Making Every Contact Count: Barriers and facilitators to delivering brief interventions for primary care mental health

Problem

The physical health of people with mental health problems is a significant source of health inequality, with this group being three times more likely to have a physical illness and mortality 15-20 years earlier than their peers. Unhealthy lifestyles are a major contributor to this and the gap in physical health is widening. The purpose of this study was to explore the barriers and facilitators of the Making Every Contact Count (MECC) approach, an opportunistic health promotion strategy, to improving the physical health of people with mental health mental health problems in primary care.

Approach

Semi-structured qualitative interviews were used to explore patient and clinician perspectives of barriers and facilitators to brief interventions within primary care from ten patients with mental health problems from a single Rossendale practice and and ten local GPs including stakeholders within the Clinical Commissioning Group.Thematic analysis was initially used to generate themes. These were further analysed based on principles of realist evaluation, identifying ‘context-mechanism-outcome’ (CMO) statements stating in a specified context a particular mechanism generates different outcomes.

Findings

Thematic analysis identified themes relating to patient factors, clinician communication, and primary care organisation, which were further broken down into CMO configurations. Patients were keen to be given brief interventions, whether or not they were willing to act upon them. They were more likely to take on brief interventions if they trusted and had good rapport with their clinician and that the brief intervention was tailored towards their particular needs. Clinicians valued transmitting knowledge of the effects of the unhealthy lifestyles. Organisational facilitators included continuity of care and the annual review, although a number of patients viewed this as lacking fruitful discussion. Medication reviews were highlighted as an area for improvement.

Consequences

The research highlights a demand from patients as well as clinicians for delivering brief interventions within primary care. A number of organisational facilitators that are in place are highlighted as well as clinician and patient factors that can be used to ‘make every contact count’ in improving the physical health of people with mental health problems. There are also gaps in terms of clinician skills as well as organisational processes.MECC appears to be an ideal approach to improve the physical health of people with mental health problems, as it is resource-low and based on building a relationship of trust and casually introducing physical health as a topic of conversation as the opportunity arises.