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Open Access Research article

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

Stefan Priebe1*, Aleksandra Matanov1, Ruth Schor1, Christa Straßmayr2, Henrique Barros3, Margaret M Barry4, José Manuel Díaz-Olalla5, Edina Gabor6, Tim Greacen7, Petra Holcnerová8, Ulrike Kluge9, Vincent Lorant10, Jacek Moskalewicz11, Aart H Schene12, Gloria Macassa13 and Andrea Gaddini14

Author Affiliations

1 Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK

2 Ludwig Boltzmann Institute for Social Psychiatry, Vienna, Austria

3 Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal

4 Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland

5 Madrid Salud, Madrid, Spain

6 National Institute for Health Development, Budapest, Hungary

7 Laboratoire de recherche, Etablissement Public de Santé Maison Blanche, Paris, France

8 Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic

9 Clinic for Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Berlin, Germany

10 Institute of Health and Society (IRSS), Université Catholique de Louvain, Bruxelles, Belgium

11 Institute of Psychiatry and Neurology, Warsaw, Poland

12 Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

13 Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden

14 Laziosanità ASP - Public Health Agency, Lazio Region, Rome, Italy

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BMC Public Health 2012, 12:248  doi:10.1186/1471-2458-12-248

Published: 28 March 2012

Abstract

Background

Socially 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.

Methods

Two 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.

Results

In 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.

Conclusions

Experts 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.

Keywords:
Marginalisation; Mental health care; Health care systems; Good practice; Autonomy