Accessing health care services is difficult for people from socially marginalized groups, especially for mental health services. The PROMO project, funded by DG SANCO and coordinated by the Queen Mary University of London, strives to identify good practices among socially marginalized groups.
The Promo project was carried out in fourteen European capital cities focusing on people from six marginalized groups: homeless, street sex workers, asylum seekers and refugees, irregular migrants, traveling communities and long-term unemployed people. Across all 14 countries the most important barriers to health care are divided into seven categories:
1. Limited entitlements and administrative barriers
2. Complexity of needs and limited ability to engage
3. Language barriers and cultural differences between clients and staff of services
4. Lack of flexibility in the organization of services and administrative procedures
5. Poor coordination and collaboration among services in the same area
6. Negative attitudes and discrimination
7. Clients from marginalized groups often mistrust or fear staff in services
Good practice has been identified by this project including establishing outreach programs to engage people, facilitation of access to general health services that includes mental health programs, coordinated services for marginalized groups and dissemination of information on health services made available to marginalized groups.
Practice in mental health care for marginalized groups varies substantially across Europe. The examples of good practices apply across health and social care systems in Europe, and may guide future policies to improve mental health care for socially marginalized groups. In addition to sufficient resources, this requires the appropriate organization of both individual services and the way services in one area are coordinated and collaborate, training programs for staff in different services, the provision of information material, and positive attitudes of health and social care professionals towards socially marginalized groups.