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Implementing effective primary care responses to poverty-related mental distress (DeStress-II).

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This project is delivered by the NIHR ARC National Priority Consortium for Health and Care Inequalities.

Find out more about the NIHR ARC National Priority Consortium for Health and Care Inequalities – which is led by ARC North East and North Cumbria.

Project title: Implementing effective primary care responses to poverty-related mental distress (DeStress-II).

Duration (start and end dates): 1 September 2021 – 31 August 2023

Funding total: £ 29,8012

Funded by the NIHR ARC Health and Care Inequalities National Priority Consortium. Led by South West Peninsula collaborating with ARC North Thames and ARC North West Coast.

What does the project aim to achieve?

Current primary care options to support patients experiencing poverty-related mental distress can be experienced as unsatisfactory by both patients and GPs.

Healthcare strategies such as the NHS Community Mental Health Framework for Adults and Older Adults advocate more integrated social solutions that look beyond medication and therapy.

A training package accredited by the RCGP has been generated by researchers, community partners and GPs to better support consultations for poverty related mental distress.

This implementation study will examine how best to deliver this GP training and understand its impact on consultation practice for low-income patients and for GPs.

The research will also capture the barriers and facilitators to intervention delivery across diverse practice/place-based settings

Who is it relevant to or who could it impact?

This qualitative research is taking place across three regions in England encompassing diverse poverty-affected populations: the South West; North Thames; and North West Coast.

A series of guiding principles and an optimised training manual for GPs and CPD providers across England will be developed to support low-income patients experiencing poverty related mental distress. Insights from this project will be shared with stakeholders including low-income patients, their family/carers, GPs, social prescribers and other primary care practice staff.

Findings will be disseminated through peer reviewed publications, conference presentations and accessible summaries.

How could it make a difference?

Mental health provision frequently reinforces health inequalities – in terms of poor access and inappropriate- and over-medicalisation when underlying stresses relate to broader social/structural issues.

Whilst antidepressants can be helpful, they often have side effects and can limit personal agency. This leaves communities and GPs conflicted and confused on how best to respond to poverty-related distress.

The DeStress intervention was co-created with, and will be co-delivered by, people from low-income communities.

DeStress involves delivery of RCGP-accredited training to change consultation culture away from ‘quick fix’ antidepressant prescribing towards a more scientifically robust personalised bio-psycho-social approach to providing support that aims to improve trust and engagement with patients (e.g. using adaptive mechanisms with different patients, to help demonstrate common humanity), foster shared decision-making with patients around treatment and support (including social interventions to address mental distress), co-creates continuity in support, and recognises and seeks to build on personal strengths.

Following community and primary care engagement, the RCGP screencast, with additional locally-tailored data on prescribing and inequalities, discussion-based training (30-60 mins) and follow-up session are being delivered in GP practice meetings by a researcher-practitioner and community partner.

GPs are being asked to commit to trialling changes in their practice between meetings and set local prescribing targets. The work will identify the barriers and facilitators needed for national roll-out and will be written up as an accessible manual to enable take-up across further ARC regions.

For further information, visit www.destressproject.org.uk

Lead contact for the project: Dr Felicity Thomas (f.thomas@exeter.ac.uk)

Co-investigators

Professor Richard Byng, University of Plymouth, Deputy Director PenARC

Professor Katrina Wyatt; Deputy theme Lead Public Health

Dr Sarah Brand, University of Exeter, Implementation Lead

ARC North Thames:

Professor Peter Fonagy, Programme Director Mental Health and Behaviour Change

Dr Mark Freestone, Deputy theme Lead Mental Health and Wellbeing

Professor Steven Pilling, Deputy Mental Health Lead

ARC North West Coast:

Professor Mark Gabbay, Director ARC NWC

Professor Nefyn Williams, Professor in Primary Care

Professor Caroline Leigh Watkins, Deputy Director and Implementation Lead, ARC NWC

Professor Umesh Chauhan, Professor of Primary Care

Community:Debbie Roche, Community Partner

Karen Coombes, Community Partner

Keith Guppy, Community Partner

Research Fellows: Carl Bescoby; Kathryn Berzins: Ilse Lee

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