National Mental Health Strategy Research Articles

A-377 The Selection and Implementation of POC Illicit Drug Toxicology Testing in Hamad Medical Corporation - Doha, Qatar

Abstract Background In 2013, Qatar launched the National Mental Health Strategy which is further supported by National Health Strategy 2018–2022 and Qatar National Vision 2030, where the mental health has been identified as a priority area of development. In doing so, the Ministry of Public Health worked closely with the Ministry of Interior in providing the appropriate treatment rehabilitation. With all considerable advantages of point-of-care testing (POCT) in rapid diagnosis, POC toxicological test has been implemented and used in screening of patients for drugs of abuse. In this study, we highlighted the challenges in selection and implementation process of POC toxicological test in Hamad Medical Corporation (HMC). Methods Due to unavailability of all required drug panels, it had to be customized and tested for the verification purpose before starting the evaluation process. Maintaining HMC procurements regulations and Clinical Laboratory Improvement Amendments (CLIA) and College of American Pathologist (CAP) standards for POC toxicology tests, two POC illicit drug toxicology screening tests has been evaluated, comparison study has been performed against the HMC central laboratory. POCT team conducted training session ensuring the appropriate practice in place. The Extendable Laboratory Information System (LIS) functionality has been utilized for seamless data management and reporting for the automated analyzer. Results QUIDEL triage meter pro is an automated drug testing analyzer which detects Amphetamines, Barbiturates, Benzodiazepines, Cannabinoids, Methadone Metabolite, Methamphetamine, Opiates, Tricyclic and Cocaine Metabolites, while the customized manual testing kit FASTEP detects Tramadol (TRA), Methylenedioxymeth-amphetamine (MDMA), Phencyclidine (PCP), Buprenorphine (BUP), Oxycodone (OXY), Fentanyl (FYL), Ethyl Glucuronide (EtG), Cotinine (COT), Pregabalin (PGB) and Gamma Hydroxybutyrate (GHB). Both analytical performances were verified. Rapid bedside testing performed for more than 100 patients in last 8 months during admission, observation, and pre- discharge process. There is An Obvious improvement observed in testing turnaround time compared to the laboratory, easy results interpretation and reporting as well as cost-effective. Conclusion The implementation of POC illicit drug toxicology testing in HMC aligned with core pillars of the Qatar vision 2030 to deliver the right treatment at the right time and place. Its enhancing patient outcomes and overall Satellite health care sector in Qatar.

Mental health reform in Australia - unfinished business.

Australia was one of the first countries to develop a national mental health strategy. This article reviews the progress of reform, outlining some strengths, weaknesses and prospective challenges.

Clinical Audit Report on Mental Health Screening by nurses at a Primary Health Care Centre

Mental health awareness is a vital part of a comprehensive National Mental Health and Wellbeing Strategy for the entire population [1]. The Ministry of Public Health (MOPH) in Qatar along with various stakeholders including PHCC are tasked with promoting and improving the delivery of Mental health services across the country as per Public Health Strategy 2017-2022 and the National Health Strategy 2018-2022 [2, 3]. The Qatar Global Burden of Disease 2010 reveals that major depressive disorder is the most burdensome disease in Qatar as per DALYs [4]. The WHO estimates about 30-50% patients attending primary care with depressive disorder are not detected and nearly two-thirds of people with a known mental disorder never seek help from a health professional due to stigma, discrimination, and negative stereotype [5]. Other reasons include limited time, access, affordability and lack of education and training. It was reported that an average delay between first symptoms presentation and intervention is approximately 11 years, which makes screening important as it allows for early identification and intervention. Recently MOPH launched Ma'ak Educational Program to enhance mental health and wellbeing in Qatar [6]. This can help bridge the gap and lead to better outcomes. Evidence suggests early treatment may also lessen long-term disability and suffering [7]. This Audit is done to review the adherence to mental health screening by nurses at our primary health care center (HC) and suggest measures to improve quality of patient care and health outcomes at PHCC if audit finds any gap in practice. A baseline audit sample of 354 health records was selected from the total volume of patients (18years and above) who were seen at nurses' station at our HC between 11th to 20th January 2023 and reviewed retrospectively against audit specific criterion. This data was then analysed to see how many of them had mental health screening performed using PHQ2 and GAD2 questionnaires. ..

