EQUICARES Identifies Key Barriers and Facilitators to Mental Healthcare Access Across Europe

EQUICARES Identifies Key Barriers and Facilitators to Mental Healthcare Access Across Europe

EQUICARES has released a comprehensive report conducted by our partner ZI, which provides one of the most detailed analyses to date on the prevalence of mental health conditions and the barriers and facilitators to accessing mental healthcare among people in vulnerable situations across the WHO European Region, synthesizing findings from two umbrella reviews.

Understanding Mental Health Inequalities

The first review examined the prevalence of mental health conditions among youth, migrants, refugees and asylum seekers, LGBTQIA+ people, Roma communities, ethnoreligious minorities, older adults, and people with disabilities.

Refugees and asylum seekers consistently showed the highest rates of depression, anxiety, and PTSD (often exceeding 30%), with unaccompanied minors at particular risk.
Migrants displayed heterogeneous outcomes, with perinatal depression emerging as a recurring concern.
LGBTQIA+ individuals experienced elevated rates of mood and anxiety disorders, while Roma communities showed high levels of both internalizing and externalizing conditions.
Among older adults, depression was the most common disorder, especially in institutional settings.

Significant data gaps remain for ethno-religious minorities, people with disabilities, and regions in Eastern and South-Eastern Europe.

Barriers and Pathways to Access

The second review examined the obstacles and facilitators that influence access to mental health services.

On the demand side, barriers often stem from stigma, discrimination, low mental health literacy, and cultural norms that discourage help-seeking.

Migrants, refugees, and Roma face additional barriers such as financial insecurity, legal uncertainty, and dependence on informal support networks.
Youth often report confidentiality concerns and poor continuity when moving from child to adult care.
People with disabilities and older adults describe limited involvement in decisions and environments that feel disempowering.

On the supply side, the review identified long waiting times, workforce shortages, fragmented service delivery, and a lack of cultural competence among providers.

Despite these challenges, the study also highlights several facilitators that make access easier:

Building trust and continuity between patients and providers
Developing culturally sensitive and community-based services
Providing interpreter support and NGO-led outreach initiatives
Investing in national and EU-funded reforms that promote inclusive care

Turning Evidence into Action

These findings reveal that while the mental health burden among vulnerable populations is high, the obstacles to accessing care are often structural and preventable. The report calls for:

Culturally competent and rights-based mental health systems
Anti-stigma and community awareness initiatives
Stronger, better-supported mental health workforce
Equitable funding and mental health service coverage across Europe

By combining scientific evidence with lived experience, EQUICARES aims to help shape inclusive, accessible, and people-centred mental health systems that leave no one behind.

Read the full report here

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EQUICARES Identifies Key Barriers and Facilitators to Mental Healthcare Access Across Europe

Understanding Mental Health Inequalities

The first review examined the prevalence of mental health conditions among youth, migrants, refugees and asylum seekers, LGBTQIA+ people, Roma communities, ethnoreligious minorities, older adults, and people with disabilities.

Refugees and asylum seekers consistently showed the highest rates of depression, anxiety, and PTSD (often exceeding 30%), with unaccompanied minors at particular risk.

Migrants displayed heterogeneous outcomes, with perinatal depression emerging as a recurring concern.

LGBTQIA+ individuals experienced elevated rates of mood and anxiety disorders, while Roma communities showed high levels of both internalizing and externalizing conditions.

Among older adults, depression was the most common disorder, especially in institutional settings.

Significant data gaps remain for ethno-religious minorities, people with disabilities, and regions in Eastern and South-Eastern Europe.

Barriers and Pathways to Access

The second review examined the obstacles and facilitators that influence access to mental health services.

On the demand side, barriers often stem from stigma, discrimination, low mental health literacy, and cultural norms that discourage help-seeking.

Migrants, refugees, and Roma face additional barriers such as financial insecurity, legal uncertainty, and dependence on informal support networks.

Youth often report confidentiality concerns and poor continuity when moving from child to adult care.

People with disabilities and older adults describe limited involvement in decisions and environments that feel disempowering.

On the supply side, the review identified long waiting times, workforce shortages, fragmented service delivery, and a lack of cultural competence among providers.

Despite these challenges, the study also highlights several facilitators that make access easier:

Building trust and continuity between patients and providers

Developing culturally sensitive and community-based services

Providing interpreter support and NGO-led outreach initiatives

Investing in national and EU-funded reforms that promote inclusive care

Turning Evidence into Action

These findings reveal that while the mental health burden among vulnerable populations is high, the obstacles to accessing care are often structural and preventable. The report calls for:

Culturally competent and rights-based mental health systems

Anti-stigma and community awareness initiatives

Stronger, better-supported mental health workforce

Equitable funding and mental health service coverage across Europe

By combining scientific evidence with lived experience, EQUICARES aims to help shape inclusive, accessible, and people-centred mental health systems that leave no one behind.

