Access to primary mental health care for hard-to-reach groups: From ‘silent suffering’ to ‘making it work’

Kovandžić, Marija; Chew‐Graham, Carolyn; Reeve, Joanne; Edwards, Suzanne; Peters, Sarah; Edge, Dawn; Aseem, Saadia; Gask, Linda; Dowrick, Christopher

doi:10.1016/j.socscimed.2010.11.027

Cited by 128 publications

(140 citation statements)

References 27 publications

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“…All such negotiations occur in a health care culture where some services are more permeable than others. (Hunter et al, 2013;Klassen et al, 2008;Koehn, 2009;Koehn et al, 2014;Kovandzic et al, 2011;Purcell et al, 2014) which extend the original model and contribute an additional dimension to the challenges of access. Both Koehn and Klassen emphasise the importance of social norms apparent in elder minority ethnic communities on the Candidacy process, and Klassen goes on to demonstrate that these, along with issues of racism and socio-economic disadvantage, construct a series of interrelated barriers to the enactment of Candidacy (Klassen et al, 2008;Koehn, 2009).…”

Section: Candidacymentioning

confidence: 99%

“…For instance, other researchers have extended Dixon-Woods' concept and adopted the Candidacy lens when exploring healthcare access across a range of social groups (Hunter et al, 2013;Klassen et al, 2008;Koehn, 2009;Kovandzic et al, 2011;Mackenzie et al, 2013;Purcell et al, 2014) and propose additional dimensions (race, gender, symptom-type), often alongside social disadvantage, that similarly impinge on the Candidacy process.…”

Section: Illness Identity As An Important Component Of Candidacy: Conmentioning

confidence: 99%

“…Both Koehn and Klassen emphasise the importance of social norms apparent in elder minority ethnic communities on the Candidacy process, and Klassen goes on to demonstrate that these, along with issues of racism and socio-economic disadvantage, construct a series of interrelated barriers to the enactment of Candidacy (Klassen et al, 2008;Koehn, 2009). Kovandzic's study of mental ill health and healthcare access illustrated that symptoms themselves together with socio-demographic factors conflate to punctuate the Candidacy process with additional illness related hurdles (Kovandzic et al, 2011).…”

Section: Candidacymentioning

confidence: 99%

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Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

Macdonald

Blane

Browne

et al. 2016

Social Science & Medicine

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How and when we use health services or healthcare provision has dominated exploration of and debates around healthcare access. Levels of utilisation are assumed as a proxy for access. Yet, focusing on utilisation conceals an important aspect of the access conundrum: the relationships that patients and potential patients have with the healthcare system and the professionals within those systems. Candidacy has been proposed as an antidote to traditional utilisation models. The Candidacy construct offers the ability to include patient-professional aspects alongside utilisation and thus promotes a deeper understanding of access. Originally applied to healthcare access for vulnerable populations, additional socio-demographic factors, including age and ethnicity, have also been shown to influence the Candidacy process. Here we propose a further extension of the Candidacy construct and illustrate the importance of illness identities when accessing healthcare.Drawing on a secondary data analysis of three data sets of qualitative interviews from colorectal cancer and heart failure patients we found that though similar access issues are apparent prediagnosis, diagnosis marks a critical juncture in the experience of access. Cancer patients describe a 2 person-centred responsive healthcare system where their patienthood requires only modest assertion. Cancer speaks for itself. In marked contrast heart failure patients, describe struggling within a seemingly impermeable system to understand their illness, its implications and their own legitimacy as patients. Our work highlights the pressing need for healthcare professionals, systems and policies to promote a person centred approach, which is responsive and timely, regardless of illness category. To achieve this, attitudes regarding the importance or priority afforded to different categories of illness need to be tackled as they directly influence ideas of Candidacy and consequently access and experiences of care.

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Section: Candidacymentioning

confidence: 99%

Section: Illness Identity As An Important Component Of Candidacy: Conmentioning

confidence: 99%

Section: Candidacymentioning

confidence: 99%

See 1 more Smart Citation

Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

Macdonald

Blane

Browne

et al. 2016

Social Science & Medicine

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“…We have published the main findings on commonalities between groups in a paper by Kovandžić et al 345 and some of the findings related to specific groups included in this study in a paper by Chew-Graham et al 346 Here we outline the main findings, illustrated with some quotations from the data. Our analysis points to an extensive overlap in access-related issues across the observed groups, along with some particularities.…”

Section: Summary Of Evidencementioning

confidence: 82%

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…8 The researchers used key findings from multiple sources of evidence (both primary and secondary) to guide the form and content of the psychosocial intervention for service users. 9,10 As a result of the empirical evidence provided by this work, and ongoing collaboration with local service providers, the programme had a direct influence on changes to the local (then) primary care trust's model of primary mental health care. Perhaps entirely unwittingly, the programme team concluded by directly paraphrasing Bazeley: 'our multilevel intervention was greater than the sum of its parts'.…”

Section: Following the Mixed Methods Trailmentioning

confidence: 93%

Following the mixed methods trail: some travel advice

Burt

2015

Br J Gen Pract

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Access to primary mental health care for hard-to-reach groups: From ‘silent suffering’ to ‘making it work’

Cited by 128 publications

References 27 publications

Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Following the mixed methods trail: some travel advice

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