Understanding Barriers to Patient Access of Primary Care Mental Health Care Services in England

Common mental health problems affect individuals, communities, societies, and economies worldwide. There are psychological treatments which have been shown to effectively support people to reduce mental health symptoms; in England these are offered by NHS Improving Access to Psychological Therapy (IAPT) services. This thesis presents mixed-methods research focused on understanding the barriers to accessing these psychological treatments for people in England who seek support for common mental health problems. Barriers to access these treatments are considered to affect over 60% of referrals made. A mixed-methods systematic review of the international literature was completed to identify factors which affect attendance to initial appointments at primary care mental health services offering similar treatments to those offered by IAPT services. Following this, an analysis of 97,020 referrals made to five IAPT services in the North of England identified characteristics associated with increased risk of non-attendance at initial IAPT appointments. Finally, an interview study explored the experiences of the IAPT referral-to-treatment pathway from three perspectives: referrers, IAPT practitioners, and people who had been referred but not attended initial IAPT appointments. Findings from the three components of this thesis demonstrate that the mental health problem experienced by people seeking support, and the ways people reflect upon their mental health influence decisions around initial appointment attendance. The experiences people have with services offering support are important, particularly in relation to communication and waiting times. Differences between services, and the source of referrals are significantly associated with initial appointment non-attendance at IAPT services. There is a need for IAPT services to provide consistency in the reporting of referral data, and address the volume of missing data from referrals, to fully investigate the level of non-attendance to IAPT assessment appointments.