Primary Care DESTRESS Getty541975802, credit:g-stockstudio, Close-up on discussion.
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Providing effective treatment and support for mental distress is a stated government aim. Within low-income communities, use of antidepressant medication is relatively high, but current strategies tend to frame mental distress as an individual psychological problem, rather than addressing the factors that are often the root causes of suffering.

This research is examining how moralising narratives relating to individual responsibility and welfare entitlements influence the medicalisation of mental distress caused by material deprivation and social disadvantage. 
In so doing, the research will inform a stated aim of the British Government's No Health Without Mental Health strategy to effectively reduce health inequalities amongst vulnerable groups (HM Government 2011), and respond to recent calls to prioritise research examining the social determinants of mental distress (Mental Health Taskforce 2015).
Working in two low-income communities, the interdisciplinary research team are using a range of qualitative methods to gain in-depth and applied understanding of the role moral narratives play in:
  • influencing individuals' decisions to seek and accept medical support for mental distress;
  • influencing healthcare consultation and prescribing practice.
This will provide an informed and nuanced contextualisation of data often missing from mental health research, and from low-income groups in particular.


Against a background of health-service cuts and on-going welfare reform, this interdisciplinary research project examines:

  • why and how people’s ability to cope with poverty-related issues e.g. social isolation, unemployment, poor housing, has become increasingly pathologised;
  • how high levels of antidepressant prescribing and use are impacting on people’s health and wellbeing in low-income communities in South West England;
  • good healthcare practice and the potential for alternative responses to mental distress in potentially vulnerable populations.


This 30 month programme of research consists of two linked stages.

Firstly, 96 people from two targeted low-income areas will participate in focus groups to explore how moral narratives are defined and used/resisted in people's daily lives.

Then, secondary analysis of 60 video-recorded consultations will enable insight into the contexts in which GPs and low-income patients discuss mental distress. Through in-depth analysis of 30 consultations we will identify how GP-patient interaction influences decision-making to prescribe/accept or withhold/reject treatment.

Further insights will be gained through interviews with ten GPs in the study sites and repeat interviews with 40 people from low-income communities who have attended a GP consultation for mental distress.

Anticipated outcomes

The research programme will inform policy and practice regarding the development of effective, meaningful and non-stigmatising responses to mental distress in low-income communities.

Identification of GP practice (relating to mental distress) that enhances patient wellbeing will be developed into guidelines on good practice for health professionals working in low-income communities. These will be refined at a Regional Practitioner workshop, where a dissemination strategy that maximizes their utility for the health sector will be agreed. Participation in the workshop by local authorities charged with health provision will ensure findings feed in to local health plans e.g. Devon Joint Health and Wellbeing Strategy.

The team

  • Felicity Thomas – University of Exeter Medical School Project Lead
  • Lorraine Hansford – University of Exeter Medical School, Postdoctoral Research Fellow
  • Katrina Wyatt – University of Exeter Medical School, Co-Investigator 
  • Susanne Hughes – University of Exeter Medical School, Research Support
  • Rose McCabe – University of Exeter Medical School, Co-Investigator
  • Richard Byng – University of Plymouth, Co-Investigator 
  • Joseph Ford – University of Exeter Medical School, Postdoctoral Research Fellow

Destress project

Richard Byng is a GP and Professor of Primary Care Research at the University of Plymouth and talks about his involvement in the project.
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Poverty-related distress is on the rise, but is medical intervention the answer?

The treatment of mental health is a key priority in the NHS Long-Term Plan. Within this context our research has focused on the effect of austerity and welfare reforms on mental health in low-income communities. The stresses of dealing with life on a low income are increasingly being dealt with as a medical problem, reflected in higher rates of antidepressant use; but framing poverty related distress as a mental health problem can mask the causes of patients’ suffering.
Related projects
  • C2 – Connecting Communities learning and delivery programme, which seeks to promote healthful behaviours and reduce inequalities in disadvantaged neighbourhoods.
  • PARTNERS2: an NIHR-funded programme to help primary care and community based mental health services work more closely together to support people with schizophrenia and bipolar disorder.
  • The Engager collaboration, focusing on mental health care for prisoners.
  • The University of Bristol's One in a Million study.
More information
Visit the DeSTRESS project website for more information.