Access to mental health in primary care: A qualitative meta-synthesis of evidence from the experience of people from 'hard to reach' groups

Jonathan Lamb, Peter Bower, Anne Rogers, Christopher Dowrick, Linda Gask

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Knowledge about depression, access and help-seeking has increasingly been influenced from a range of disciplines including clinical and applied social science. A range of interventions can improve outcomes of depression and anxiety. However, many in need do not seek help, or their interaction with care-givers does not address their needs. We carried out a systematic search for qualitative articles focusing on the experiences of eight exemplar groups with exceptional problems in access (the homeless, long-term unemployed, adolescents with eating disorders, depressed elderly people, advanced cancer sufferers, patients with medically unexplained symptoms, asylum seekers and people from black and minority ethnic groups). Twenty articles representing these groups were selected, findings were then developed using qualitative meta-synthesis, this suggested a range of mechanisms accounting for poor access among these groups. Many regarded their mental health problems as rooted in social problems and employed a variety of self-management strategies to maintain function. These strategies could involve social withdrawal, focusing available resources on close family relationships and work roles. Over-investment in these roles could result in a sense of insecurity as wider networks were neglected. Material disadvantage affected both the resources people could bring to performing social roles and influenced help-seeking. A tacit understanding of the material, psychological and social 'costs' of engagement by patients and health professionals could influence decisions to seek and offer help. These costs were felt to be proportionally higher in deprived, marginalized and minority communities, where individual resources are limited and the stigma attached to mental ill-health is high. © The Author(s) 2011.
    Original languageEnglish
    Pages (from-to)76-104
    Number of pages28
    JournalHealth
    Volume16
    Issue number1
    DOIs
    Publication statusPublished - Jan 2012

    Keywords

    • access
    • inequalities
    • mental health
    • meta-synthesis
    • primary care

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