Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators
Open accessAbstract
BACKGROUND: This work aimed to identify studies of interventions seeking to address mental health inequalities, studies assessing the economic impact of such interventions and factors which act as barriers and those that can facilitate interventions to address inequalities in mental health care. METHODS: A systematic mapping method was chosen. Studies were included if they: (1) focused on a population with: (a) mental health disorders, (b) protected or other characteristics putting them at risk of experiencing mental health inequalities; (2) addressed an intervention focused on addressing mental health inequalities; and (3) met criteria for one or more of three research questions: (i) primary research studies (any study design) or systematic reviews reporting effectiveness findings for an intervention or interventions, (ii) studies reporting economic evaluation findings, (iii) primary research studies (any study design) or systematic reviews identifying or describing, potential barriers or facilitators to interventions. A bibliographic search of MEDLINE, HMIC, ASSIA, Social Policy & Practice, Sociological Abstracts, Social Services Abstracts and PsycINFO spanned January 2008 to December 2018. Study selection was performed according to inclusion criteria. Data were extracted and tabulated to map studies and summarise published research on mental health inequalities. A visual representation of the mapping review (a mapping diagram) is included. RESULTS: Overall, 128 studies met inclusion criteria: 115 primary studies and 13 systematic reviews. Of those, 94 looked at interventions, 6 at cost-effectiveness and 36 at barriers and facilitators. An existing taxonomy of disparities interventions was used and modified to categorise interventions by type and strategy. Most of the identified interventions focused on addressing socioeconomic factors, race disparities and age-related issues. The most frequently used intervention strategy was providing psychological support. Barriers and associated facilitators were categorised into groups including (not limited to) access to care, communication issues and financial constraints. CONCLUSIONS: The mapping review was useful in assessing the spread of literature and identifying highly researched areas versus prominent gaps. The findings are useful for clinicians, commissioners and service providers seeking to understand strategies to support the advancement of mental health equality for different populations and could be used to inform further research and support local decision-making. SYSTEMATIC REVIEW REGISTRATION: Not applicable.
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Arundell and colleagues found that strategies including increasing inclusivity, audio-visual displays, culturally relevant tools, co-creating interventions with communities, training staff to communicate with marginalised communities, and using positive language contributed to improved access to care.
“They found that employing the following strategies contributed to improved access to care: increasing inclusivity in programmes for individuals with various learning disabilities”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [101]
Four of the seven reviews focused on high-income countries and three had no geographical limitations.
“Four focused on HICs [99][100][101][102] and three had no geographical limitations.[103][104][105]”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [101]
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The Lancet Commission on ending stigma and discrimination in mental health
Thornicroft, G., Sunkel, C., Alikhon Aliev, A., Baker, S., Brohan, E., el Chammay, R., Davies, K., Demissie, M., Duncan, J., Fekadu, W., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01470-2 · Cited by 748 · see citing works
Mental health problems in children with intellectual disability
Totsika, V., Liew, A., Absoud, M., Adnams, C. M., & Emerson, E. (2022) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(22)00067-0 · Cited by 177 · see citing works
Arundell, L.-L., Barnett, P., Buckman, J. E. J., Saunders, R., & Pilling, S. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102063 · Cited by 137 · see citing works
“Involving patients and their families as well as community leaders (Arundell et al., 2020; Lwembe, Green, Chigwende, Ojwang, & Dennis, 2017) in the development of improved access to services, might increase the effectiveness of such interventions.”
BackgroundSelf-citationThe Lancet Psychiatry Commission: transforming mental health implementation research
McGinty, E. E., Alegria, M. M., Beidas, R. S., Braithwaite, J., Kola, L., LESLIE, D. L., Moise, N., Mueller, B., Pincus, H. A., Shidhaye, R. R., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00040-3 · Cited by 127 · see citing works
The effects of housing insecurity on children’s health: a scoping review
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Lowther-Payne, H. J., Ushakova, A., Beckwith, A., Liberty, C., Edge, R., & Lobban, F. A. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-10030-8 · Cited by 61 · see citing works
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“Intervention strategies such as target-based psychological support, community engagement, social and financial barrier reduction, and improved access to care can be used to reduce social inequalities in mental health.(30,31) To effectively evaluate mental health equity, such interventions would need nationwide baselin…”
MethodBaskin, C., Duncan, F., Adams, E. A., Oliver, E. J., Samuel, G., & Gnani, S. (2023) · BMC Public Health · doi:10.1186/s12889-023-17404-x · Cited by 21 · see citing works
“Most interventions focused on socioeconomic factors, race disparities, and age-related issues and the most common intervention was providing psychological support [21].”
