Clients using interpreters wait longer and have poorer outcomes in Talking Therapies for Anxiety and Depression - a retrospective cohort study on waiting times and treatment outcomes

Ahmad, G., McManus, S., Cooper, C., Hatch, S. L., & Das-Munshi, J. (2022). Prevalence of common mental disorders and treatment receipt for people from ethnic minority backgrounds in England: repeated cross-sectional surveys of the general population in 2007 and 2014. British Journal of Psychiatry, 221, 520–527. https://doi.org/10.1192/bjp.2021.179 Amati, F., Green, J., Kitchin, L., Watt, H., Jones, S., AlRubaye, N., McCann, L., & Greenfield, G. (2023). Ethnicity as a predictor of outcomes of psychological therapies for anxiety and depression: a retrospective cohort analysis. Behavioural and Cognitive Psychotherapy, 51(2), 164–173. https://doi.org/10.1017/S1352465822000558 Arafat, N. (2021). One size does not fit all: key messages from Pakistani, Somali and Yemeni (PSY) patients in Sheffield, UK, regarding the language and cultural challenges of the IAPT programme. Perspectives in Public Health, 141(5):266-268. doi:10.1177/17579139211011502 Baker, C., & Kirk-Wade, E. (2024). Mental Health Statistics: Prevalence, Services, and Funding in England. House of Commons. https://researchbriefings.files.parliament.uk/documents/SN06988/SN06988.pdf Baas, K. D., Cramer, A. O., Koeter, M. W., van de Lisdonk, E. H., van Weert, H. C., & Schene, A. H. (2011). Measurement invariance with respect to ethnicity of the Patient Health Questionnaire-9 (PHQ-9). Journal of affective disorders, 129(1-3), 229–235. https://doi.org/10.1016/j.jad.2010.08.026 Bauer, A. M., & Alegría, M. (2010). Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review. Psychiatric Services, 61(8), 765-773. Beck, A. (2016). Transcultural Cognitive Behaviour Therapy for Anxiety and Depression: A Practical Guide. Routledge. Beck, A., Naz, S., Brooks, M., & Jankowska, M. (2019). Improving Access to Psychological Therapies (IAPT) Black, Asian and Minority Ethnic Service User Positive Practice Guide. https://babcp.com/BAME-Positive-Practice-Guide Brennan, S., & Seymour, L. (2024). Community languages, translation and interpreting services: The development of the Community Languages Translation and Interpreting Improvement Framework. National Voices & South Central West Commissioning Support Unit. https://s42139.pcdn.co/wp-content/uploads/Community-Languages-Translation-and-Interpretating-Services-v2.pdf Carter, O., Pannekoek, L., Fursland, A., Allen, K. L., Lampard, A. M., & Byrne, S. M. (2012). Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Behaviour research and therapy, 50(7-8), 487–492. https://doi.org/10.1016/j.brat.2012.03.003 Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23(4), 318–327. https://doi.org/10.3109/09540261.2011.606803 Clark, D. M. (2018). Realizing the mass public benefit of evidence-based psychological therapies: the IAPT program. Annual Review of Clinical Psychology, 14(1), 159-183. Costa, B. (2022a). Interpreter-mediated CBT – a practical implementation guide for working with spoken language interpreters. The Cognitive Behaviour Therapist, 15, e8. doi:10.1017/S1754470X2200006X Costa, B. (2022b, February 8). Equal access: Interpreter-mediated spoken language CBT – An implementation guide. Cambridge Core Blog. https://www.cambridge.org/core/blog/2022/02/08/equal-access-interpreter-mediated-spoken-language-cbt-an-implementation-guide/ Costa, B., & Briggs, S. (2014). Service-users’ experiences of interpreters in psychological therapy: a pilot study. International Journal of Migration, Health and Social Care, 10(4), 231-244. d'Ardenne, P., Capuzzo, N., Ruaro, L., & Priebe, S. (2005). One size fits all? Cultural sensitivity in a psychological service for traumatised refugees. Diversity in Health and Social Care, 2, 29-36. d'Ardenne, P., Ruaro, L., Cestari, L., Fakhoury, W., & Priebe, S. (2007). Does interpreter-mediated CBT with traumatised refugee people work? A comparison of patient outcomes in East London. Behavioural and Cognitive Psychotherapy, 35(3), 293-301. Department of Health. (2005). Delivering race equality in mental health care. An Action Plan for Reform Inside and Outside Services and The Government’s Response to the Independent Inquiry into the Death of David Bennett. London. Fazil, Q., & Beavan, J. (2015). Working with interpreters for spoken languages. Diversity and Equality in Health and Care, 12(3), 126-129. Fenn, K, & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6(9), 579-585. doi:10.1177/1755738012471029 Gill, P. S., Beavan, J., Calvert, M., & Freemantle, N. (2011). The unmet need for interpreting provision in UK primary care. PLoS one, 6(6), e20837. Hadziabdic, E., Albin, B., Heikkilä, K., & Hjelm, K. (2014). Family members’ experiences of the use of interpreters in healthcare. Primary Health Care Research & Development, 15(2), 156-169. Harwood, H., Rhead, R., Chui, Z., Bakolis, I., Connor, L., Gazard, B., & Hatch, S. L. (2023). Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychological Medicine, 53, 1084–1095. Kapadia, D., Brooks, H. L., Nazroo, J., & Tranmer, M. (2017). Pakistani women’s use of mental health services and the role of social networks: a systematic review of quantitative and qualitative research. Health & Social Care in the Community, 25, 1304–1317. https://doi.org/10.1111/hsc.12305 Kapadia, D., Zhang, J., Salway, S., Nazroo, J., Booth, A., Villarroel-Williams, N., Becares, L., & Esmail, A. (2022). Ethnic inequalities in healthcare: A rapid evidence review. NHS Race and Health Observatory. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine., 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x Kunorubwe, T. (2025). Bridging the Language Gap: A Review of Cognitive Behavioural Therapy with Spoken Language Interpreters. Manuscript submitted for publication. Kunorubwe, T., O’Leary, C., & Wynne, J. (2025). Exploring staff experiences and perspectives on barriers in interpreter-mediated therapy within NHS England’s Talking Therapies. The Cognitive Behaviour Therapist, 18, e28. doi:10.1017/S1754470X25000194 Kunorubwe, T. (2023). Cultural adaptations of group CBT for depressed clients from diverse backgrounds: a systematic review. The Cognitive Behaviour Therapist, 16, e35. https://doi.org/10.1017/S1754470X23000302 Kunorubwe, T., John, P., Molina, P., Davies, P., Gait, S., John, B., Roderique-Davies, G., & Lancastle, D. (2024). Guidance and an associated action plan to improve access to, and provision of, psychological interventions to people from Black, Asian and minority ethnic (BAME) communities. Public Health Wales Report. https://performanceandimprovement.nhs.wales/functions/quality-safety-and-improvement/improvement/our-work/mental-health/psychological-therapies/resources-psychological-therapies/summary-report-of-a-rapid-review/ Leanza, Y., Miklavcic, A., Boivin, I., & Rosenberg, E. (2014). Working with interpreters. In L. J. Kirmayer, J. Guzder, & C. Rousseau (Eds.), Cultural consultation: Encountering the other in mental health care (pp. 89–114). https://doi.org/10.1007/978-1-4614-7615-3_5 MacLellan, J., McNiven, A., & Kenyon, S. (2024). Provision of interpreting support for cross-cultural communication in UK maternity services: A Freedom of Information request. International Journal of Nursing Studies Advances, 6, 100162. Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. H. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. The British Journal of Psychiatry, 180, 461–464. https://doi.org/10.1192/bjp.180.5.461 National Collaborating Centre for Mental Health. (2023). Ethnic inequalities in improving access to psychological therapies (IAPT): Full report. NHS Race and Health Observatory. https://nhsrho.org/wp-content/uploads/2023/10/Ethnic-Inequalities-in-Improving-Access-to-Psychological-Therapies-IAPT.Full-report.pdf National Collaborating Centre for Mental Health. (2024). NHS talking therapies manual (Version 7.1). https://www.england.nhs.uk/wp-content/uploads/2018/06/NHS-talking-therapies-manual-v7-1.pdf NHS Digital. (2024, May). Interpreter present at care contact indication code. NHS Data Model and Dictionary. Retrieved January 10, 2025, from https://archive.datadictionary.nhs.uk/DD%20Release%20May%202024/data_elements/interpreter_present_at_care_contact_indication_code.html NHS Digital. (2025). NHS Talking Therapies monthly statistics including employment advisors: Performance April 2025 – Outcomes. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-talking-therapies-monthly-statistics-including-employment-advisors/performance-april-2025/outcomes NHS England. (n.d.). NHS Talking Therapies for anxiety and depression. https://www.england.nhs.uk/mental-health/adults/nhs-talking-therapies/ Njeru, J. W., DeJesus, R. S., St Sauver, J., Rutten, L. J., Jacobson, D. J., Wilson, P., & Wieland, M. L. (2016). Utilization of a mental health collaborative care model among patients who require interpreter services. International Journal of Mental Health Systems, 10, 15. https://doi.org/10.1186/s13033-016-0044-z Office for Health Improvement and Disparities. (2021). Language interpreting and translation: Migrant health guide. GOV.UK. https://www.gov.uk/guidance/language-interpretation-migrant-health-guide Office for National Statistics. (2022). Language, England and Wales: Census 2021. UK Statistics