Pharmacological intervention in people with intellectual disability (ID) for their underlying mental illnesses and challenging behaviour has been fraught with difficulties due to a lack of robust evidence base (Brylewski and Duggan, 2003), lack of standardized diagnostic criteria, diagnostic overshadowing, problems with communication and a considerable overlap with co-morbid physical health problems (Bhaumik et al., 2005).

Equal access to psychological treatment is a central tenet of the Improving Access to Psychological Therapy (IAPT) programme and the NHS value that ‘everyone counts’. A clinical audit was undertaken in a Step 4 IAPT service to establish whether referrals reflected local population and national IAPT referral demographic profiles and whether certain groups disengaged early from treatment. Anonymised audit data was extracted from the electronic clinical record system. 1269 clients had started or ended treatment between 1 January 2013 and 31 December 2013. Chi-squared tests and odds ratios were used to establish whether there was any association between demographic category and the number of clients moving between each stage of the care pathway. Overall, demographic profiles were found to be consistent across referral, assessment and treatment, indicating fairly good equality of access to all stages of the care pathway. However, the odds of men dropping out of treatment were higher than for women. There were greater odds of ethnic minority clients failing to reach assessment stage. Clients with partners had lower odds of attending assessment or completing treatment. Finally, clients with a disability had lower odds of completing treatment once started. These findings were presented to clinicians and managers in the relevant NHS Trust. Positive actions were agreed, including introducing a leaflet to help clients discuss their referral with partners and considering paying for transport to help disabled clients stay in treatment. Every CBT therapist working in an NHS setting is duty-bound, under the NHS Constitution, to help promote equal access to treatment. Therapists could encourage their service to run a similar audit and take similar actions to improve equal access, where relevant.