Mind the Gap: increasing access to mental health treatments for minorities – Sweden

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Olof Molander, Josefin Särnholm, Anna-Clara Hollander & Nitya Jayaram-Lindström

BMC Global and Public Health height 2Article number: 61 (2024) Cite this article

Benefits

The Mind the Gap (MTG) consortium aims to increase mental health literacy and access to evidence-based online therapies for underserved populations. Strategies include digital recruitment, psychoeducational materials, and culturally appropriate therapeutic content. MTG is committed to inclusiveness and increasing access to prevent the mental health gap for minorities.

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Minorities, including forced migrants, suffer from disproportionate mental health problems, including post-traumatic stress disorder (PTSD), depression and anxiety. [1]. Despite the clear need for mental health care, minority groups have low health care costs and low mental health care utilization. [2]. Barriers to accessing mental health care in these communities include structural barriers such as language barriers, health literacy and distance from needed care, as well as perceived barriers such as stigma and cultural norms. [3].

One way to close this treatment gap and improve access to mental health care is through Internet-delivered Cognitive Behavioral Treatments (I-CBT). Individuals can now access evidence-based treatment online through standardized text-based modules with exercises tailored to their needs, as well as ongoing professional support from private family practice. he saw. I-CBT is effective in treating many common mental health conditions such as depression, anxiety, PTSD, substance use disorders and depression. [4]. Furthermore, I-CBT has been successfully integrated into specialist psychiatric services in Sweden and other countries [5]. Thus, I-CBT appears to offer a revolutionary approach to mental health care, with the potential to provide interventions that are accessible, simple and effective.

For minority populations, I-CBTs for common mental health conditions may offer significant benefits by increasing access to independent and traditional psychotherapy, which works to reduce barriers. related to seeking mental health care. This can be done if online remedies are developed in collaboration with minority groups. In a recent systematic review of internet-based interventions, Spanhel et al. [3] identifies a taxonomy of cultural variables, including characters/situations, events, places/objects, and language concepts. However, I-CBT is widely accepted in the community [3] and is currently underutilized by minority groups that would benefit from such interventions, such as migrant youth who are experiencing significant distress. [6].

In an effort to improve equity in access to mental health care, the research organization Mind the Gap (MTG; www.mindthegapstudies.com) was launched in 2020 at Karolinska Institutet, Stockholm, Sweden. Language mismatches with the health care system increase the risk of inadequate communication, misdiagnosis, mistrust of the system, and worsening of symptoms. [7, 8]. This, together with the government’s planned cuts to language interpretation services, widens the mental health equality gap in Sweden. As such, MTG’s main goal is to expand access to mental health for people who typically have difficulty accessing evidence-based mental health treatment, such as those hindered by language barriers. The objective of MTG will be achieved by using a comprehensive research design including a wide range of methods.

To raise awareness of mental health

An important area of ​​research within the MTG is aimed at mental health literacy, emphasizing educational and cultural practices in the form of advertising, psychoeducation and therapeutic literature. We will develop and use custom digital ads and short social media posts in different languages, to increase awareness of common mental health issues and help seek treatment among people with concerned. Current work within MTG also includes the production of psychoeducational films on cross-examination with experts in this field, which will be launched together with the publication of various I-CBT programs. To understand the effectiveness and validity of these methods, we aim to systematically evaluate different content (ie, advertising and treatment tools) with the support of stakeholders and end users, representing minority groups. For example, in a recent social media campaign with a PTSD specialist, we showed a psychoeducational video along with a case example to provide real-time diagnostic information and a patient report on symptoms and experience with CBT. With this campaign, we aimed to encourage participation in an I-CBT treatment study designed specifically for immigrants with PTSD in Sweden. As a result, we have received more than 100 applicants from our target population, registering for I-CBT treatment between February and April 2024, possibly demonstrating a significant clinical need and potential success. attend educational and organized campaigns. When participants registered on the MTG website, we also collected data on other relevant information including participant feedback, language preferences, and campaign involvement.

Using a broad approach to targeting people in need of treatment

While it may be important to target specific groups in need, we recommend starting with a broad, focused approach. [1] with knowledge and mental health conditions that are more common among minorities, and [2] using I-CBT to adapt for the largest minority languages ​​spoken in Sweden, for example, Swedish, English or Arabic which is easy to read. Using such a broad approach may make it less likely to recruit treatment for participants from a few minority populations, while at the same time emphasizing the importance of systematic data analysis. of the post-treatment process to find groups that may not be reached. Inclusive research that includes diverse populations also allows for more effective implementation in real-world settings.

Evidence-based culturally-adapted therapies

Although several treatment barriers may exist among minority groups, we emphasize that the lack of treatment methods that include direct language may be a structural barrier for of minorities. A recent meta-analysis shows promising results that culturally evidence-based interventions are effective across cultures. [9]although there is a need to study and identify aspects of cultural practices for different groups and treatment methods [10]. MTG’s clinical track focuses on the cultural and linguistic adaptation, assessment, and large-scale dissemination of I-CBT for common mental health problems in minority populations. Examples of ongoing and planned studies within the consortium include I-CBT for anxiety, PTSD, insomnia, harmful alcohol use, common mental health problems among groups sexual minorities, and telephone support for problem gambling, in plain Swedish, English, Arabic. , and other less important discourses (see, for example, Clinical trials NCT06193161 https://clinicaltrials.gov/study/NCT06193161 and Center for Open Science https://osf.io/g7bkv/). We strive to evaluate treatments in a systematic and phased manner, starting with feasibility trials, followed by randomized controlled trials, and then efficacy and implementation studies.

From a clinical perspective, we emphasize that I-CBT interventions are built on evidence-based principles, which are considered universal in how mental health conditions are treated. Therefore, as a rule of thumb, treatment factors, components and measures should be close to the original treatment methods, to ensure an evidence-based method. Cultural practices may consider language and structure, such as shortening treatment texts, emphasizing basic treatment principles, and including examples of patients from different cultures. [3]. We systematically evaluate cultural norms in I-CBT programs by collecting participants’ opinions about treatment tools. This includes assessing how well patient models and clinical descriptions fit their cultural background. As for other treatment results, we recommend that they be based on collaborative work with experienced users. These outcomes may include engagement, mental health knowledge, perceived barriers to seeking treatment, health care utilization, or first-hand experiences of culturally based attitudes from health care agents. Furthermore, it is important to clearly define the rationale for I-CBT. This can be achieved, for example, through telephone medication review discussions and by providing clear information about the treatment process to improve treatment adherence.

Implementation and publication

The ultimate goal is for I-CBT to be implemented as part of health care. If the culture is adapted, I-CBT can be effectively delivered in an unsupervised manner (without professional support), which can help the emergency health care process in terms of reducing the need for knowledge of language and improve cost effectiveness. Therefore, the MTG clinical track aims to identify the need for language definition, level of cultural adaptationand professional involvementso that I-CBT is easily feasible. In the same way, we also recognize the importance of continuing education for doctors in the field of traditional psychology to meet the needs of patients receiving care. Therefore, the implementation process will help to continue education within the MTG consortium. Over time, we continue to plan to investigate whether MTG increases access to, and use of, digital interventions over time, and its impact on minority health equity. who use linked health care records.

Results

In summary, the MTG research consortium aims to create a knowledge base to increase access to mental health care and culturally appropriate I-CBT for minorities. MTG works as a resource to achieve equality of mental health by reducing barriers to treatment and prioritizing personal care, which is achieved through systematic and continuous assessment in collaboration with minority groups. The global call for collaborative efforts is extended in relation to MTG, recognizing that similar disparities in mental health persist among minority groups across different nations.