Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries.

Stefan Priebe,Margaret M Barry,Vincent Lorant,Petra Holcnerová,Tim Greacen,Henrique Barros,Jacek Moskalewicz,José Manuel Díaz-Olalla,Aleksandra Matanov,Edina Gabor,Christa Straßmayr,Aart H Schene,Gloria Macassa,Ulrike Kluge,Ruth Schor,Andrea Gaddini

doi:10.1186/1471-2458-12-248

Abstract

BackgroundSocially marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care. Providing mental health care for these groups represents a particular challenge, and evidence on good practice is required. This study explored the experiences and views of experts in 14 European countries regarding mental health care for six socially marginalised groups: long-term unemployed; street sex workers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities.MethodsTwo highly deprived areas were selected in the capital cities of 14 countries, and experts were interviewed for each of the six marginalised groups. Semi-structured interviews with case vignettes were conducted to explore experiences of good practice and analysed using thematic analysis.ResultsIn a total of 154 interviews, four components of good practice were identified across all six groups: a) establishing outreach programmes to identify and engage with individuals with mental disorders; b) facilitating access to services that provide different aspects of health care, including mental health care, and thus reducing the need for further referrals; c) strengthening the collaboration and co-ordination between different services; and d) disseminating information on services both to marginalised groups and to practitioners in the area.ConclusionsExperts across Europe hold similar views on what constitutes good practice in mental health care for marginalised groups. Care may be improved through better service organisation, coordination and information.

Highlights

Marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care
It is linked to social exclusion [2,3], and is frequently considered a consequence of economic marginalisation [4]
This study aimed to identify components of good practice in the provision of mental health care across six groups that are widely considered as socially marginalised [17]: long-term unemployed; street sex workers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities

Summary

Introduction

Marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care. Providing mental health care for these groups represents a particular challenge, and evidence on good practice is required. Various studies show a higher prevalence of psychiatric disorders in marginalised groups than in the age-matched general population [5,6,7]. Providing mental health care for people from these groups represents a particular challenge. Services providing mental health care can struggle to reach people with mental disorders in these groups and engage them in care. Compounding these various difficulties, there is limited systematic research evidence to guide service provision for these groups

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Discussion

Conclusion