Evaluating a complex model designed to increase access to high quality primary mental health care for under-served groups: a multi-method study.

Christopher Dowrick,Mark Gabbay,Linda Gask,Linda Gask,Susan Beatty,Karina Lovell,Suzanne Edwards,Mark Hann,Mark Hann,Katie Bristow,Carolyn Chew-Graham,Peter Bower,Peter Bower,Heather Burroughs,Waquas Waheed,Waquas Waheed,Jonathan Lamb

doi:10.1186/s12913-016-1298-5

Abstract

BackgroundMany people with mental distress are disadvantaged because care is not available or does not address their needs. In order to increase access to high quality primary mental health care for under-served groups, we created a model of care with three discrete elements: community engagement, primary care training and tailored wellbeing interventions. We have previously demonstrated the individual impact of each element of the model. Here we assess the effectiveness of the combined model in increasing access to and improving the quality of primary mental health care. We test the assumptions that access to the wellbeing interventions is increased by the presence of community engagement and primary care training; and that quality of primary mental health care is increased by the presence of community engagement and the wellbeing interventions.MethodsWe implemented the model in four under-served localities in North-West England, focusing on older people and minority ethnic populations. Using a quasi-experimental design with no-intervention comparators, we gathered a combination of quantitative and qualitative information. Quantitative information, including referral and recruitment rates for the wellbeing interventions, and practice referrals to mental health services, was analysed descriptively. Qualitative information derived from interview and focus group responses to topic guides from more than 110 participants. Framework analysis was used to generate findings from the qualitative data.ResultsAccess to the wellbeing interventions was associated with the presence of the community engagement and the primary care training elements. Referrals to the wellbeing interventions were associated with community engagement, while recruitment was associated with primary care training. Qualitative data suggested that the mechanisms underlying these associations were increased awareness and sense of agency. The quality of primary mental health care was enhanced by information gained from our community mapping activities, and by the offer of access to the wellbeing interventions. There were variable benefits from health practitioner participation in community consultative groups. We also found that participation in the wellbeing interventions led to increased community engagement.ConclusionsWe explored the interactions between elements of a multilevel intervention and identified important associations and underlying mechanisms. Further research is needed to test the generalisability of the model.Trial registrationCurrent Controlled Trials, reference ISRCTN68572159. Registered 25 February 2013.

Highlights

Many people with mental distress are disadvantaged because care is not available or does not address their needs
2. that quality of primary mental health care is increased by the presence of the community engagement and wellbeing intervention elements
We would expect access to the wellbeing interventions to be greater in the two localities which were offered the full AMP community engagement programme, and for patients registered with one of the seven practices which participated in AMP trainingplus; and greatest for those who were involved with both the community engagement and the practice training elements

Summary

Introduction

Many people with mental distress are disadvantaged because care is not available or does not address their needs. In order to increase access to high quality primary mental health care for under-served groups, we created a model of care with three discrete elements: community engagement, primary care training and tailored wellbeing interventions. We assess the effectiveness of the combined model in increasing access to and improving the quality of primary mental health care. Many people with high levels of mental distress are disadvantaged because the benefits of these effective models are limited by problems in access: people may not be aware of or express a mental health need, or be aware of the availability of suitable services [4]. Older people often receive inadequate help when they do access primary care. For example depression is common in older people, those with chronic physical illness, but tends to be underdiagnosed and inadequately managed [8, 9]

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