Can primary care reduce inequalities in mental health?

To explore the contributions that primary care could make to reducing and preventing inequalities in mental health through policy, local strategy and practice.

The study used an interpretive policy analysis framework to investigate the ways in which inequalities in mental health and inequalities in health were interpreted by health and social policies, incorporated into a local strategic process in a primary care organization, and understood and acted upon by frontline primary care and mental health practitioners. The study involved analysis of nine health and social policy documents, observation of a mental health needs assessment process, and interviews with 21 frontline professionals from 14 different disciplines.

Data were collected using document analysis, observation, and interviews with frontline staff which included a vignette. Data were sorted using the Atlas-ti software programme, and a grounded theory approach guided the data collection and analysis.

Policy documents demonstrated a disjointed picture of definitions and actions, and lacked a clear overall interpretation of inequalities in health or inequalities in mental health. The mental health needs assessment did not incorporate discussion about inequalities in mental health, despite some individual steering group members demonstrating concerns about inequalities in mental health. Frontline professionals defined inequalities as being linked to access to health services rather than social factors, and were often uncomfortable about discussing inequalities in mental health. A small minority suggested that they would explore or take action on the social circumstances of a patient presenting with potential mental health problems.

The study found that policies were not driving practice for reducing inequalities in mental health within primary care, and the primary care organization studied was not conducive to addressing inequalities in mental health. However, some building blocks were in place at all levels that have the potential to be developed to enable primary care to address inequalities in mental health.