Supporting patients' mental health without the use of medication – what difference did it make in deprived communities?
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Supporting patients’ mental health without the use of medication – what difference did it make in deprived communities?
This Evidence Summary shares findings from the PRIME (PRImary care MEntal health) study.
Read more about the PRIME study.
Please note: This Evidence Summary is split into two parts. The first part covers the quantitative part of the research (looking at statistics). The second part covers the qualitative part (looking at research that involved people sharing their views).
Watch: Lead Researcher Dr Sarah Sowden talk to the British Journal of General Practice about this project and its implications for primary care.
Or follow this link to listen to an audio recording
Part one – Quantitative study
Study title: Non-pharmaceutical primary care interventions to improve mental health in deprived populations: a systematic review.
Quick read summary
This quantitative study looked at existing statistical research which explored the effectiveness of non-pharmaceutical (not using medical prescriptions) ways to improve mental health in deprived populations
The review of this research showed that mental health interventions which do not involve drugs, do work for people living in areas of disadvantage. It also found that more high-quality studies are needed to draw stronger conclusions about this.
Who is the evidence for?
Healthcare professionals, including social prescribers, who are involved in the treatment of mental health in primary care. Healthcare commissioners who are involved in procuring services.
Research summary
Mental health is important for an individual’s wellbeing. However, mental-ill health, including depression and anxiety, are widespread amongst people from socially disadvantaged backgrounds. Interventions that do not involve drugs, such as social prescribing (when people are referred to community services through a link worker) and collaborative care (when a person’s care manager works with the clinician to support their mental health) can be important alternative options.
Little is known about the impact of these interventions for socially disadvantaged patients. To find out more, we carried out a systematic review – which is a piece of research that aims to identify, select and report all research published on a particular question or topic. In total, this review included 13 studies that evaluated these interventions.
What the research found
Mostly positive results were reported across the 13 studies for depression and anxiety. One study reported that the interventions had a more positive effect on the mental health of people who were most disadvantaged, when compared to the least disadvantaged people. However, the methodological quality of the studies was weak.
Implications for practice and research
Much of the evidence was of low quality and further research using more robust study designs is needed. The focus for this review was on socio-economic inequalities only, however research is also needed to explore other measures of inequalities (e.g., gender, age, ethnicity). It would also be helpful to understand which components of the interventions (for example, speaking to a link worker, undertaking an activity, or socialising with others) are associated with a positive effect.
Project lead
Dr Sarah Sowden, Newcastle University
Co-authors
Louise Tanner, Josephine Wildman, Akvile Stoniute, Madeleine Still, Kate Bernard, Rhiannon Green, Claire Eastaugh and Katie Thomson
Get in touch about this research
Read the full paper
Non-pharmaceutical primary care interventions to improve mental health in deprived populations: a systematic review – British Journal of General Practice, April 2023
Part two – Qualitative study
Study title: Experiences of non-pharmaceutical primary care interventions for common mental health disorders in socioeconomically disadvantaged groups: A systematic review of qualitative studies
Quick read summary
We looked at existing qualitative research (using interviews or focus groups) which explored how non-pharmaceutical (or non-drug) interventions impact mental health in deprived communities and the barriers (things that might prevent them being used) and facilitators (things that could support them being used) associated with their use in primary care settings.
The review showed that mental health interventions which do not involve drugs do work for socially disadvantaged people in some circumstances. It also found that accessibility to the interventions (that is, being able to take advantage of them) was affected by socioeconomic disadvantage.
Who is the evidence for?
Healthcare professionals, including social prescribers, who are involved in the treatment of mental health in primary care. Healthcare commissioners who are involved in precuring services.
Research summary
We undertook a systematic review which is a piece of research that aims to identify, select and report all research published on a particular question or topic. In total, this review included 22 qualitative studies that evaluated these interventions.
What the research found
Mostly positive results were reported across the 22 studies. People felt empowered to make choices and act on them, and they also benefited from connecting with other people. Many of the interventions showed benefits beyond improving mental health, resulting in the improved management of other physical health conditions in addition. The barriers to effectiveness and engagement included socioeconomic deprivation and the underfunding of community sector organisations.
Implications for practice and research
The focus for this review was on socio-economic inequalities only, however research is also needed to explore other measures of inequalities (e.g., gender, age, ethnicity). Most of the research identified looked at the role of social prescribing, other non-pharmaceutical options such as using new models of care or new methods of clinical practice were not well evaluated. For interventions to be effective, the community sector organisations they rely upon need to be adequately and sustainably funded. Raising awareness of non-pharmaceutical interventions among both healthcare professionals and service users is also likely to be beneficial for engagement and their successful delivery.
Project lead
Dr Sarah Sowden, Newcastle University
Co-authors
Louise Tanner, Josephine Wildman, Akvile Stoniute, Madeleine Still, Kate Bernard, Rhiannon Green, Claire Eastaugh and Katie Thomson
Get in touch about this research
Read the full paper
Experiences of Non-Pharmaceutical Primary Care Interventions for Common Mental Health Disorders in Socioeconomically Disadvantaged Groups: A Systematic Review of Qualitative Studies – International Journal of Environmental Research and Public Health, March 2023
Funding and references
This research was funded by the NIHR Research Capability Funding (RCF) from the NHS North of England Care System Support (NECS). The study was supported by Research Fellows funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) for the Northeast and North Cumbria (NENC). Full references are included in the published papers.