NHS Talking Therapies for Anxiety and Depression (TTad) offers evidence-based psychological interventions for individuals with depression and anxiety disorders across England. Despite substantial progress in improving access to therapy, disparities remain, particularly for clients from diverse backgrounds. Given the increasing linguistic diversity across England and the reported preference among clients to engage in therapy in their first language, it is not yet known whether requiring or requesting an interpreter affects access to timely and appropriate therapy, or whether such needs contribute to disparities in treatment outcomes. This study, therefore, examined waiting times and outcomes for interpreter-mediated CBT within TTad. The sample consisted of 177,340 clients who accessed TTad services for the year 2022 to 2023 and received Step 3 CBT. Clients using an interpreter were significantly more likely to wait longer for treatment compared with those not using an interpreter. Treatment outcomes differed significantly; only 58.5% of clients using an interpreter showed reliable improvement, compared with 69.2% of those not using an interpreter. Similarly, reliable recovery was lower in the interpreter group (32.5%) versus the non-interpreter group (44.5%). Among those requiring an interpreter, the lowest reliable recovery was seen in clients using professional interpreters (28.8%). These findings highlight the need for targeted strategies to reduce delays and improve outcomes for interpreter-mediated therapy, ensuring more equitable access and effectiveness of psychological interventions within TTad. Further research is needed to explore the underlying factors contributing to these disparities and to identify best practices for delivering effective, culturally and linguistically appropriate therapy.

Key learning aims

1. (1) To examine whether a request or requirement for an interpreter is associated with increased or altered waiting times for Step 3 CBT within NHS Talking Therapies for anxiety and depression.

2. (2) To investigate differences in clinical outcomes, specifically reliable improvement and reliable recovery, for clients using interpreters compared with those who do not use interpreters.

3. (3) To compare outcomes across different interpreter arrangements, including professional interpreters, family/friend interpreters, others, and instances where interpreters did not attend, exploring any differences in outcomes.

This paper provides a description of a postgraduate clinical psychology training programme's journey towards becoming more biculturally responsive and how the learnings from this have been applied to the wider Department of Psychology at the University of Canterbury (UC), Aotearoa New Zealand (NZ). The paper includes a discussion of cultural competency, and frameworks which have been proposed as a way to blend Western and Māori knowledge and clinical and cultural practices. The reasons for introducing the changes, the process of change and the actual changes are described, together with a discussion of the outcomes of the changes. Key principles in undertaking the changes were that it was considered important that the process that was seen as an ongoing journey. Further guiding principles were that a graded, integrated approach was required, undertaken in partnership with Māori, and with a commitment to biculturalism before multiculturalism.