Understanding the health context for implementation of a new digital psychosocial intervention for improvement of the mental health in North Macedonia

The aim of this study was to identify the contextual attributes in North Macedonia and their characteristics relevant to the implementation of a new digital intervention to improve mental health, called DIALOG+. This research is the first of its kind in North Macedonia due to the analysis of contextual attributes that may affect the effectiveness of the intervention and its acceptability in various settings of mental health care. Some of the data processed in this paper were provided and analyzed by the National Mental Health Strategy 2018-2025 and other relevant accompanying documents from the World Health Organization and action plans, as well as through interviews with stakeholders (patients, carers, clinicians and policy makers) for their opinion before introducing the DIALOG + intervention and the report on the assessment of the situation in the centers where the implementation of the intervention should have started. The collected data were then mapped to a framework developed by the Ottawa Implementation Group, which included 14 contextual attributes. The results are summarized in 2 subgroups, and are presented as facilitators and barriers to implementation, specific to the mental health system in North Macedonia. The characteristics of DIALOG + (widely applicable psychosocial intervention) are in accordance with modern assumptions for psychosocial rehabilitation of patients with psychosis. Hence, we can conclude that it is a useful tool for professionals in monitoring and achieving the true vision and mission of these institutions. It will help patients reintegrate into society, become more independent and use their full potential in the pursuit of healthy and functional living.

Fit for Purpose-Re-Designing Australia's Mental Health Information System.

Background: Monitoring and reporting mental health is complex. Australia’s first National Mental Health Strategy in 1992 included a new national commitment to accountability and data collection in mental health. This article provides a narrative review of thirty years of experience. Materials and Methods: This review considers key documents, policies, plans and strategies in relation to the evolution of mental health data and reporting. Documents produced by the Federal and the eight state and territory governments are considered, as well as publications produced by key information agencies, statutory authorities and others. A review of this literature demonstrates both its abundance and limitations. Results: Australia’s approach to mental health reporting is characterised by duplication and a lack of clarity. The data available fail to do justice to the mental health services provided in Australia. Mental health data collection and reporting processes are centrally driven, top–down and activity-focused, largely eschewing actual health outcomes, the social determinants of mental health. There is little, if any, link to clearly identifiable service user or carer priorities. Consequently, it is difficult to link this process longitudinally to clinical or systemic quality improvement. Initial links between the focus of national reform efforts and mental health data collection were evident, but these links have weakened over time. Changes to governance and reporting, including under COVID, have made the task of delivering accountability for mental health more difficult. Conclusion: Australia’s current approach is not fit for purpose. It is at a pivotal point in mental health reform, with new capacity to use modelled data to simulate prospective mental health reform options. By drawing on these new techniques and learning the lessons of the past, Australia (and other nations) can design and implement more effective systems of planning, reporting and accountability for mental health.

Community-Based Mental Health Services in Azerbaijan: a Course Toward Development

Community mental health care in Azerbaijan was established in 2011 in the line with the countrys mental health reform. The main directions of the reform, as described in the National Mental Health Strategy, were deinstitutionalization, improving quality of care, integration of mental health into primary healthcare, and implementation of modern community-based services. Over the last decade, the number of beds in psychiatric hospitals has significantly decreased, and many psychiatrists and psychiatric nurses have been transferred to primary care facilities. At the same time, programs focusing on comprehensive care have been implemented in different regions of the country.
 Community mental health services currently employ various kinds of mental health professional including psychiatrists, clinical psychologists, social workers, occupational therapists, and nurses to ensure a multidisciplinary approach to care provision. Team-based care may focus on crisis resolution, psychosocial rehabilitation, case management, family support, and early intervention for psychosis.
 Among the barriers preventing development of community mental health services, one should note, in particular, stigma belittling the priority of mental healthcare, uncertainty in distribution of authority between the Ministry of Health and the State Agency for Mandatory Health Insurance, and a general scarcity of human resources, especially in the rural regions. Nevertheless, the mental health care in Azerbaijan is continuing its transition from an institutional model to community-based services.