Authority. Parkerson, H. A., Thibodeau, M. A., Brandt, C. P., Zvolensky, M. J., & Asmundson, G. J. (2015). Cultural-based biases of the GAD-7. Journal of anxiety disorders, 31, 38–42. https://doi.org/10.1016/j.janxdis.2015.01.005 Porter, A., Franklin, M., De Vocht, F., d'Apice, K., Curtin, E., Albers, P., & Kidger, J. (2024). Estimating the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a real-world evaluation. BMJ open, 14(1), e077220. https://doi.org/10.1136/bmjopen-2023-077220 Punton, G., Dodd, A. L., & McNeill, A. (2022). ‘You’re on the waiting list’: An interpretive phenomenological analysis of young adults’ experiences of waiting lists within mental health services in the UK. PLOS One, 17(3), e0265542. Quiroz Molinares, N. (2024). Does Interpreter-Mediated PTSD Treatment for Refugees Work? A Comparison Study in The Netherlands. Master’s thesis, Utrecht University. Reichert, A., & Jacobs, R. (2018). The impact of waiting time on patient outcomes: Evidence from early intervention in psychosis services in England. Health economics, 27(11), 1772–1787. https://doi.org/10.1002/hec.3800 Rolland, L., Dewaele, J. M., & Costa, B. (2017). Multilingualism and psychotherapy: Exploring multilingual clients' experiences of language practices in psychotherapy. International Journal of Multilingualism, 14(1), 69-85. Sander, R., Laugesen, H., Skammeritz, S., Mortensen, E. L., & Carlsson, J. (2019). Interpreter-mediated psychotherapy with trauma-affected refugees–A retrospective cohort study. Psychiatry Research, 271, 684-692. Schulz, P. M., Resick, P. A., Huber, L. C., & Griffin, M. G. (2006). The effectiveness of cognitive processing therapy for PTSD with refugees in a community setting. Cognitive and Behavioral Practice, 13(4), 322-331. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. Tannenbaum, M., & Har, E. (2020). Beyond basic communication: The role of the mother tongue in cognitive-behavioral therapy (CBT). International Journal of Bilingualism, 24(4), 881-892. Tomkow, L., Prager, G., Drinkwater, J., Morris, R. L., & Farrington, R. (2023). ‘That’s how we got around it’: a qualitative exploration of healthcare professionals’ experiences of care provision for asylum applicants with limited English proficiency in UK contingency accommodation. BMJ Open, 13, e074824. https://doi.org/10.1136/bmjopen-2023-074824 Transformation Partners in Health and Care. (n.d.). Challenges and barriers for different ethnic groups. NHS. https://www.transformationpartners.nhs.uk/iapt-transformation/specific-population-groups/different-ethnic-groups/challenges-and-barriers/ Tribe, R., & Lane, P. (2009). Working with interpreters across language and culture in mental health. Journal of Mental Health, 18(3), 233–241. https://doi.org/10.1080/09638230701879102 Tribe, R., & Morrissey, J. (2004). Good practice issues in working with interpreters in mental health. Intervention: Journal of Mental Health and Psychosocial Support in Conflict Affected Areas, 2 (2), 129-142. Tribe, R., & Thompson, K. (2017). Working with interpreters in health settings: Guidelines for psychologists. The British Psychological Society. https://doi.org/10.53841/bpsrep.2017.inf288 Tribe, R., & Thompson, K. (2022). Working with interpreters when working with forced migrants in mental health. International Review of Psychiatry, 34(6), 613-621. Tutani, L., Eldred, C., & Sykes, C. (2018). Practitioners’ experiences of working collaboratively with interpreters to provide CBT and guided self-help (GSH) in IAPT; a thematic analysis. The Cognitive Behaviour Therapist, 11, e3. doi:10.1017/S1754470X17000204 van Dijk, D. A., Meijer, R. M., van den Boogaard, T. M., Spijker, J., Ruhé, H. G., & Peeters, F. P. M. L. (2023). Worse off by waiting for treatment? The impact of waiting time on clinical course and treatment outcome for depression in routine care. Journal of affective disorders, 322, 205–211. https://doi.org/10.1016/j.jad.2022.11.011 Williams, C. H. J. (2015), Epistemological assumptions and current controversies. Journal of Psychiatric Ment Health Nursing, 22: 344-351. https://doi.org/10.1111/jpm.12181 Woodward, M. J., Orengo-Aguayo, R., Stewart, R. W., & Rheingold, A. A. (2020). A Case Study of Interpreter-Mediated Prolonged Exposure Therapy for Posttraumatic Stress Disorder: Challenges and Recommendations for Effective Implementation. Clinical Case Studies, 19(1), 17-33. https://doi.org/10.1177/1534650119881787. Young, A., Vicary, S., Tipton, R., Rodríguez Vicente, N., Napier, J., Hulme, C., & Espinoza, F. (2023). Mental health professionals’ (AMHPs) perspectives on interpreter-mediated mental health act assessments. Journal of Social Work, 24(2), 219-239. https://doi.org/10.1177/14680173231197987