BackgroundPatel, N. M., Savaliya, G. V., Mehta, P. J., & Kataria, L. (2025) · Indian Journal of Psychological Medicine · doi:10.1177/02537176251379999 · Cited by 18 · see citing works
Equity by design principles for digital health interventions
Bitomsky, L., Nißen, M., & Kowatsch, T. (2025) · International Journal for Equity in Health · doi:10.1186/s12939-025-02645-6 · Cited by 21 · see citing works
“…Finally, partnerships and advocacy refer to building sustainable community partnerships based on shared goals, trust, and mutual respect (e.g., [77, 83, 87, 93]), engaging with local boards, community groups, and political representatives to create visibility for own health equity efforts and…”
Qi, X., Kong, H., Li, J., & Chen, C. (2024) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2024.105661 · Cited by 13 · see citing works
Viana, M. C., Kazdin, A. E., Harris, M., Stein, D. J., Vigo, D., Hwang, I. H., Manoukian, S. M., Sampson, N. A., Alonso, J., Andrade, L. H., et al. (2025) · International Journal of Mental Health Systems · doi:10.1186/s13033-024-00658-2 · Cited by 13 · see citing works
“Financial barriers, although the focus of considerable attention in the literature on barriers to treatment of mental disorders [25, 51], were reported by only about one-third of the respondents who failed to get treatment (32.9% among all respondents, 38.6% among those with at least 1 barrier…”
InfluentialMcElroy, B., & Walsh, E. (2023) · BMC Public Health · doi:10.1186/s12889-023-17070-z · Cited by 10 · see citing works
“Socio-economic inequalities in depressive symptoms and the role of housing quality in nine European countries Brendan McElroy 1* and Edel Walsh 1 in Europe [1], and calls have been made for purposeful strategies aimed at reducing inequalities in mental health conditions such as depression [2].”
BackgroundLaxton, S., Moriarty, C., Sapiets, S. J., Hastings, R. P., & Totsika, V. (2024) · Journal of Policy and Practice in Intellectual Disabilities · doi:10.1111/jppi.12486 · Cited by 8 · see citing works
“…have limited awareness of available services and how to access them (related to a lack of accessible information), or lack the knowledge/skills to advocate on behalf of their child and family (e.g., Arundell et al., 2020; Chinn & Abraham, 2016; Sapiets et al., 2021; Welterlin & LaRue, 2007).”
BackgroundPerry, A., Gardener, C., Shieh, J., Hồ, Q. T., Doan, A., & Bhui, K. (2024) · Transcultural Psychiatry · doi:10.1177/13634615241228071 · Cited by 7 · see citing works
“This essentially shifts the focus away from numerous service and treatment barriers to provision (Arundell et al., 2020; Bansal et al., 2022; Harwood et al., 2021; Prajapati & Liebling, 2022) and despite increased efforts to improve the quality and acceptability of psychological therapies for…”
Mental health service use and cost by Australian women in metropolitan and rural areas
Dolja‐Gore, X., Depczynski, J., Byles, J., & Loxton, D. J. (2023) · Australian Journal of Rural Health · doi:10.1111/ajr.13078 · Cited by 6 · see citing works
The nexus between peace and mental well-being: contributions for public happiness
Marujo, H. Á. (2023) · Mental Health and Social Inclusion · doi:10.1108/mhsi-07-2023-0077 · Cited by 6 · see citing works
Belief in Jinn Possession Scale: Development and validation
Naz, N. F., & Aslam, N. (2024) · Archive for the Psychology of Religion · doi:10.1177/00846724231225675 · Cited by 4 · see citing works
“…these indigenous knowledge systems is important because culturally specific notions about mental health may determine how people seek out medical care (Martinez et al., 2020), respond to disease, and the implementation of effective approaches to mental health care (Arundell et al., 2020).”
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Griffiths, J., Baldwin, H., Vasikaran, J., Jarvis, R. R., Pillutla, R., Saunders, K. R. K., Cooper, R. E., Foye, U., Rains, L. S., Lusted-Challen, M., et al. (2025) · International Journal of Mental Health Systems · doi:10.1186/s13033-025-00669-7 · Cited by 3 · see citing works
“Mental health care services should not necessarily be considered as a one-size-fits-all approach– more granular consideration of sociodemo-graphic and diagnostic factors in service delivery may help to improve the quality of care [32].”
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Financiamento da saúde mental pública: estudo do caso do Rio de Janeiro (2019 a 2022)
Athié, K., & Amarante, P. (2024) · Saúde em Debate · doi:10.1590/2358-289820241418568p · Cited by 1 · see citing works
Kassa, G. M., Yu, Z., Yitayew, F. M., & Gross, D. A. (2025) · Journal of Global Health · doi:10.7189/jogh.15.04018 · Cited by 6 · see citing works
“Previous reviews have generally focused on broader mental health interventions, addressing a wide range of mental health issues across various populations [ 20 – 22 ].”
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Financing public mental health: a case study of Rio de Janeiro (2019 to 2022)
Athié, K., & Amarante, P. (2024) · Saúde em Debate · doi:10.1590/2358-289820241418568i · Cited by 1 · see citing works
“In the international literature review, there is a perception of the same tendency observed in First World countries 30 in the development of governmental policies for mental health systems 31 .”
