Strategies to facilitate access to mental health care in marginalized local communities: case studies from India and Australia


This article was originally published here

J Ment Health Policy Econ. 2022 Mar 1;25(1):11-19.


BACKGROUND: Mental disorders are among the major contributors to the global burden of disease. However, despite the universal scope of these disorders, there are great disparities in the provision of mental health services both between and within nations. Marginalized groups such as rural communities, ethnic minorities, refugees and indigenous peoples are known to be at higher risk of suffering from mental disorders, but do not receive adequate care.

STUDY OBJECTIVES: The purpose of this article is to describe lessons learned in designing and implementing mental health services for two marginalized communities – one in rural India and the other in a community native to southeastern Australia.

METHODS: Two case studies of mental health service development are described and compared to identify key elements to consider when developing services for hard-to-reach and marginalized communities.

RESULTS: Four key elements were identified. These are: (i) Overcoming mental health literacy issues (Recognizing mental illness and knowing where treatment is available) (ii) De-stigmatizing the service (iii) Making the service culturally safe and (iv) Ensuring sustainability financial.

DISCUSSION: Marginalized communities often have an unmet need for mental health services. This includes indigenous peoples around the world who continue to experience various forms of disadvantage. As a result, traditional consumer services need to rethink the way they do business so as not to exclude those who need it most. The involvement of appropriate liaison persons can play a crucial role in addressing the unmet need for mental health services in these communities.

IMPLICATIONS FOR THE DELIVERY AND UTILIZATION OF HEALTH CARE: The increasing movement of population groups across geographic boundaries, including refugees, has resulted in major changes in the cultural composition of populations over a short period of time. The elements generated from these models can be used to expand mental health service delivery to include these communities.

HEALTH POLICY IMPLICATIONS: Clear policies must be developed to address the unmet need of hard-to-reach and marginalized communities for appropriate and accessible mental health services. This document provides guidance for policy development in this area.

IMPLICATIONS FOR FURTHER RESEARCH: Further research and testing of service models to address the unmet need for mental health services in marginalized communities can be informed by lessons learned from these experiences.



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