The 1996 TheMHS Conference, Brisbane: A Reflection on Consumer Involvement in Mental Health and the Birth of the Australian National Consumer Network

The 1996 TheMHS Conference, Brisbane: A Reflection on Consumer Involvement in Mental Health and the Birth of the Australian National Consumer Network Melanie Schuth (née Scott) (bio), Helen Glover (bio), and V. Kalyansundarum (bio) As compared to the rest of Australia, deinstitutionalisation and the development of community mental health services commenced relatively late in Queensland. Yet, once it started in the mid-1990s, there was a time of exceptional innovation and change in the state’s mental health sector. After the publication of the influential Burdekin report (1993) and with the momentum of the first National Mental Health Strategy, there was an openness among government officials and policymakers to explore new ideas and explore new ways of working.1 Consumer voices were being heard—many dared not only to speak, but to speak loudly. Many people are able to ignore the history of the Australian consumer movement until it is told boldly and loudly. During the early 1990s, the involvement of lived experience in mental health was still novel in Australia. In 1994, The Mental Health Services conference (TheMHS; one of the most progressive organisations in Australia and New Zealand in mental health), responding to then prominent consumer advocacy voices, advanced consumer involvement by dedicating a day to consumers.2 This spearheaded opportunities that would not have occurred as early, organically, or as genuinely as they did during this period. The organisers were convinced that consumer involvement should not be merely tokenistic: if lived experience voices were to be incorporated in the planning and running of mental health services, they had to be incorporated in an authentic and genuine way. We, the authors of this paper—Dr Kalyansandarum (Kaly in everyday life), Helen Glover, and Melanie Scott—were involved in the planning of the 1996 TheMHS conference and in various initiatives in mental health afterwards. We came together nearly thirty years later to reflect on what transpired during that time. We realised that much time had passed since the mid-1990s and that our memories were somewhat patchy as to the finer details of how the three of us joined forces and how both lived and learned experiences participated to co-create the 1996 TheMHS [End Page 135] conference and attempted to advance the ‘consumer’ movement. To this end, we recorded interviews about our recollections with each other about the conference and what emerged afterwards. Three key themes emerged from the discussions about our recollections. These themes, we think, remain pertinent today: 1. A strong desire to do things differently 2. Thinking big and well outside the box 3. An openness to experimentation A note on language: In the 1990s, the term ‘consumer’ indicated a radical shift from the term ‘patient’ or ‘ex-patient’. We acknowledge that we use the term in the context of the time it originated, noting that a broader range of person-first language is currently widely accepted in the sector’s linguistic lexicon and preferred by individuals who access services. 1. A Strong Desire to do Things Differently In our conversations with Dr Kaly, we inquired about his motivation to engage and include people with a lived experience of mental ill-health in the work he did in mental health. As this was during the post-Burdekin era, we anticipated that he would emphasise the importance of upholding people’s human rights, and their right to be heard and taken seriously in matters of service delivery. Whilst this was important to him, it was not his main motivation: Dr. Kaly: I was not so much interested in lived experience involvement in itself, but much more interested in the notion of personal recovery and learning from that to improve both my own practice and how we delivered services. Involvement and participation was the method we utilised. Instead of reading books about it I wanted to hear from their hearts. I wanted to learn from people who knew, based on their experiences. I firmly believed in the potential that people with serious mental illness and institutionalisation can lead good and fulfilling lives. Dr Kaly’s ethos about being led, informed, and, very often, challenged by lived experience wisdom extended well beyond mere consultation. His genuine desire...

Promoting follow-up attendance among mental health patients at a primary healthcare center in Lebanon: A randomized controlled trial.

In 2015, the Lebanese Ministry of Public Health launched the 2015-2020 National Mental Health Strategy in an effort to integrate Mental Health into Primary Healthcare centers. One of the key objectives of the strategy was to increase the detection, assessment, and management of mental disorders including depression. In addition to diagnosis and patient education, a successful management of depression requires that patients systematically follow-up with their healthcare provider to ensure that they are on the optimal path to recovery. This study evaluates the impact of a visual self-assessment card to increase patients' attendance to a follow-up appointment with their healthcare provider. A clustered randomized controlled trial was implemented at a Primary Healthcare center located in South Lebanon. The final sample consisted of 405 patients (209 treated and 196 untreated patients) who were diagnosed with mild-to-severe depression using the Patient Health Questionnaire (PHQ-9 > 4). Patients were asked to attend a follow-up appointment with their health provider 2-3 weeks following the initial assessment. Treated patients were provided with a visual self-assessment card that tracked their daily mood changes and reminded them of their follow-up appointment. Overall, the results provide evidence supporting the use of the self-assessment card to remind mental health patients of their follow-up appointments. Patients who received the card were 9 percentage points more likely to attend their follow-up appointment (p = 0.05), with new patients (vs existing patients) exhibiting a 15 percentage points increase (p < 0.05). Efforts focused on increasing compliance with follow-up appointments should be at the cornerstone of mental health integration approaches. Not only do our findings suggest a great potential for cost-effective interventions but also highlight new avenues to optimize on the use of reminders to promote compliance.