BackgroundJonescu, E. E., Chirichilli, S., White, C., Uylaki, T. J., & Piggot, I. (2024) · Springer eBooks · doi:10.1007/978-3-031-65766-5_22 · Cited by 1 · see citing works
Csontos, J. K., Edwards, D. J., Gillen, E., Hounsome, J. C., Kiseleva, M., Mann, M. K., Sha’aban, A., Lewis, R. A., Cooper, A., & Edwards, A. (2024) · medRxiv · doi:10.1101/2024.02.28.24303432 · Cited by 1 · see citing works
Intimayta-Escalante, C. (2024) · Research Square · doi:10.21203/rs.3.rs-4078911/v1 · Cited by 1 · see citing works
Griffiths, J., Baldwin, H., Vasikaran, J., Jarvis, R. R., Pillutla, R., Saunders, K. R. K., Cooper, R. E., Foye, U., Rains, L. S., Lusted-Challen, M., et al. (2023) · medRxiv · doi:10.1101/2023.12.13.23298812
Self-citationSimanjuntak, N., Tampubolon, M., & Farinella, F. (2024) · Studies in systems, decision and control · doi:10.1007/978-3-031-49544-1_53
Mental Health and Its Relationship with the Gentrification Process
Matos, A. G. M. (2024) · Gentrification · doi:10.62486/gen202469
Schick, V., Williams, J., & Tsai, J. (2025) · Journal of Mental Health · doi:10.1080/09638237.2025.2558507
“Like physical health, mental health exhibits a social gradient, where individuals with a higher SES tend to report better mental health, while those with a lower SES are more likely to report poor mental health (Islam & Jaffee, 2024).”
InfluentialArgyriou, K., & Méndez, R. L. P. (2025) · Revista crítica de ciências sociais/Revista crítica de ciências sociais · doi:10.4000/14y4o
“Estos estudios avalan el impacto positivo de los cambios sociolegales y actitudinales que se han centrado en la despatologización y la atención orientada a las personas (Arundell et al., 2020; Duncan ‐ Shepherd & Hamilton, 2022; Freeman & Stewart, 2022).”
Barnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19681799
Barnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19681790
Lowther-Payne, H. J., Ushakova, A., Beckwith, A., Liberty, C., Edge, R., & Lobban, F. A. (2024) · Figshare · doi:10.6084/m9.figshare.26620945
Lowther-Payne, H. J., Ushakova, A., Beckwith, A., Liberty, C., Edge, R., & Lobban, F. A. (2024) · Figshare · doi:10.6084/m9.figshare.26620939
Barnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19681802
Baskin, C., Duncan, F., Adams, E. A., Oliver, E. J., Samuel, G., & Gnani, S. (2024) · Figshare · doi:10.6084/m9.figshare.26650839
McElroy, B., & Walsh, E. (2023) · Figshare · doi:10.6084/m9.figshare.24531879
Lowther-Payne, H. J., Ushakova, A., Beckwith, A., Liberty, C., Edge, R., & Lobban, F. A. (2024) · Figshare · doi:10.6084/m9.figshare.26620936
Barnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19681793
Barnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19681805
Barnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19681808
Barnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19681787
Barnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19681796
Lowther-Payne, H. J., Ushakova, A., Beckwith, A., Liberty, C., Edge, R., & Lobban, F. A. (2024) · Figshare · doi:10.6084/m9.figshare.26620942
Pagani, L. S. (2025) · Euro-Mediterranean Journal for Environmental Integration · doi:10.1007/s41207-025-00996-8
“Psychological interventions enhance eco‑ nomic outcomes (Arundell et al. 2020).”
Mobile apps for psychotic disorders: a systematic review protocol
Ananthakrishnan, A., Sharma, A., Anderson, D., Shankar, R., & Meinert, E. (2026) · Systematic Reviews · doi:10.1186/s13643-025-02943-8
“Even in countries such as the UK, which has a relatively robust EIP service, issues such as regional variation in quality, racial inequalities, stigma, and perceived stigma can be significant barriers to seeking and accessing support [3–9].”
- Authors
- Arundell, L.-L., Greenwood, H., Baldwin, H., Kotas, E., Smith, S., Trojanowska, K., & Cooper, C.
- Affiliations
- University College London (GB)
- Royal College of Psychiatrists (GB)
- University of York (GB)
- King's College London (GB)
- University of Oxford (GB)
- Corresponding author
- Arundell, Laura-Louise
- Venue
- Systematic Reviews
- Published
- 2020-05-26
- Volume
- 9
- Issue
- 1
- Pages
- 115-115
- ISSN
- 2046-4053 (ISSN-L)
- PMC
- PMC7251669
- OpenAlex
- W3030435011
- Cited by
- 53
- References
- 162
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 18 · 2023: 8 · 2022: 12 · 2021: 1 · 2020: 2
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Systematic Reviews (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Explore Bristol Research (submittedVersion, cc-by)
- Bristol Research (University of Bristol) (submittedVersion, cc-by)
- Funders
- NHS England (N/A)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Keywords
- mental health disparities, intervention, economic evaluation, barriers and facilitators, access to mental health care, socioeconomic factors, racial disparities, psychological support, protected characteristics, cost-effectiveness
- MeSH terms
- Mental Disorders, Cost-Benefit Analysis, Humans, Mental Health, Research Design, Socioeconomic Factors
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