title: Improving mental health outcomes: achieving equity through quality improvement.
abstract: OBJECTIVE
  To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative.
  
  
  METHODS
  Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control.
  
  
  METHODS
  A psychological therapy service in Westminster, London, UK.
  
  
  METHODS
  People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012.
  
  
  METHODS
  s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks.
  
  
  METHODS
  s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator.
  
  
  RESULTS
  Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = -6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories.
  
  
  CONCLUSIONS
  QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome.
authors: Address reprint requests to: Alan J. Poots; a.poots@imperial.ac.uk.
authors: Alan J
authors: AJ
authors: Poots
authors: Stuart A
authors: SA
authors: Green
authors: Emmi
authors: E
authors: Honeybourne
authors: John
authors: J
authors: Green
authors: Thomas
authors: T
authors: Woodcock
authors: Ruth
authors: R
authors: Barnes
authors: Derek
authors: D
authors: Bell
mesh_terms: D003865:Major Depressive Disorder / Q000628:therapy*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008389:Marketing of Health Services / Q000379:methods*; D008605:Mental Health Services / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: inequalities; mental health; outcome assessment (health care); public health; quality improvement