Clinical update on public and private psychiatric practice shared-care partnerships - Can the twain work together?

We explore the previous research and current context regarding opportunities for shared-care partnerships between public and private psychiatric practice. Since the early 2000s, when there was impetus for the development of public-private psychiatric shared-care models as part of a previous National Mental Health Strategy, there has been surprisingly little research and policy development. Given an apparent exodus of psychiatrists to private practice due to current challenges facing the public health sector, it is timely to reconsider models of private and public sector shared-care that may improve the quality of public mental healthcare.

Using complex systems mapping to build a strategic public health response to mental health in England

PurposeThis paper aims to use systems mapping as a tool to develop an organisation-wide approach to public mental health to inform strategic direction within a national public health agency. Design/methodology/approachTwo workshops were facilitated with internal staff from a wide range of public health policy teams working in small groups to produce paper-based maps. These were collated and refined by the project team and digitised. FindingsThe approach engaged a range of teams in forming a shared understanding and producing a complex system map of the influences on population mental health and well-being, where current policy initiatives were addressing them and what the gaps and priorities were. Participants valued the approach which led to further study and organisational commitment to the whole system working as part of national public mental health strategy. Research limitations/implicationsThe approach was limited to internal stakeholders and wider engagement with other sectors and community members would help further the application of complex system approaches to public mental health. Originality/valueIt was a valuable process for developing a whole-organisation approach and stimulating thinking and practice in complex system approaches. The paper provides a practical example of how to apply systems mapping and its benefits for organising public mental health practice.

Establishing comprehensive forensic mental health services in Qatar.

Qatar has experienced exponential economic and healthcare infrastructural development recently. Mental health has been prioritized for development by the state with the launching of the ambitious National Mental Health Strategy in 2013 which incorporates the development of specialist Forensic psychiatry services. Traditionally, some aspects of forensic psychiatry care were provided under general psychiatry, being largely reactive. The new strategy supported the development of specialist Forensic service with a focus on developing safer communities, preventing victimization and supporting the criminal justice system. We provide an overview of the development of this service in Qatar, one of the first of its kind in the region.

A Systematic Review of Culturally Responsive Approaches to Child and Adolescent Mental Health Care in Ethiopia.

In 2012/2013, the prevalence of child mental illness was estimated to be between 12 and 25% in Ethiopia. The Federal Ministry of Health is currently considering the implementation of the second national mental health strategy guided by the World Health Organization’s pyramid model for an optimal mix of services. This model states self-care as the fundamental concept and practice that can be facilitated by the formal and informal sectors surrounding an individual. Despite this remarkable move toward endorsing contemporary approaches to mental health services, Ethiopia struggles with a limited number of knowledgeable and skilled mental health professionals. This systematic review aims at identifying the main challenges Ethiopia might face while implementing the pyramid model. We will suggest ways to bridge the gap between the need for child/adolescent trained mental health professionals and training mental health professionals informed with the value of integrating the concepts of the pyramid model into the system of mental health care for Ethiopians. The paper also discusses the importance of integrating the Wellness based mental health approach into mental health professionals’ training as a means of developing a culturally responsive approach to child and adolescent services. This review provides implications for further studies and mental health policy, systems and services in Ethiopia.

The impact of COVID-19 on the mental health of Canadian children and youth

Children and youth flourish in environments that are predictable, safe, and structured. The COVID-19 pandemic has disrupted these protective factors making it difficult for children and youth to adapt and thrive. Pandemic-related school closures, family stress, and trauma have led to increases in mental health problems in some children and youth, an area of health that was already in crisis well before COVID-19 was declared a global pandemic. Because mental health problems early in life are associated with significant impairment across family, social, and academic domains, immediate measures are needed to mitigate the potential for long-term sequalae. Now more than ever, Canada needs a national mental health strategy that is delivered in the context in which children and youth are most easily accessible—schools. This strategy should provide coordinated care across sectors in a stepped care framework and across a full continuum of mental health supports spanning promotion, prevention, early intervention, and treatment. In parallel, we must invest in a comprehensive population-based follow-up of Statistics Canada’s Canadian Health Survey on Children and Youth so that accurate information about how the pandemic is affecting all Canadian children and youth can be obtained. It is time the Canadian government prioritizes the mental health of children and youth in its management of the pandemic and beyond.

