Mental health-care provision for marginalized groups across Europe: findings from the PROMO study

Eur J Public Health. 2013 Feb;23(1):97-103. doi: 10.1093/eurpub/ckr214. Epub 2012 Feb 7.


Background: Providing mental health care to socially marginalized groups is a challenge. There is limited evidence on what form of mental health-care generic (i.e. not targeting a specific social group) and group-specific services provide to socially marginalized groups in Europe.

Aim: To describe the characteristics of services providing mental health care for people with mental disorders from socially marginalized groups in European capitals.

Methods: In two highly deprived areas in different European capital cities, services providing some form of mental health care for six marginalized groups, i.e. homeless, street sex workers, asylum seekers/refugees, irregular migrants, travelling communities and long-term unemployed, were identified and contacted. Data were obtained on service characteristics, staff and programmes.

Results: In 8 capital cities, 516 out of 575 identified services were assessed (90%); 297 services were generic (18-79 per city) and 219 group-specific (13-50). All cities had group-specific services for the homeless, street sex workers and asylum seekers/refugees. Generic services provided more health-care programmes. Group-specific services provided more outreach programmes and social care. There was a substantial overlap in the programmes provided by the two types of services.

Conclusions: In deprived areas of European capitals, a considerable number of services provide mental health care to socially marginalized groups. Access to these services often remains difficult. Group-specific services have been widely established, but their role overlaps with that of generic services. More research and conceptual clarity on the function of group-specific services are required.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Delivery of Health Care / organization & administration*
  • Emigrants and Immigrants / psychology
  • Europe
  • Female
  • Health Services Accessibility
  • Humans
  • Ill-Housed Persons / psychology
  • Male
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Mental Health Services / organization & administration*
  • Mental Health Services / statistics & numerical data
  • Middle Aged
  • Sex Workers / psychology
  • Social Class*
  • Unemployment / psychology
  • Urban Population
  • Vulnerable Populations / psychology*
  • Vulnerable Populations / statistics & numerical data
  • Young Adult