Unmet needs, unequal access: socioeconomic inequalities and inequities in mental health care in Europe

Abstract

Objectives: Unmet mental health care needs remain prevalent and persistent, coexisting with unequal patterns of service utilisation that disproportionately affecting vulnerable populations. Yet, despite their policy relevance, cross-country empirical evidence remains limited. Methods: We use data from the 2019 wave of the European Health Interview Survey (EHIS), covering a wide set of European countries to examine affordability-related unmet mental health care needs in Europe by analysing their determinants, quantifying and decomposing incomerelated inequalities across countries and regions, and assessing inequity in access to mental health professionals. A two-level mixed effects logistic regression model was used to investigate the relationship between unmet needs and individual characteristics also accounting for country-level factors. Socioeconomic inequalities in unmet needs due to affordability and inequity in access to mental health care were assessed using the concentration index framework. Results: Overall, we observe socioeconomic inequalities in affordability-related unmet mental health care needs and inequity in utilisations of mental health care across Europe. The inequalities are shaped not only by individual characteristics, but also by the broader institutional and macroeconomic contexts in which care is provided. Conclusions: Policy responses aimed at reducing unmet needs should account for cross-country differences in health system organisation, financial protection, and the availability of mental health services.