Well-being status and post-traumatic stress symptoms in health workers attending mindfulness sessions during the early stage of the COVID-19 epidemic in Mexico

Introduction. In Mexico, a National Mental Health Strategy was implemented to identify and attend the mental health repercussions of the COVID-19 pandemic. It included the creation of five virtual clinics for health workers, being the Burnout, Post-traumatic Stress and Compassion Fatigue clinic one of them. Objective. To describe the basal sociodemographic and psychological characteristics of health workers attending online mindfulness sessions as part of the treatment of the aforementioned clinic. Method. This is a cross-sectional report part of a major nationwide and longitudinal project. All attendants responded to digital sociodemographics and COVID-19 questionnaires, the Extended Physician Well-Being Index (EPWBI), and the Post-traumatic Stress Disorder (PTSD) TOP-8 index. Results. Of the 507 health workers that participated, 70.02% of them were at risk of burnout according to the Extended Well-Being Index and 57.31, 7.91 and 2.77% had a mild, moderate, and severe risk of PTSD, respectively. The most affected were the female health workers, from metropolitan or central areas of the country, and those diagnosed with COVID-19 or exposed to a person with the diagnosis. Discussion and conclusion. Mexican health workers attending mindfulness sessions presented high frequencies of PTSD symptoms and burnout. Female workers at urban hospitals could be at a special risk for developing PTSD or Well-ness alterations, and thus, they must be cared for closely, particularly those having direct contact with COVID 19 positive persons. The early participation in mental health strategies might lessen the immediate and long-term pandemic effects.

Primary care mental health services in Qatar.

With rapid growth and development in recent decades, the State of Qatar has been redefining strategies and policies towards building a world-class healthcare system. Mental health has emerged as a priority area for development. As a result, mental health services in the region are being redefined and expanded, and this was realised with the launching of the ambitious National Mental Health Strategy in 2013. Traditionally, mental healthcare in Qatar had been considered to be the remit of psychiatrists within secondary care. The new strategy supported the transition towards community-based care. It outlined a plan to design and build a comprehensive and integrated mental health system, offering treatment in a range of settings. In this article, we provide an overview of the advent of primary care mental health services in Qatar. We discuss the historical aspects of psychiatric care and development of primary care mental health services in Qatar.

Private practice metropolitan telepsychiatry in smaller Australian jurisdictions during the COVID-19 pandemic: preliminary analysis of the introduction of new Medicare Benefits Schedule items.

To analyse the smaller Australian state/territory service impact of the introduction of new COVID-19 psychiatrist video and telephone telehealth Medicare Benefits Schedule (MBS) items. MBS item service data were extracted for COVID-19 psychiatrist video and telephone telehealth item numbers corresponding to the pre-existing in-person consultations for the Australian Capital Territory (ACT), Northern Territory (NT), South Australia (SA) and Tasmania. The overall rate of consultations (face-to-face and telehealth) increased during March and April 2020, compared to the monthly face-to-face consultation average, excepting Tasmania. Compared to an annual monthly average of in-person consultations for July 2018-June 2019, total telepsychiatry consultations were higher for April than May. For total video and telephone telehealth consultations combined, video consultations were lower in April and higher in May. As a percentage of combined telehealth and in-person consultations, telehealth was greater for April and lower for May compared to the monthly face-to-face consultation average. In the smaller states/territories, the private practice workforce rapidly adopted COVID-19 MBS telehealth items, with the majority of psychiatric consultation shifting to telehealth initially, and then returning to face-to-face. With a second wave of COVID-19 in Australia, telehealth is likely to remain a vital part of the national mental health strategy.

