Strategies to Facilitate Mental Healthcare Access in Marginalised Local Communities: Case Studies from India and Australia

Background: Mental disorders are amongst the highest contributors to the Global Burden of Disease. However, despite the universal reach of these disorders, there are vast disparities in the provision of mental health services both between and within nations. Marginalised groups such as rural communities, ethnic minorities, refugees and indigenous peoples are known to be at higher risk of experiencing mental disorders but do not receive adequate care for it. Aims of the Study: The purpose of this paper is to describe lessons learnt in designing and setting up mental health services for two marginalised communities – one in rural India and the other in an Aboriginal community in South Eastern Australia. Methods: Two case studies of setting up a mental health service are described and compared to identify key elements to consider when developing services for hard to reach and marginalised communities. Results: Four key elements were identified. They are: (i) Overcoming issues related to mental health literacy (Recognising mental illness and knowing where treatment is available) (ii) Destigmatising the service (iii) Rendering the service culturally safe and (iv) Ensuring financial sustainability. Discussion: Marginalised communities commonly experience 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 mainstream services are needing to rethink the way they do business so as not to exclude those who need them the most. The involvement of suitable link persons can play a crucial role in addressing the unmet need for mental health services in these communities. Implications for Health Care Provision and Use: The increasing movement of population groups across geographical boundaries including refugees has resulted in major changes in the cultural make-up of populations over a short period of time. The elements generated from these models can be utilised in expanding mental health service provision to include such communities. Implications for Health Policies: Clear policies need to be developed to address the unmet need of hard to reach and marginalised communities for appropriate and accessible mental health services. This paper offers some direction for policy development in this space. Implications for Further Research: Further research and trials of service models to address the unmet need for mental health services among marginalised communities can be informed by the lessons learnt from these experiences.