The study aimed to gain insight into the ways that narratives of self-responsibility were taken up and embodied - or alternatively, resisted - within economically disadvantaged communities; the ways that these narratives and associated welfare reforms impacted on mental distress; and the way that these narratives interconnected with the medicalisation and pathologisation of poverty-related distress. (1) The study involved sixteen focus groups with ninety-seven participants (aged 18-65) from economically disadvantaged communities to establish the source and impact of narratives of self-responsibility within people’s everyday lives (36 men, 61 women). (2)Fifty-seven low-income residents (aged 18-65) who had experienced poverty-related mental distress were also interviewed (26 men, 31 women) to understand the cause(s) of their distress, and their responses to this. Participants who were receiving mental health treatment at the time of the study, and participants who wanted more time to discuss their experiences were interviewed on two occasions (total interviews n=80), enabling us to track responses over time and facilitating the triangulation of data. All lived on low-incomes. Whilst not specifically asked to define their status in terms of class, people commonly defined themselves through characteristics or inferences usually associated with being ‘working class.’ (3) Interviews with General Practitioners (n=10) working in low income areas were undertaken to understand their experiences and the challenges they faced supporting mental health amongst patients experiencing poverty, and their perceptions of current treatment options. The provision of effective treatment and support for mental distress is a stated aim of the Department of Health and civil society organisations e.g. Mind. Yet despite a stated need to tackle health inequalities, current strategies e.g. Closing the Gap: Priorities for Essential Change in Mental Health (DoH 2014), frame mental distress as a psychological problem that lies within the individual concerned. This not only suggests that distress can be 'corrected' through medical treatment, but also masks the factors that often underlie the root causes of suffering e.g. poor living conditions, unemployment. At the same time, policies in place to restrict welfare support, and popular media e.g. Benefits Street, draw on moralising narratives that promote the idea that people are responsible for their own actions and circumstances. This research aims to explore how these moralising narratives impact on the ways that people in low-income communities perceive and respond to mental distress caused by material deprivation and social disadvantage, and to examine the impacts of this on their wellbeing. This was achieved through in-depth research in two low-income communities in the South West, which sought to understand: i) the way that moral narratives are defined and used or resisted in people's everyday lives in relation to mental distress; ii) the influence of moral narratives on people's decisions to seek medical support for distress; iii) how moral narratives manifest within GP consultations and influence treatment decisions and patient wellbeing; iv) which responses to mental distress have the potential to effectively support vulnerable populations, and to inform ethical debates on the medicalisation of distress in a way that benefits patients, and assists practitioners and policy makers seeking to support low-income communities. The DeStress Project was a two and half-year research project with two very low-income urban communities (one post-industrial, one coastal with a seasonal employment structure) in the UK’s south-west region. Ethics permission was obtained from the NHS Cambridgeshire and Hertfordshire Research Ethics Committee. The study aimed to gain insight into the ways that narratives of self-responsibility were taken up and embodied - or alternatively, resisted - within economically disadvantaged communities; the ways that these narratives and associated welfare reforms impacted on mental distress; and the way that these narratives interconnected with the medicalisation and pathologisation of poverty-related distress. (1) The study involved sixteen focus groups with ninety-seven participants (aged 18-65) from economically disadvantaged communities to establish the source and impact of narratives of self-responsibility within people’s everyday lives (36 men, 61 women). (2) Fifty-seven low-income residents (aged 18-65) who had experienced poverty-related mental distress were also interviewed (26 men, 31 women) to understand the cause(s) of their distress, and their responses to this. Of these participants, eighty one per cent had been prescribed antidepressants, whilst a further seven per cent had refused the prescription offered. The remaining thirteen per cent had been advised to self-refer to talking therapy, or had chosen to avoid interaction with health services. Potential participants were alerted to the study by community and health practitioners, social media and word-of-mouth and recruited through community groups and GP surgeries. Participants who were receiving mental health treatment at the time of the study, and participants who wanted more time to discuss their experiences were interviewed on two occasions (total interviews n=80), enabling us to track responses over time and facilitating the triangulation of data. In almost all cases, study participants had lived in an economically disadvantaged area throughout their lives, though older participants in one area had also lived there at a time when it was more prosperous. All lived on low-incomes. Whilst not specifically asked to define their status in terms of class, people commonly defined themselves through characteristics or inferences usually associated with being ‘working class.’ (3) Interviews with General Practitioners (n=10) working in low income areas were undertaken to understand their experiences and the challenges they faced supporting mental health amongst patients experiencing poverty, and their perceptions of current treatment options. Informal discussions with key service providers from health, education and social sectors were also undertaken to gain insight into their experiences of working with people living with the stresses of poverty.

Sixteen focus groups with a total of ninety-seven participants, aged 18-65, from the two study sites (36 men and 61 women), with the gender ratio reflecting reported rates of common mental disorders in England (NHS Digital 2016) . Participants were recruited via community groups and settings, word of mouth and advertising on posters and social media. Participants were asked about the main health issues and stresses faced by local residents, how people respond to those stresses and their impact on wellbeing. In addition, eighty interviews were undertaken with fifty-seven residents (aged 18-65) who had experienced poverty-related distress (26 men, 31 women) to gain a more in-depth understanding of the source(s) of this distress, and their responses to it. Interviewees were recruited via the focus groups and word of mouth but also via GP surgeries to capture a broad range of views and experiences (including those who may be socially isolated). In the majority of cases, people had sought medical support for their distress, although two had chosen not to. Participants who were engaged in the health system for their distress at the time of the study, and participants who wanted more time to discuss their experiences were interviewed on two occasions, enabling us to capture any changes over time and understand the ongoing dynamic interaction between mental ill-health and welfare reform. The interviews and focus groups generated a rich body of narrative data that gives prominence to the voices and experiences of people living in low-income communities. This data has been supplemented with interviews with General Practitioners (n=10) to understand the challenges they face supporting people experiencing poverty-related distress.