Social inequalities in the demand, supply and utilisation of psychological treatment

Introduction: Socioeconomic deprivation is associated with higher prevalence of mental disorders but poor access to care. We conducted a national workforce survey to examine the demand, supply and utilisation of primary care psychological services.

Aim: To understand the variability in the rates of access to psychological care in different geographical areas.

Method: This was a cross-sectional survey of Improving Access to Psychological Therapies (IAPT) services. Data were collected from 144 services covering 180 local areas in England, using a freedom of information request. The access gap (AG) was defined as the percentage of cases that did not receive treatment, from the wider pool of cases referred for psychological care. We examined correlations between the demand (number of referrals), and supply (workforce size) of psychological care with local area prevalence rates of common mental disorders and the index of multiple deprivation (IMD). Regression analyses were used to assess if the variability in AG may be explained by IMD and workforce size, controlling for local population statistics.

Results: Workforce size was weakly correlated with the IMD (r = 0.16, p = 0.04) and prevalence rates (r = 0.16, p = 0.03). The AG was significantly associated with IMD, number of referrals, prevalence rates and treatment waiting times, but not with workforce size. Together, these variables explained approximately 26% of variance in the AG.

Conclusions: Socioeconomic deprivation is associated with psychological service utilisation, irrespective of the demand–supply function, particularly when contrasting the poorest and most affluent areas.