'Hard-to-Reach' or 'Hardly Reached'? Underservice, Marginalisation and Inequity in Care

Area of Science:

• Public Health
• Mental Health Services Research
• Sociology of Health

Background:

• The term 'hard-to-reach' is commonly used in mental health care to describe individuals with limited service access and engagement.
• This terminology can obscure systemic factors influencing access and place blame on individuals for disengagement.

Purpose of the Study:

• To critically examine the implications of the 'hard-to-reach' framing in mental health care.
• To propose an alternative framework, 'hardly reached,' to re-center service system responsibilities.

Main Methods:

• Discursive analysis of the term 'hard-to-reach' within mental health care literature.
• Utilizing the experiences of unhoused populations as a case study.
• Conceptual reframing from 'hard-to-reach' to 'hardly reached'.

Main Results:

• The 'hard-to-reach' label directs attention away from service limitations and reinforces deficit-based views of marginalized populations.
• The 'hardly reached' concept shifts focus to how service design and structural barriers contribute to disengagement.
• Unhoused individuals exemplify populations often labeled 'hard-to-reach' due to systemic underservice.

Conclusions:

• Shifting to a 'hardly reached' framework is crucial for ethically responsive and socially just mental health care.
• Mental health services and systems have an obligation to address structural barriers impacting access.
• This reframing encourages a focus on systemic inequities rather than individual failings.