Sustaining poverty-aware mental health practice: evaluating the long-term impacts of DeStress-II.

Abstract

Deepening poverty in the UK is associated with high levels of antidepressant prescribing in economically deprived areas. Primary care practitioners often do not feel confident to address the socioeconomic causes of distress. The <i>DeStress-II</i> training programme was co-developed with primary care practitioners and people from low-income communities to improve consultations, but evidence of long-term sustainability is required. To explore practitioners' perspectives on sustained changes to practice one year after DeStress-II training. Qualitative follow-up study in English primary care practices. Semi-structured interviews with 30 multidisciplinary practitioners12 months post-training. Data were analysed using thematic analysis, framed by Normalisation Process Theory to explore the embedding of new practices. Practitioners reported that DeStress-II principles were generally retained, with sustained confidence in asking about patients' socioeconomic circumstances. Reported impacts included increased referrals to social prescribers, strengthened multi-disciplinary teamwork, and a perceived shift towards non-pharmacological alternatives. Training provided professional legitimisation for holistic care and reinforced existing values, although full normalisation was hindered by systemic challenges such as limited consultation times, language barriers and patient expectations around the prescribing of antidepressant medication. The DeStress-II training intervention facilitates the embedding of socioeconomic determinants of health into consultations, aligning with the ambitions of the 10 Year Health Plan and the NICE guidelines for Depression. While practitioners perceive a positive shift in practice maximising the benefits requires integrated care approaches which support broader community service networks.