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Access to mental health in primary care: A qualitative meta-synthesis of evidence from the experience of people from ‘hard to reach’ groups
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.
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“While there are many differences commonalities include the impact of chronicity, social isolation, stigma and a lack of identification with routine biomedical understandings of mental health [20].”
From Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care (2014) · cites this paper as [20]
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Metadata
- Authors
- Lamb, J., Bower, P., Rogers, A., Dowrick, C., & Gask, L.
- Affiliations
- University of Manchester (GB)
- University of Liverpool (GB)
- Venue
- Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
- Publisher
- SAGE Publications
- Published
- 2012-01
- Volume
- 16
- Issue
- 1
- Pages
- 76-104
- ISSN
- 1363-4593 (ISSN-L)
- 1461-7196
- OpenAlex
- W2119715782
- Cited by
- 101
- References
- 48
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 6 · 2023: 4 · 2022: 6 · 2021: 7 · 2020: 9 · 2019: 1 · 2018: 6 · 2017: 7 · 2016: 9 · 2015: 6 · 2014: 17 · 2013: 3 · 2012: 6
- FWCI
- 11.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- National Institute for Health and Care Research (RP-PG-0606-1071)
- University of Manchester
- NIHR School for Primary Care Research
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- access to mental health care, help-seeking, hard-to-reach populations, depression, anxiety, homelessness, long-term unemployment, eating disorders, geriatric depression, advanced cancer, medically unexplained symptoms, asylum seekers, Black and minority ethnic communities, stigma, social roles, self-management strategies, material disadvantage, primary care, marginalized communities
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Mental Disorders, Female, Health Services Accessibility, Humans, Male, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Primary Health Care, Young Adult
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