Qualitative study of candidacy and access to secondary mental health services during the COVID-19 pandemic.
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Authors
Richards, Natalie
Parker, Jennie
Willars, Janet
Scott, David
Boydell, Nicola
Pinfold, Vanessa
Martin, Graham
Jones, Peter B
Publication Date
2022-03Journal Title
Soc Sci Med
ISSN
0277-9536
Publisher
Elsevier BV
Volume
296
Language
eng
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Liberati, E., Richards, N., Parker, J., Willars, J., Scott, D., Boydell, N., Pinfold, V., et al. (2022). Qualitative study of candidacy and access to secondary mental health services during the COVID-19 pandemic.. Soc Sci Med, 296 https://doi.org/10.1016/j.socscimed.2022.114711
Description
Funder: The Health Foundation
Abstract
Candidacy, 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.
Keywords
Mental health, Qualitative, Mental Health Services, United Kingdom, Candidacy, Healthcare Access, Covid-19
Sponsorship
This 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.
Funder references
Health Foundation (unknown)
Identifiers
PMC8744250, 35063916
External DOI: https://doi.org/10.1016/j.socscimed.2022.114711
This record's URL: https://www.repository.cam.ac.uk/handle/1810/334355
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