Table 3 Initial thematic analysis

Awareness of depression

Levels of understanding from the patients about how they are feeling and why.

What I couldn’t understand, love, is that I like to think I’m probably above average intelligence. I’m not a thicky, I’m not a thicko, and I just can’t understand why I feel like I do when I shouldn’t be doing. (PX01)

Time/someone to listen

From a patient perspective time is crucial in affording them to open up to a professional and feel like they are being listened to.

Yeah, I think the time factor is a lot to do with it. You know, you can just open up and speak and she’ll listen and advise, you know, where doctors haven’t really got that time with you, (PX02)

Stigma

Patients may feel more comfortable disclosing their physical health problems compared to their mental health problems to professionals.

I don’t worry about my physical health; it’s the mental health I dread really. I would much rather have a physical problem than a mental problem, because it’s horrible. My ex-husband or my, he’s passed away now, but he used to be, it was a stigma to him if you can understand. And I used to say if you could just have half-an-hour of how I feel you would know. People don’t understand it unless they’ve had it. (PX02)

Stigma from professionals who do not have the skills or confidence to approach patients with mental health concerns

There are barriers and some of them are from the patient and some of them are from the health professional, because a lot of health professionals don’t feel confident about talking about mental health issues to patients. They feel they can’t say the S word, the suicide, you know if people have been suicidal in the past they feel that’s a difficult conversation to have, and that’s all about education isn’t it really and collaboration and trying to make connections between agencies that could support you in doing those sort of things, but you’re up against it a little bit I think (PN02)

Up-skilling of PNs

The up-skilling of PNs leads to an increase in their confidence and abilities in addressing mental health concerns with their patients. However, this can only be achieved through adequate and effective supervision.

I think having a GP on the premises throughout the day, I think that was like a mental support for me as well. So if somebody said something that I was concerned about I could go and speak to the GP rather than leaving a message or picking up the phone or something. So I think that was like a strong point for me mentally, I felt that there is somebody that I can turn to straightaway if there is a problem. (HCA)

Competing practice priorities

Resource issues lead to competing practice priorities for different practice staff. This can result in the implementation of tick-box exercises for those lower priorities.

To actually coordinate it and to put all the information on there, and then obviously getting the patients onto the programme and then monitoring them and reviewing them regularly and having that formal communication, because you’ve got to understand that you’ve got so many competing priorities. (GP04)