A R&D programme to increase equity of access to high quality mental health services in primary care

Aims:To increase equity of access to high quality primary care mental health services for hard to reach groups. Objectives:to clarify mental health needs in these groups, identify relevant services and their barriers and facilitators, develop and test credible interventions, establish dissemination strategies and integrate new services into primary care.Background:Mental health problems impose substantial burdens patients, carers, and health care systems. A wide range of interventions have demonstrable efficacy in improving the lives of people experiencing common but disabling mental health problems. However many people with high levels of mental distress are disadvantaged either because they are unable to access care (e.g. black and ethnic minorities, homeless, asylum seekers, adolescents with eating disorders), or because access does not lead to adequate care (e.g. people with unexplained symptoms, prolonged sickness absence, advanced cancers or older people with depression). Key research issues needing to be addressed include complex problem presentation and diagnostics in primary care, user defined perspectives on problem formulation, management and outcome, engagement and communication, and the professional context of mental health encounters. Research Plans:The programme will link knowledge about barriers to access for our exemplar groups with the perspectives of users, and developing creative ways to meet the particular needs of these groups. Phase 1 (months 1 to 24): Understanding the Problems and Generating Potential Solutions. We will undertake a general review of barriers to access to care, and interventions to overcome these barriers, using a combination of systematic review and qualitative meta-synthesis techniques. We will focus on user perspectives on mental health issues in relation to each of the hard-to-reach groups, in order to understand whether there are any access issues specific to each group, and how different issues affect them all. We will then consider the results of our reviews, and use a consensus process to develop exemplar interventions which take account of known barriers while remaining sensitive to the needs, preferences and priorities of our exemplar hard-to-reach groups and other stakeholders. Phase 2 (months 19-48):Testing Potential Solutions. We will develop interventions in three domains: improving access (e.g. outreach, transport, accessibility, internet use), improving understanding (e.g. knowledge and attitudes of care providers, public understanding) and improving care (e.g. skills training, psychological interventions, self management, role of voluntary sector). We will test interventions in terms of acceptability and credibility to service users and other stakeholders, their impact on the mental health of service users, and their service implications and cost effectiveness. Phase 3 (months 43-60):Putting what Works into Practice. We will develop and evaluate methods to disseminate our findings across the broad economy of primary health care, including a focused implementation experiment in two PCT sites. Our programme brings together previously separate streams of research and development activity. In so doing it reduces duplication of effort and enables synergies. Lessons can thus more readily be learned about effective research and clinical methods and their dissemination into routine practice.Research Team:We bring together internationally recognised mental health researchers from Universities of Liverpool and Manchester, with policy makers and managers from two Primary Care Trusts. We have substantial expertise in the range of methodologies necessary for applied health research, in service and diagnostic issues, and in the design and prosecution of trials and related interventions for our exemplar hard to reach groups.Research Environment:Our team is strongly represented within the new National School for Primary Care, and key NHS bodies including the Mental Health Research Netw