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Past research has suggested that there are significant differences in the prevalence and progress of anxiety and depression in different ethnic groups in England and that patterns of help seeking also differ. In parallel, research has also reported distinctive differences in the language and representations of mental distress across different ethnic groups. Differences both in the expression of depression and underlying conceptual models of mental health and illness may be part of the explanation for different patterns of help seeking, as the accounts people give of their experience of health and illness, including the meaning they attach to symptoms and signs for example, have been shown to be an important mediator of the action they take to protect their health or to respond to ill health. In this paper we will use evidence from recent mixed-method research with people of Pakistani origin and white people living in a locality in northwest England to explore the constructions and representations of mental distress, and in particular the physical imagery and ‘somatic metaphors’ of narratives used by our respondents, and consider how these data might illuminate debates about the experience of mental ill health and help-seeking practices.

Objectives: This study aimed to describe social problems presented to general practitioners (GPs) in UK inner cities and GPs’ responses; describe patients help-seeking pathways; and consider how these pathways can be improved. Methods: The study involved a pilot survey and follow-up qualitative interviews with patients in two inner city areas in London and Salford in 2001–2. The pilot survey involved five practices in each locality. GPs completed questionnaires on 57 people presenting with social problems. A diversity sample of 12 patients was followed up for interview. Results: Study results are presented in two parts. Here (Part II) qualitative research results are reported highlighting four themes: the complex and enduring nature of social problems; the persistence people display seeking help; the fragmented and problematic pathways available; and the roles GPs play as: primary medical adviser; formal gateway to another service; advocates or facilitators to another service; and sources of support and advice during a process of recovery. Commonly, GPs occupied more than one role. Conclusions: GPs do help people deal with social problems, but their responses are limited. More integrated pathways to help and advice for social problems are needed. Existing pathways could be more visible and accessible, and new pathways developed through commissioning and extending social prescribing. More partnerships across sectors may create more co-ordinated provision, but these are notoriously difficult, and other trends such as the focus on lifestyle issues and long-standing conditions may make it more difficult for people with social needs to access support. -------------------------------------------------------------------------------- Abbreviations: GP, general practitioner; LAA, Local Area Agreement; RSI, repetitive strain injury