529581.html
The King’s Fund (2016). Reading List: Mental health - black and minority ethnic communities. Available at: https://www.kingsfund.org.uk/sites/default/files/field/field_document/Library_reading_list_Mental_health_BAME_2016_02.pdf
The King’s Fund Library Catalogue (2018). Available at: https://koha.kingsfund.org.uk/
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

the Cognitive Behaviour Therapist
  • ISSN: -
  • EISSN: 1754-470X
  • URL: /core/journals/the-cognitive-behaviour-therapist
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Addressing issues of race, ethnicity and culture in CBT to support therapists and service managers to deliver culturally competent therapy and reduce inequalities in mental health provision for BAME service users

  • Saiqa Naz (a1), Romilly Gregory (a2) and Meera Bahu (a3)
Submit a response

Comments

No Comments have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *