Understanding barriers and facilitators to accessing IAPT for people on low incomes.

Low-income communities have a poorer experience of care in Improving Access to Psychological Therapies (IAPT) services. This study explored: a) how IAPT referral and treatment rates have changed for people on low incomes after Covid-19 (Study 1); b) barriers people on low incomes face in accessing IAPT and what could facilitate access (Study 2). The study thus comprised two parts. Study 1 used national data on IAPT referrals received during 2018-2022 (N = 6,544,536). The treatment access rate, access gap and completion rate were calculated for each socio-economic group, separately for each year. Outcomes between those most and least deprived were compared using chi-square tests. Associations between time of measurement (pre/post-pandemic), level of deprivation and treatment access or completion were explored using log-linear analyses. Study 2 involved semi-structured interviews with people on low incomes who had not accessed IAPT (N = 5). Data were analysed using Thematic Analysis. Study 1 suggested that IAPT referrals decreased during Covid-19, but more so for the most deprived group; referrals exceeded pre-pandemic levels in 2021-2022. Treatment access and completion improved during Covid-19, however the most deprived group benefited less. The gap between those most and least deprived has widened after Covid-19 regarding treatment access and completion. Study 2 identified three themes: 1) Navigating the system; 2) Us and Them; 3) Perceived mismatch between needs and available support. The findings of the two studies are discussed separately and in conjunction, with reference to the literature on IAPT and the experiences of people on low incomes in psychological services. It is argued that IAPT services need to attend to the socio-economic context within which mental health difficulties occur and consider their relevance for low-income communities, given the number of low-income individuals who do not access the service and widening inequalities in treatment access and completion following Covid-19.