For individuals employed in NHSTT services such as NHS Talking Therapies, the COVID-19 pandemic ushered in swift changes to the way services operated starting in 2020. Practitioners were required to quickly pivot to delivering evidence-based care either remotely or with significant modifications for in-person sessions. This shift raised questions about how clients would navigate these changes and what factors might affect their access and engagement with services. Concerns were also raised about potential barriers certain groups might face, such as digital poverty and a lack of private space at home. Despite a notable decline in referrals during lockdown, the exact reasons for this decrease and the barriers faced by different demographic groups remained unclear.
Verbist and colleagues (2023) conducted a groundbreaking study examining retrospective data of clients referred to four NHSTT services in the North West of England. Their research aimed to explore the impact of remote therapy on access and engagement with NHSTT services and identify risk factors for non-attendance pre-, during, and post-lockdown. The results shed light on the disparities in access and engagement across different timeframes.
During the COVID-19 pandemic, mental health services swiftly transitioned to predominantly remote therapy delivery, prompting ongoing research to comprehend its effect on clients. The study adopted an observational retrospective cohort design, analyzing data from 46,861 referrals to NHSTT services between March 23, 2019, and September 23, 2021. Following exclusions, the final sample consisted of 9,676 clients accessing services before, during, and after lockdowns. Each referral’s demographic information, placement in the stepped-care model, and engagement with treatment were tracked. Notably, disability status and preliminary diagnoses were not considered due to insufficient data.
Findings from the study revealed that a significantly higher number of individuals accessed NHSTT treatment post-lockdown than before or during lockdown periods. Factors influencing access varied across timeframes, with distinct demographics showing disparities. For instance, during lockdown, individuals with a non-English first language, unemployed individuals, and clients from Black ethnic backgrounds were less likely to access treatment. Meanwhile, age, perinatal status, unemployment, and medication usage were consistent predictors of treatment disengagement across all timeframes.
The study’s strengths include controlling for waiting times and assessing unique timeframes within the COVID-19 pandemic to understand their impact on access and engagement. However, limitations such as a lack of consideration for step-ups within NHSTT services and the geographical specificity of the sample group were noted. The study calls for further research to explore the increase in clients taking psychotropic medications and address potential disparities in access and engagement across different demographic groups.
