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

In mental health care, the term 'hard-to-reach' is frequently used in relation to individuals and populations who have reduced access and engagement with services. While positioned as a neutral term, this term can conceal and minimise the multiple factors influencing access to and engagement with care. It also clearly places the responsibility for disengagement as an individual decision or failing, removing responsibility from services themselves. In this paper, we consider the term 'hard-to-reach' and provide a counter-framing of 'hardly reached' to centre patterns of underservice within mental health services and systems. Using the phenomenon of being unhoused as a lens, we consider how language informs assumptions about people and populations. We propose that the label 'hard-to-reach' operates discursively to redirect attention from service limitations and reinforce deficit-based positioning of marginalised people and populations. Contrary to this framing, the concept of 'hardly reached' refocuses attention back to the ways in which service design contributes to disengagement with care services. We highlight the obligations of mental health services and systems to recognise and effectively address structural barriers. We argue that embracing a 'hardly reached' position provides us with a more ethically responsive and socially just framework for understanding and addressing systemic inequities in mental health care.