Access to mental healthcare in the year after first fit note: a longitudinal study of linked clinical records

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OBJECTIVES: Sickness absence is strongly associated with poor mental health, and mental disorders often go untreated. In this population-based cohort study, we identified people receiving fit notes from their general practitioner (GP) and determined access to mental health treatment stratified by health complaint and demographic variables.

DESIGN: Longitudinal study of health records.

SETTING: Primary care and secondary mental health care in the borough of Lambeth, South London. Forty-five GP practices in Lambeth and the local secondary mental healthcare trust.

PARTICIPANTS: The analytical sample included 293 933 working age adults (16-60 years) registered at a Lambeth GP practice between 1 January 2014 and 30 April 2016.

PRIMARY AND SECONDARY OUTCOME MEASURES: Three indicators of mental healthcare in the year after first fit note were antidepressant prescription, contact with Improving Access to Psychological Therapy (IAPT) services and contact with secondary mental health services.

RESULTS: 75% of people with an identified mental health condition at first fit note had an indicator of mental healthcare in the following year. Black Caribbean and Black African groups presenting with mental disorders were less likely to have a mental healthcare indicator compared with White British groups.

CONCLUSIONS: The majority of those with an identified mental health need receive some treatment in the year following a fit note; however, our results suggest Black African and Black Caribbean groups with an identified mental healthcare need have less complete access compared to the White British group.

Original languageEnglish
Article numbere044725
JournalBMJ Open
Issue number11
Early online date11 Nov 2021
Publication statusPublished - 11 Nov 2021


  • Fit note
  • Adult
  • Clinical records
  • Healthcare
  • Inequalities
  • Mental Disorders/therapy
  • Mental Health Services
  • General Practice
  • Primary Health Care


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