Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis

Area of Science:

• Social Sciences
• Health Services Research
• Psychiatry

Background:

• Discriminatory practices in mental health care violate the right to health for marginalized populations.
• Intersectional approaches are crucial for understanding simultaneous discrimination often missed by single-axis analyses.

Purpose of the Study:

• To review intersectionality-informed qualitative literature on discriminatory practices in mental health care.
• To understand the experiences of marginalized service users and their navigation of mental health services.

Main Methods:

• A systematic search of EBSCO, PubMed, MEDLINE, and JSTOR was conducted for studies published between 1989 and 2022.
• Qualitative evidence synthesis with thematic analysis was performed on eligible qualitative and mixed-methods studies using an intersectional approach.
• Included studies focused on discrimination experiences, mechanisms, and coping strategies from service user and provider perspectives.

Main Results:

• Fifteen studies involving 383 service users and 114 providers were synthesized.
• Common intersections included mental illness with race, and sexual and gender diversity, primarily in US and Canadian settings.
• Four key themes emerged: social identity relevance, knowledge gaps, microaggressions, and user responses to discrimination.

Conclusions:

• Discriminatory practices create significant barriers to care for multiply marginalized individuals.
• Institutions like universities and hospitals should implement training to recognize and prevent discrimination.
• Developing institutional competencies is vital for improving mental health care equity.