Social Science & Medicine 53 (2001) 465–476 Perceptions of illness causation among new referrals to a community mental health team: ‘‘explanatory model’’ or ‘‘exploratory map’’? Brian Williams a, *, David Healy b a Department of Epidemiology and Public Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK b Department of Psychological Medicine, Hergest Unit, Ysbyty Gwynedd, Bangor, Gwynedd LL57 2PW, UK Abstract Thehealthbeliefsofpeoplesufferingfrommentalhealthproblemsareimportant.Suchbeliefshavebeenidentifiedas key factors in models of health and illness behaviour, and may therefore indirectly influence clinical outcome. In addition, the increasing move towards patient-centred health care suggests that such beliefs need to be identified if a patient’s perspective of his or her illness is to be addressed in the care process. Past research on health beliefs surrounding depression have concentrated on identifying ‘‘explanatory models’’ among the general community or among people who already have an established diagnosis of depression. This paper describes the content and status of health beliefs among people who are in the process of receiving a diagnosis. In-depth interviews were carried out with new referrals to a community mental health team (CMHT). Individuals expressed a variety of perceived causes throughout the interview. Beliefs were therefore characterised as changeable. It is argued that the concept of an ‘‘explanatorymodel’’istoofixedtofullyconveythefluidstatusofbeliefsamongthispatientgroup.Theconceptofan ‘‘exploratorymap’’issuggestedasareplacement.Suchmapsoutlinetheavenuesofthoughtwhichindividualsexplored when attempting to understand why they were currently experiencing particular psychological problems. The strength andpersistenceofbeliefsisdiscussedinrelationtoboththeoreticalandclinicalimplications. # 2001 Elsevier Science Ltd. All rights reserved. Keywords: Health beliefs; Mental health; Illness behaviour; Depression; UK Introduction Research into health beliefs has been ongoing in medical sociology, health psychology and medical anthropology for several decades. A variety of models that link health beliefs to varied forms of health and illness behaviour have been developed and extensively researched (Conner & Norman, 1998). Such research is of great importance to those clinical specialties where client behaviour is regarded as problematic. This is particularly the case in the field of mental health where there is often a reluctance to seek help, and frequently low adherence rates to prescribed drugs. For example, approximately one half of people with mental health problems either do not seek help or do not overtly present their symptoms to a general practitioner (Gold- berg & Huxley, 1980; Jenkins et al., 1997), and between 50 and 70% may fail to comply with medication (Kane, 1985). While health beliefs may be important in terms of theirrelationshiptosubsequentbehaviour,recentmoves towards more patient-centred services suggests that they are also important in their own right (Williams et al., 1999; Williams & Grant, 1998). Policy documents have argued that people should be ‘‘valued as individuals’’ *Corresponding author. Tel.: +44-1382-632439; fax: +44- 1382-644197. E-mail address: bwilliams@eph.dundee.ac.uk (B. Williams). 0277-9536/01/$-see front matter # 2001 Elsevier Science Ltd. All rights reserved. PII:S0277-9536(00)00349-X