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Primary care is often the first point of contact for adults with complex mental health difficulties, yet many experience persistent barriers to accessing timely and appropriate support. Despite policy commitments to integrated and equitable care, there remains a need to better understand how individuals make sense of distress and navigate services that may struggle to meet complex needs. This study aimed to better understand the experiences of adults with complex mental health difficulties as they access primary care services. It sought to further understand how they made sense of their difficulties accessing care and their psychological distress.

This study used a qualitative design with reflexive thematic analysis. Nineteen participants with complex mental health difficulties were interviewed using a semi-structured schedule. They were recruited via their GP practices.

Three themes were identified: participants' desire to understand why they felt the way they did, the mental health condition itself creating barriers to care, and the precarity of self-management and help. An overarching theme of "Contradictions" was evident across all three themes. "Contradictions" included professionals talking of connecting but then distancing, help being offered but never arriving, trauma being present but ignored, and diagnosis getting in the way of receiving care.

Overall, the study provided further evidence that those with complex mental health difficulties are currently underserved in the NHS. Novel insight into their health literacy questioned the assumptions that those with complex mental health difficulties lack understanding; rather, it provides evidence that services need to collaborate effectively with service users to enable better communication.