Better evidence for better mental health policy: Mind the inequalities gap

Research output: Types of ThesisDoctoral ThesisInternal

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Mental disorders pose an extremely high burden to society, both in terms of their direct effects on health but also societal welfare losses. This burden is distributed unequally and strongly impacts groups of low socioeconomic status. Also unequal is the access and utilization of mental health services, which should be concentrated among those who most need treatment. This thesis aimed to produce evidence to guide mental health policy in reducing inequalities in mental health care and outcomes.

The objective was achieved by addressing two different knowledge gaps. The first research question, descriptive by nature, aimed to complement the scarce existing knowledge about inequalities during mental health treatment. The paper addressing this question shows that inequalities unfavorable to low-income individuals persist along the mental health treatment pathway in the Netherlands. These results are pivotal in showing that policy agendas need to move beyond just promoting access to care to understand and address the reasons behind low-income people starting care with more severe disease and being much less likely to improve in outcomes after the first treatment.

The second research question focused on identifying mental health related interventions, programs and policies that impact the existing inequalities. This question was addressed using quasi-experimental methods to causally evaluate interventions and applying an equity lens through the measurement of differential effects by socioeconomic status or the focus on interventions that impact vulnerable groups. Three studies addressed this research question by covering related but distinct policy levers in granting access to mental health support: coverage, by examining the increase of cost-sharing as a financial barrier to mental health care; eligibility, to supported housing as living arrangement for those with mental disorders, and availability of psychologists to provide non-pharmacological treatment for depression.
Original languageEnglish
Awarding Institution
  • Erasmus University Rotterdam
  • Lingsma, Hester, Supervisor
  • Harper, Samuel, Supervisor
  • Van Ourti, Tom, Supervisor
  • Riumalló Herl, Carlos, Co-supervisor
Award date4 Apr 2024
Place of PublicationRotterdam
Print ISBNs978-94-6473-404-1
Publication statusPublished - 4 Apr 2024


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