Read the full report here

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Research on Accessibility Barriers

The EQUICARES approach adopts the Levesque Framework, which assesses service accessibility through the lenses of approachability, acceptability, availability, affordability, and appropriateness.The framework will be expanded to specifically address the needs of individuals in vulnerable situations.

A mixed-methods approach will be used, including:

● Ethnographic research (both in-person and digital)

● Application of the Levesque framework to create new mental health-related indicators for evaluating accessibility barriers

● Conducting interviews, focus groups, and surveys

● Collaboration with cultural mediators when needed to build trust and facilitate engagement with vulnerable populations

● Enhancement and integration of existing EU and national databases (e.g., EU-SILC, European Health Interview Survey) for comprehensive analysis

Key Components

● Provides data on service affordability and accessibility as well as on other life satisfaction elements. Tracks impact through cost-consequence analysis and performance tools.

● Helps evaluate financial and social implications in mental health access.

● Dashboard of the identified innovative solutions

● Categorised solutions with interactive visualisations

● Customisable preferences

● Provides personalised mental health support

● Is tested by end-users in the Smart Health Labs

● Fosters mental health and digital literacy.

● Analyses trends and forecasts needs

● Matches policymakers with relevant solutions

● Summarises research and pilot findings

● Provides tailored policy recommendations for stakeholders

● Deploys the roadmap for scaling successful interventions to address mental health challenges

● Provides guidance in developing a roadmap for assessing access to mental health and care service

● Includes the EQUICARES methodology and the project’s solutions

Co-creating and Piloting the proposed solutions

Policy Dashboard

The Policy Dashboard is a centralised platform monitoring, assessment, and cost analysis tools; the Atlas; the AI Assistant; and the policy recommendations

With the Policy Dashboard, policymakers, healthcare providers, researchers and all interested stakeholders can:

● Analyze disparities in mental health service accessibility

● Identify solutions tailored to specific populations

● Use insights to inform policy decisions

WP1: Framework for Mental Healthcare Access

WP1 will develop a framework to assess mental health service access for people in vulnerable situations using an adapted Levesque model. It will analyse key drivers of mental health disruptions and identify barriers at macro, meso, and micro levels through interviews, surveys, and field studies.

WP2: Ιdentification and assessment of innovative solutions that promote and improve access to mental health and care services

WP3: Pilot Case Profiling and Community Engagement

WP3 will profile pilot cases, conduct awareness campaigns, and co-creation workshops to establish 8 “Smart Health Labs”. It will implement capacity-building programs and develop an “AI assistant” for personalised mental health support.

WP4: Evaluation, cost analysis, and policy support

WP4 will engage citizens, service providers and care workers to co-design local deployment roadmaps and implement “small-scale pilot projects” to test mental health solutions.

WP5: Evaluation and Policy Recommendations

WP5 will evaluate project outcomes, conduct cost-benefit analyses, and develop the EQUICARES Policy Dashboard. It will ensure sustainability through a “Replication Handbook” and provide policy recommendations through targeted policy briefs.

WP6, WP7, WP8: Dissemination, exploitation, and sustainability

These horizontal WPs will disseminate project’s results, establish a ”Network of Interest”, form synergies with other initiatives, and develop a “Sustainability and Exploitation Plan”, including IP and innovation management.

WP9, WP10, WP11: Project Management and coordination

These horizontal WPs will oversee administrative, financial, legal, and ethical aspects, ensuring compliance, quality assurance, and smooth coordination across project partners.

WP1: Rahmen für den Zugang zur psychischen Gesundheitsversorgung

WP2: Identifikation und Bewertung innovativer Lösungen zur Förderung und Verbesserung des Zugangs zu Angeboten der psychischen Gesundheitsversorgung

WP3: Profilierung von Pilotfällen und Einbindung von Communities

WP4: Evaluation, Kostenanalyse und politische Unterstützung

WP4 wird Bürger*innen, Dienstleistungsanbieter und Fachkräfte der psychosozialen Versorgung einbinden, um gemeinsam lokale Implementierungspläne zu entwickeln und „kleine Pilotprojekte“ zur Erprobung von Lösungen im Bereich psychische Gesundheit umzusetzen.

WP5: Evaluation and Policy Recommendations