Camille Wets about her PhD research: “Discursive power in practice - A qualitative study of general practitioners’ accounts of patients with a migration background and mental health problems”

This dissertation explores the discursive dimensions of provider bias in Belgian general practice, focusing on how general practitioners (GPs) construct their accounts of patients with a migration background and mental health problems. Rather than viewing bias as an individual and psychological phenomenon, the study adopts a social-constructionist perspective to examine how language, power, and institutional discourse shape clinical encounters and decision-making. These dynamics are situated within broader concerns about health equity and persistent disparities in mental health care access for migrant populations.

GPs play a central role in Belgium’s stepped care model, particularly in mental health pathways. Their perceptions and interactions are therefore highly consequential for patients who face structural barriers such as language difficulties, cultural differences, and systemic fragmentation. Drawing on Foucault’s concepts of power-knowledge and Tyler’s theorisation of stigma as a form of power, the dissertation interrogates how dominant discourses influence GPs’ accounts and treatment of patients with a migration background.

The research employs a multi-layered qualitative design to analyse policy documents, interviews, and focus groups with Belgian GPs. Across these analyses, the findings reveal that GPs’ accounts are deeply embedded in institutional discourses that often reproduce inequality. “Health literacy” and “culturalising” discourses position patients as deficient or problematic, reinforcing power imbalances. At the same time, counter-discourses such as person-centred or humanitarian approaches, offer spaces for empathy and resistance. Though these remain fragile and sometimes reproduce paternalistic dynamics. Structural barriers, including language and bureaucratic hurdles, further constrain GPs’ ability to provide equitable care, creating tensions between professional ideals and systemic limitations.

By foregrounding the discursive construction of provider bias, this dissertation contributes to a more nuanced understanding of how inequality is sustained in mental health care. It illustrates how bias cannot be addressed solely at the level of individual attitudes but must be tackled through systemic reforms that challenge dominant ideologies and institutional practices. Policy recommendations include improving access to culturally competent services, integrating intercultural mediators into general practice, and developing training programmes that foster reflexivity and critical awareness among health professionals.

In sum, this research advances sociological knowledge by showing how power operates through language and institutional structures in everyday clinical practice. It highlights the need for transformative change in mental health care, moving beyond individual responsibility toward structural solutions that promote equity for patients with a migration background.

Supervisors: Prof. dr. Piet Bracke and dr. Melissa Ceuterick