title: Community Engagement in a complex intervention to improve access to primary mental health care for hard-to-reach groups.
abstract: BACKGROUND
  Despite the availability of effective evidence-based treatments for depression and anxiety, many 'harder-to-reach' social and patient groups experience difficulties accessing treatment. We developed a complex intervention, the AMP (Improving Access to Mental Health in Primary Care) programme, which combined community engagement (CE), tailored (individual and group) psychosocial interventions and primary care involvement.
  
  
  OBJECTIVE
  To develop and evaluate a model for community engagement component of the complex intervention. This paper focuses on the development of relationships between stakeholders, their engagement with the issue of access to mental health and with the programme through the CE model.
  
  
  METHODS
  Our evaluation draws on process data, qualitative interviews and focus groups, brought together through framework analysis to evaluate the issues and challenges encountered.
  
  
  METHODS
  A case study of the South Asian community project carried out in Longsight in Greater Manchester, United Kingdom.
  
  
  RESULTS
  Complex problems require multiple local stakeholders to work in concert. Assets based approaches implicitly make demands on scarce time and resources. Community development approaches have many benefits, but perceptions of open-ended investment are a barrier. The time-limited nature of a CE intervention provides an impetus to 'do it now', allowing stakeholders to negotiate their investment over time and accommodating their wider commitments. Both tangible outcomes and recognition of process benefits were vital in maintaining involvement.
  
  
  CONCLUSIONS
  CE interventions can play a key role in improving accessibility and acceptability by engaging patients, the public and practitioners in research and in the local service ecology.
authors.affiliation: Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lamb
authors.affiliation: Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowrick
authors.affiliation: Institute of Primary Care and Health Sciences, Keele University, Keele, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Burroughs
authors.affiliation: Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Beatty
authors.affiliation: Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Edwards
authors.affiliation: Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Bristow
authors.affiliation: Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Pam
authors.initials: P
authors.lastname: Clarke
authors.affiliation: Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hammond
authors.affiliation: Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Waquas
authors.initials: W
authors.lastname: Waheed
authors.affiliation: Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Gabbay
authors.affiliation: Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
mesh_terms: D003256:Community Participation; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration; D017146:Models, Organizational; D011320:Primary Health Care / Q000458:organization & administration; D016730:Program Development; D011584:Psychology
keywords: BME; action research; community engagement; evaluation; interventions; mental health