Table 8 Types of barriers, populations at risk and facilitators as identified in the literature

Limited treatment options and service limitations

Homeless people, pregnant women with low socioeconomic status

• Institutional challenges, such as time/length of session [32, 49]

• Inexperienced or unhelpful staff [50]

• Lack of provision of home treatment [50]

• Lack of service coordination [34]

• Limited treatment options [147]

• Long waiting lists and availability of treatment [44, 147]

• Lack of adequate discharge planning [56]

• The use of specialist services as the ‘default’ [57]

• Perceived or actual availability of resources [57]

• Inappropriate or limited booking systems [66]

• Appointments scheduled during working hours [38]

• Perceived difficulties in administering treatment [141]

• Diversity of treatment options (e.g. outreach, home-based care, help over the phone, street clinics) [147]

• Collaborative agency approach [32]

Perceived or real discrimination (from staff, family or the community)

Aboriginal communities, ethnic minorities

• Clinician bias [49]

• Discrimination towards patients from staff [50]

• Racism [33]

• Failure to acknowledge non-mainstream concepts of health [33]

• Stigma and shame around help-seeking [38, 39, 45, 47, 57, 103, 147]

• Sociocultural barriers that may reduce motivation for treatment [147]

• Fear of harassment [147]

• Attitudinal factors [57]

• Cultural naivety, insensitivity and discrimination [103]

• Existing social and cultural values or norms concerning gender and traditional family structure [109]

• Staff trained in providing culturally appropriate alternatives to mainstream care [33]

Access to care (including physical access, such as transportation)

People with disabilities (learning or physical), homeless people, people with co-occurring substance use problems, people with low socioeconomic status, people living in rural or remote locations, young people with low socioeconomic status

• Difficulties getting an appointment and contacting health providers [50]

• Transport and the physical environment of treatment, access to buildings and facilities [44, 50]

• Inappropriate referrals and referral rejections [57]

• Geographical location of treatment provision [36, 44]

• Need for registration at GP practice in order to be treated [66]

• Inappropriate or limited booking systems [66]

• Integration of different services [34]

• Reducing transportation barriers through use of mobile health interventions [35]

• Provision of services within geographical reach [36]

• Services provided in close proximity to where people live [37]

• Support for people’s ability to access treatment considering their working conditions [38]

• Involvement of family in the person’s care [38]

• GP as the first point of contact and with a link to external agencies, collaboration between GPs and other healthcare workers [39]

• Convenient location and provision of outreach [32]

• Internet-based interventions, as these offer flexibility regarding time and location, low effort, accessibility and (sometimes) anonymity [40]

• Widened programme/intervention eligibility (e.g. allowing women who already have a child to participate in the programme) [41]

Financial constraints

Homeless people, people with low socioeconomic status, ethnic minorities

• Financial access to medication [42, 89]

• Cost of care and treatment [35, 44, 147]

• Inadequate income support [56]

• Affordability of technological/digital means as requirements for some treatments (e.g. mobile phones, mobile data 3G/4G) [35, 43]

• Lack of health insurance [148]

• Lack of childcare provisions [66]

• Reduction in spending on health and social care [110]

• Housing insecurity [41]

• Removal of financial barriers to prescription medication [42]

• Reduce the financial costs associated with data usage by consolidating content onto health apps and minimising the need for online linkages [43]

• Provision of free health services and treatment [44]

• Provision of affordable services within reach of, and financial support for, families with low socioeconomic status [36]

• Subsidies for treatment-related expenses [38]

Communication issues

Ethnic minorities, immigrants and migrants, people with disabilities (learning or physical)

• Availability of accessible information [34, 50, 57]

• Difficulty contacting practitioners [50]

• Perceived ineligibility for treatment based on communication difficulties [57]

• Language barriers/lack of translators [84, 89, 127, 148]

• Poor literacy [41, 89]

• Problems in communicating, articulating or negotiating problems and needs [41, 153]

• Define and provide specific staff training on communication strategies focused on health needs of the identified population (e.g. migrants) [148]

• Meeting the needs of people with low literacy using health apps that provide audio recordings, audio-visual displays and diagrams as well as written information [43]

Awareness of available services

Older people, ethnic minorities

• Reliance on informal supports and poor knowledge about services available [116, 147]

• Ignorance about services [57]

• Lack of understanding from staff about types of care available and who these are designed for [57]

• Lack of education about available services and what treatment entails [44, 57]

• Lack of knowledge about the healthcare system and about informal networks of healthcare professionals [148]

• Making campaigns more relevant and effective, use of simpler, more positive language, use of less individualistic language (e.g. ‘me’), respecting different beliefs [45]

• Community engagement [46]

• Primary care professionals to map community activities [46]

• Engaging the local targeted community (including members of the religious community, e.g. the local rabbi )[47]

Trust in services or ‘the system’

People living in rural or remote locations, aboriginal communities, ethnic minorities

• Patient cultural views and/or perceptions of the clinician’s culture [49]

• Anxiety and/or lack of confidence in asking for help [50]

• Fear of medical services [33, 127]

• Confidentiality concerns [40, 147]

• Negative past experiences with services [147]

• Past experience of punitive or forced mental health care making patients unwilling to take up treatment [57]

• Concerns about privacy [66]

• Decision to seek help from a traditional or religious healer [36]

• Fear of ‘asylums’ [45]

• Distrust of social workers and doctors, fear of being asked too many questions, lack of trust in measures to protect confidentiality [45, 116]

• Facilitation of opportunities for disclosure through tele-mental health methods [48]

• Building trusting relationships [37]

Appropriateness of available services

Aboriginal communities, ethnic minorities, immigrants, children and young people

• Patient cultural views [49]

• Limited culturally appropriate services [34, 116]

• Diagnostic overshadowing [57]

• Complex comorbidity [62]

• Technical ability [43]

• Inconsistent methods and application of treatment (e.g. for trans-identifying patients) [65]

• Lack of GP training in mental health and/or substance use issues [39]

• Failure to provide age-appropriate environments [32]

• Provision of culturally appropriate alternatives to mainstream care [33]

• Cultural and linguistic competence of staff; cultural reference points [34]

• Developing services that are acceptable to people at risk of disadvantage, such as older people and those from ethnic minorities [35]

• Making services ‘holistic’ and ensuring ‘cultural safety’ of primary healthcare services [37]

• Providing access to male and female therapists, provision of choice in care and maintaining confidentiality [47]