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dc.contributor.authorLiberati, Elisa
dc.contributor.authorRichards, Natalie
dc.contributor.authorParker, Jennie
dc.contributor.authorWillars, Janet
dc.contributor.authorScott, David
dc.contributor.authorBoydell, Nicola
dc.contributor.authorPinfold, Vanessa
dc.contributor.authorMartin, Graham
dc.contributor.authorJones, Peter
dc.contributor.authorDixon-Woods, Mary
dc.description.abstractCandidacy, a construct describing how people's eligibility for care is negotiated between themselves and services, has received limited attention in the context of mental health care. In addition, candidacy research has only rarely studied the views of carers and health professionals. In this article, we use concepts relating to candidacy to enable a theoretically informed examination of experiences of access to secondary mental health services during the first wave of the COVID-19 pandemic in England. We report a qualitative study of the views and experiences of service users, carers, and healthcare professionals. Analysis of 65 in-depth interviews was based on the constant comparative method. We found that wide-ranging service changes designed to address the imperatives of the pandemic were highly consequential for people's candidacy. Macro-level changes, including increased emphasis on crisis and risk management and adapted risk assessment systems, produced effects that went far beyond restrictions in the availability of services: they profoundly re-structured service users' identification of their own candidacy, including perceptions of what counted as a problem worthy of attention and whether they as individuals needed, deserved, and were entitled to care. Services became less permeable, such that finding a point of entry to those services that remained open required more work of service users and carers. Healthcare professionals were routinely confronted by complex decisions and ethical dilemmas about provision of care, and their implicit judgements about access may have important implications for equity. Many of the challenges of access exposed by the pandemic related to pre-existing resource deficits and institutional weaknesses in care for people living with mental health difficulties. Overall, these findings affirm the value of the construct of candidacy for explaining access to mental healthcare, but also enable deepened understanding of the specific features of candidacy, offering enduring learning and implications for policy and practice.
dc.description.sponsorshipThis project was funded by THIS Institute’s grant from the Health Foundation. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. All contracted parties contributed to the study under agreements through the same funding. PBJ is supported by the NIHR Applied Research Collaboration East of England and by RP-PG-0161-20003. Mary Dixon-Woods is an NIHR Senior Investigator (NF-SI-0617-10026). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
dc.publisherElsevier BV
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.titleQualitative study of candidacy and access to secondary mental health services during the COVID-19 pandemic.
dc.publisher.departmentDepartment of Public Health And Primary Care, This Institute
prism.publicationNameSoc Sci Med
dc.contributor.orcidLiberati, Elisa [0000-0003-4981-1210]
dc.contributor.orcidJones, Peter [0000-0002-0387-880X]
dc.contributor.orcidDixon-Woods, Mary [0000-0002-5915-0041]
rioxxterms.typeJournal Article/Review
pubs.funder-project-idHealth Foundation (unknown)
cam.orpheus.successTue Feb 01 19:02:39 GMT 2022 - Embargo updated
pubs.licence-display-nameApollo Repository Deposit Licence Agreement

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Attribution-NonCommercial-NoDerivatives 4.0 International
Except where otherwise noted, this item's licence is described as Attribution-NonCommercial-NoDerivatives 4.0 International