Background

People from the groups who experience social marginalisation are more likely to experience mental health problems compared to the rest of the population. They also tend to be over-represented in psychiatric hospital admissions. Socially marginalised individuals have restricted lifestyle choices and fewer and less effective means of coping with psychological distress. It has been long recognised that factors such as lack of money, discrimination, social exclusion, lack of education and poor housing standards have a major impact on their mental health.

The burden of mental illness among the homeless, the long term unemployed, minorities and other marginalized groups is presenting a challenge to reducing inequalities and promoting unity in European society. It is not clear how much priority this issue has been given, and whether adequate policies and services are in place to lessen the risk of socially marginalized people developing mental illness, or to ensure their access to appropriate care.

The PROMO project aimed to identify good practice in mental health care for socially marginalised groups in Europe. The focus was on the delivery of health and social care for people with mental health problems who belong to one of the six following groups: long-term unemployed; homeless; street sex workers; asylum seekers/refugees; irregular/undocumented migrants; travelling communities. The project was conducted within the two most deprived areas in the capital cities of the following 14 EU countries: Austria, Belgium, Czech Republic, France, Italy, Germany, Hungary, Ireland, Netherlands, Poland, Portugal, Spain, Sweden, and United Kingdom.

Research questions

• What are the organisational characteristics of mental health services that provide care to clients from socially marginalised groups in European capitals?
• What are the barriers to mental health care for clients from marginalised groups, and how to overcome them?
• What constitutes good practice in the provision of mental health care for clients from socially marginalised groups?
• What policies and legislation addressing the provision of mental health care to socially marginalised exist across European Union?

Research activities

• We identified a total of 28 highly deprived geographic areas across 14 participating EU capitals (two in each) and assessed the characteristics of 617 services that provide mental health care to clients from socially marginalised groups. PROMO tool was designed to document provider and funding information, accessibility, characteristics of employees and clients, programmes provided, service co-ordination and evaluation.
• We interviewed 154 health and social care experts about pathways into mental health care for socially marginalised clients, barriers they encounter and ways to overcome them.
• Based on data collected we identified the components of good practice in the provision of mental health care for socially marginalised groups.
• We identified and assessed policies and legislation relevant to the provision of mental health care to socially marginalised and carried out a critical review.
• The findings and relevant policy recommendations were disseminated widely to stakeholders including health departments in all EU member states, the European Commission and WHO Europe.

Conclusion

Provision of mental health care for individuals from marginalised groups varies substantially across Europe .A  considerable number of services provide care to these groups in European capitals, but access often remains difficult. Generic and group-specific services perform distinct roles, but there is also significant overlap in care provided. Despite differences in health care systems, there are some common barriers to good care for these clients. Experts across Europe hold similar views on what constitutes good practice of mental health care for marginalised groups. Care may be improved through better service organisation, coordination and information.

Staff

• Aleksandra Matanov
• Prof. Stefan Priebe

Associated papers

Priebe S, Matanov A, Barros H, Canavan R, Gabor E, Greacen T, Holcnerová P, Kluge U, Nicaise P, Moskalewicz J, Diaz-Olalla JM, Straßmayr C, Schene AH, Soares JJF, Tulloch S, Gaddini A (2013) Mental health-care provision for marginalized groups across Europe: findings from the PROMO Study. European Journal of Public Health; 23:97-103.

Priebe S, Matanov A, Schor R, Straßmayr C, Barros H, Barry MM, Diaz-Ollala JM, Gabor E, Greacen T, Holcnerová P, Kluge U, Lorant V, Moskalewicz J, Schene AH, Macassa G, Gaddini A (2012) Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries. BMC Public Health, 12:248.

Canavan R, Barry M, Matanov A, Barros H, Gabor E, Greacen T, Holcnerová P, Kluge U, Nicaise P, Moskalewicz J,, Díaz-Olalla JM, Straßmayr C, Schene AH, Soares JJ, Gaddini  A, Priebe S (2012) Service provision and barriers to Gaborcare for homeless people with mental health problems across 14 European capital cities. BMC Health Services Research, 12:222.

Straßmayr C, Matanov A, Priebe S, Barros H, Canavan R, Diaz-Ollala JM, Gabor E, Gaddini A, Greacen T, Holcnerová P, Kluge U, Welbel M, Nicaise P Schene AH, Soares JJ, Katschnig (2012). Mental health care for irregular migrants in Europe: barriers and how they are overcome. BMC Public Health, 12:367.

Funder

European Commission – DG Sanco Public Health Programme