The service user voice in shaping mental health policy

Abstract Background Over the last 7 years CMH Malta provided holistic evidence for a mental health strategic framework with the regular input of patients, families, NGOs and civil society. Methods This evidence featured in published Annual Reports, conference presentations, bilateral meetings, and media interventions. The National Mental Health Strategy 2020-2030 was published in July 2019. CMH proffered advice, experience and supporting documents to the Strategy Team. 80% of the action points in the strategy reflect CMH recommendations. Results The philosophy of care should emphasise person-centred multi-disciplinary care. The primary health care system must be an effective gatekeeper providing mental health promotion and care in the community thus preventing hospital admissions. Acute psychiatric care must be provided within the acute general hospital setting with active support of A&amp;E and 24/7 intervention services that deal promptly with emergencies. Transition of youngsters to adult psychiatry and of adults to old age psychiatry should be flexible. Community-based rehabilitation is required for Adult Psychiatry, Child/Adolescent/Youth Psychiatry, Old Age Psychiatry, Forensic Psychiatry and Learning Disability. Policymakers must provide care options for older persons with chronic mental disorders, safe settings for youngsters with severely challenging behaviour, and shelters for persons suffering from substance misuse who resist treatment or rehabilitation. Conclusions Implementation of the Mental Health Strategy requires substantial capital investment and new resources. Service re-engineering and synergy are necessary to avoid duplication and waste. Better complements of professionals must be available to provide alternative therapies to the current medical pharmacological model. Key messages Patients, families, NGOs and civil society are critical partners in strategy development. Action points and implementation plans must reflect service user views and advice.

18.L. Workshop: Public mental health policies - experiences and challenges

Abstract The workshop has the aim to help developing and strengthening policies for Public Mental Health and support experience sharing platform for Public Mental Health policy development. Mental health policy defines the vision for the future mental health of the national population and internationally. The WHOs developed three recommendations for the development of mental health policy, strategic plans and for organizing services which are to deinstitutionalise mental health care; to integrate mental health into general health care; and to develop community mental health services. For each this aim a situational analysis and needs assessment is recommended as first step. Therefore, this workshop consists of four talks in the development of mental health policies at the regional and national level. First, the process of population consultations and participatory research is described (Felix Sisenop). Participatory research enables exchanging experiences, results and key challenges in Public Mental Health. Participatory research can contribute greatly in empowering people to discuss and deal with mental health issues and therefore is a step towards a more involved and active general public. Second, a policy development at the regional level is described (Elvira Mauz). On behalf of the federal ministry of health the Robert Koch Institute as the German public health institute is currently developing a concept for a national Mental Health Surveillance (MHS). In the talk objectives, framework model and work processes are presented. The MHS should systematically gather, process and analyze primary and secondary data, thus an integrating and monitoring system is working. Third, the Public Mental Health policy in Malta will be described (John Cachia) Over the last 7 years CMH Malta developed a strategic framework for the mental health with the input of patients, families, service providers, NGOs and civil society. The Maltese National Mental Health Strategy 2020-2030 was published in July 2019. This strategy will be described in the Talk. Fourth presenter (Ignas Rubikas) will introduce the national perspective on development of Lithuanian mental health policy addressing major public mental health challenges of suicide prevention, alcohol control policies and mental health promotion in a broader context of national mental health care. Key messages Participatory research in Public Mental Health is an approach to involve the population in policy development. Development of mental health policies can benefit from sharing experiences and lessons learned on a national and regional levels.

Mental health services in Cambodia: an overview.

Mental health services in Cambodia required rebuilding in their entirety after their destruction during conflict in the 1970s. During the late 1990s there was rapid growth and development of professional mental health training and education. Currently, basic mental healthcare is available primarily in urban areas and is provided by a mixture of government, non-government and private services. Despite the initial rapid growth of services and the development of a national mental health strategy in 2010, significant challenges remain in achieving an acceptable, standardised level of mental healthcare nationally.

How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives

Background: Improving Access to Psychological Therapies (IAPT) constitutes a key element of England’s national mental health strategy. Accessing IAPT usually requires patients to self-refer on the advice of their GP. Little is known about how GPs perceive and communicate IAPT services with patients from low-income communities, nor how the notion of self-referral is understood and responded to by such patients.Aims: This paper examines how IAPT referrals are made by GPs and how these referrals are perceived and acted on by patients from low-income backgroundsMethod: Findings are drawn from in-depth interviews with low-income patients experiencing mental distress (n = 80); interviews with GPs (n = 10); secondary analysis of video-recorded GP-patient consultations for mental health (n = 26).Results: GPs generally supported self-referral, perceiving it an important initial step towards patient recovery. Most patients however, perceived self-referral as an obstacle to accessing IAPT, and felt their mental health needs were being undermined. The way that IAPT was discussed and the pathway for referral appears to affect uptake of these services.Conclusions: A number of factors deter low-income patients from self-referring for IAPT. Understanding these issues is necessary in enabling the development of more effective referral and support mechanisms within primary care.