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Primary mental healthcare: patients’ perspectives1155with their network. Also, MH problems themselves could be perceived as a barrier to involving network relations: participants indicated feeling uncomfortable talking about their MH in the presence of the network; and others, as can be seen in the next quote, did not want to burden their spouse with their problems.I can’t bother my husband with this. He has enough problems with me now as it is. Because of this [the MH problems], my relationship isn’t as good as it should be. (P9)MH problems are often accompanied by strong emotions that, according to the participants, make it even more difficult to open up to their GP and express their symptoms.Usually, if I’m sad then I just shut down. And then they [the GP and the MHNP] know that they sometimes have to drag the words out of me. And that I lie a little bit then sometimes. Then I just avoid things and say that there isn’t a problem. (P11)In addition, participants had concerns about being stigmatised by MH problems or misunderstood by their GP, and that, once they were known to have MH problems, somatic problems would be dismissed as psychological.That they’ll just take pity on you and then you get a ‘P’ on your medical record … so that all of your problems are seen as psychiatric. (P1) [Category P in primary care coding stands for ‘known to have MH problems’, note author KP] These concerns could be reinforced by negative past experiences with GPs, but also with MH services and their support network. Finally, participants found it difficult to express dissatisfaction with a consultation or advice, or to acknowledge that they did not understand the information given, mainly because of a feeling of shame and fear of disrupting the doctor–patient relationship.Katrien Pouls sHL.indd 115 24-06-2024 16:26