Primary care responses to mental distress (DeStress-2), Version 1
Research type
Research Study
Full title
Implementing effective primary care responses to poverty-related mental distress
IRAS ID
303179
Contact name
Felicity Thomas
Contact email
Sponsor organisation
University of Exeter
Duration of Study in the UK
1 years, 9 months, 31 days
Research summary
Research Summary
Living on a low income can lead to poor mental wellbeing. Providing appropriate support for mental distress is needed. However, people living in economically-disadvantaged areas are likely to be prescribed antidepressants and often remain on them for long periods of time. While some people find this helpful, many people experience harmful side effects, and do not experience improvements in their mental health and wellbeing.
The DeStress project involved researchers, community partners and healthcare professionals working together to understand: i) how austerity and welfare reforms affect mental health; ii) the treatments offered to and used by low-income patients, iii) people’s experiences of using these treatments, and iv) best practice in supporting low-income patients. Working together, we developed training resources for general practitioners (GPs) to help deliver this best practice. The resources are accredited by the Royal College of GPs.
Aims: To deliver DeStress training to GPs in three areas of England (South West, North London, North West Coast) with diverse population groups affected by poverty to understand whether and how healthcare professionals adapt their practice, and how this is received by their patients.
Methods: A GP, researcher and a community partner will deliver the one-hour training and follow-up session in 36 GP practices per Applied Research Collaboration (ARC) region. We will research how the training is delivered and received and what changes result from this. After 18 months, all regions in England will be offered the resources and training.
Results: We will monitor uptake of training and how well the adapted consultation delivery is achieved, as well as collect patient and GP experiences, and monitor prescribing. These will be examined together to assess impact. We will look for best ways to deliver the training and how communities can support delivery.
Impact: More appropriate support from GPs for people experiencing poverty-related mental distress.
Summary of Results
The DeStress-II training programme was developed in collaboration with General Practitioners (GPs) and community partners to assist primary care health professionals to know when to act in a supportive rather than a ‘fixing’ (through medications) role. In Stage 1, training teams comprising a researcher, GP and community partner delivered this training to 508 health professionals in 53 GP practices across three regions of England. Feedback was used to refine core messages and inform the development of an online training resource that time-pressed primary care teams could engage with in a one-hour facilitated group session.In Stage 2, this resource was tested by over 150 healthcare professionals in 30 GP practices from across England. Training was facilitated by an internally nominated practice team member. Facilitation instructions were provided. Forty-nine healthcare professionals were interviewed to understand their experience of using the DeStress online training resource; key learning; any aspects of the training they would amend; ease of facilitation; any aspects of the training they would implement in practice and/or were already implementing; and whether they would recommend the training to others.
All of those interviewed commented positively on the training. The scripts, GP and patient videos, the mock-consultation, the data on antidepressant efficacy and the opportunities for practice team reflection and discussion were cited as especially useful.
Key learning focused around: better understanding of the connections between poverty and mental distress; improved knowledge around how to engage and build trust with patients from low-income backgrounds; better understanding of the value of offering a range of treatment and support options for patients experiencing poverty related mental distress; improved recognition of practice team roles and remits.
Suggested amendments to the training:
Only one GP felt that the mock consultation in the training resource was not an accurate reflection of practice. Other GPs explicitly praised this aspect of the resource for its accuracy, relevance and helpfulness.Ease of facilitation:
The resource was found to be easy to use and the instructions clear and easy to follow. The majority of those interviewed had completed the training within 60 minutes, although a minority had taken up to 90 minutes. The facilitation instructions clearly break down the recommended time for each part of the training and suggest that it be done across two sessions if this is an area the practice is particularly keen to explore in more depth.Impact on practice:
GPs interviewed who were already using some of the techniques discussed in the training felt that the training helped to legitimise and validate their practice. This also opened up team conversations and sharing of good practice that was welcomed across the practice team. GPs and allied health professionals reported that the training emboldened them to ask questions about the socio-economic circumstances of their patients which then helped them to decide how best to treat or support them and to better understand when prescribing antidepressant medications was/was not appropriate; interviewees across all staff roles reported that the training had improved their awareness of the wider practice team; GPs commented that this had increased their referrals to other practice staff e.g. social prescribers.Recommending the training:
All interviewees said that they would recommend the training to other primary healthcare professionals.Patient feedback
Patients who received a consultation which the health professional felt had been influenced by the DeStress training were asked to complete a short anonymous patient survey.107 patient surveys were completed. 101 people (95%) said that the consultation was appropriate to their needs. 76 made comments that explicitly praised the health professional’s skills in listening, and in showing compassion and empathy. Of those who made any negative comments, only two were actually about the style of consultation; others were about the length of time they’d had to wait for an appointment or not being able to see their usual GP.
REC name
South West - Frenchay Research Ethics Committee
REC reference
21/SW/0133
Date of REC Opinion
16 Nov 2021
REC opinion
Further Information Favourable Opinion