Perceived risks to quality in community mental health care for socially marginalised adults in Slovenia: a qualitative stakeholder study
DOI:
https://doi.org/10.12923/pielxxiw-2026-0022Keywords:
community mental care, people with mental disorders, the risk of quality of mental health care, inequalityAbstract
PERCEIVED RISKS TO QUALITY IN COMMUNITY MENTAL HEALTH CARE FOR SOCIALLY MARGINALISED ADULTS IN SLOVENIA: A QUALITATIVE STAKEHOLDER STUDY
Aim. The provision of high-quality mental health care is a fundamental obligation of welfare states, a professional duty, and a basic human right. However, significant knowledge gaps persist at the intersection of patient needs and service delivery—particularly in relation to access, quality, and the effects of stigma and discrimination. These gaps disproportionately affect socially marginalised (SM) and medically vulnerable (HV) adults with mental disorders. This study investigates the perceived risks to the quality of community mental health (CMH) care for adults with mental disorders, as identified by various stakeholders. It further explores proposed measures for mitigating these risks.
Material and methods. A qualitative design was employed, involving three focus groups with CMH professionals and 26 semi-structured interviews with service users, students, researchers, experts, and policy makers.
Results. The perceived risks were categorised into six thematic domains, while the proposed measures were organised into eight strategic categories. Several of the proposed actions hold broader relevance for improving CMH care and service equity beyond the national context.
Conclusions. The findings highlight the urgent need to establish local CMH action groups and to develop inclusive strategies involving SM and HV representatives to address systemic quality risks in community-based mental health care.
References
1. Mental health, human rights and legislation: guidance and practice. Geneva: World Health Organization and the United Nations (represented by the Office of the United Nations High Commissioner for Human Rights); 2023.
2. Rehm J, Shield KD. Global burden of Disease and the impact of mental and addictive disorders. Curr. Psychiatry Rep. 2019;21(2):1-7. https://doi.org/10.1007/s11920-019-0997-0
3. European Union. Mental Health. Eurobarometer, 2023. https://europa.eu/ eurobarometer/surveys/detail/3032.
4. Priebe S, Matanov A, Schor R, et al. Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries. BMC Public Health. 2012;12:248. https://doi.org/10.1186/1471-2458-12-248
5. Silva Nero RM, Benjamim CJR, de Medeiros Carvalho PM, et. al. Psychological effects caused by the COVID-19 pandemic in health professionals: A systematic review with meta-analysis. Prog. Neuropsychopharmacol Biol. Psychiatry. 2021;10(104):110062. https://doi.org/10.1016/j.pnpbp.2020.110062
6. Mezzina R, Gopikumar V, Jenkins J, et al. Social vulnerability and mental health inequalities in the „Syndemic”: call for action. Front. Psychiatry. 2022; 30(13):894370. https://doi.org/10.3389/fpsyt.2022.894370
7. Ray LA, Hopper TD, Mchugh TLF. “We could just be what we wanted to be”: The role of leisure and recreation in supporting women’s mental health during COVID-19. Leisure Studies. 2022;42(6):941-955. https://doi.org/10.1080/02614367.2022.2157465
8. Santomauro DF, Herrera AMM, Shadid J, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet. 2021;398(103):1700-1712. https://www.thelancet. com/article/S0140-6736(21)02143-7/fulltext
9. Romanello M, McGushin A, Di Napoli C, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. The Lancet. 2021;398(10311):1619-1662. https://www.thelancet.com/article/S0140-6736(21)01787-6/fulltext
10. Berardi C, Hinwood M, Smith A, et al. Barriers and facilitators to the integration of digital technologies in mental health systems: a protocol for a qualitative systematic review. PLoS One. 2021;16(11):e0259995. https://doi.org/10.1371/journal.pone.0259995
11. Bickman L. Improving Mental Health Services: A 50-Year Journey from Randomized Experiments to Artificial Intelligence and Precision Mental Health. Adm. Policy Ment. Health. 2020; 47(5):795-843. https://doi.org/10.1007/s10488-020-01065-8
12. Samartzis L, Talias MA. Assessing and Improving the Quality in Mental Health Services. Int. J. Environ. Res. Public Health. 2019;17(1):249. https://doi.org/10.3390/ijerph17010249
13. Phelan SM, Salinas M, Pankey T, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: barriers and recommendations. Ann. Fam. Med. 2023;21:S56-S60. https://doi.org/10.1370/afm.2924
14. Hempeler C, Schneider-Reuter L, Windel AS, et al. Intersectional discrimination in mental health care: a systematic review with qualitative evidence synthesis. Psychiatr. Serv. 2024;75(11):1125-1143. https://doi.org/10.1176/appi.ps.20230252
15. Kilbourne AM, Beck K, Spaeth-Rublee B, et al. Measuring and improving the quality of mental health care: a global perspective. World psychiatry. 2018;17(1):30-38. https://doi.org/10.1002/wps.20482
16. Zubin J, Spring B. Vulnerability-a new view of schizophrenia. J. Abnorm. Psychol. 1977;86(2):103-126. https://doi.org/10.1037/0021-843X.86.2.103
17. Costa A, Foucart A, Hayakawa S, et al. Your morals depend on language. PLoS One. 2014;9(4):e94842. https://doi.org/10.1371/journal.pone.0094842
18. Tangcharoensathien V, Woranan Witthayapipopsakul W, Panichkriangkrai W, et al. Health systems development in Thailand: a solid platform for successful implementation of universal health coverage The Lancet. 2018;391(10126):24-30. https://doi.org/10.1016/S0140-6736(18)30198-3
19. Isaacs AN, Mitchell EKL. Mental health integrated care models in primary care and factors that contribute to their effective implementation: a scoping review. Int. J. Ment. Health Syst. 2024;18(1):5. https://doi.org/10.1186/s13033-024-00625-x
20. Powell N, Dalton H, Lawrence-Bourne J, et al. Co-creating community wellbeing initiatives: what is the evidence and how do they work?. Int. J. Ment. Health Syst. 2024;18:28. https://doi.org/10.1186/s13033-024-00645-7
21. Galderisi S, Appelbaum PS, Gill N, et al. Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs. World Psychiatry. 2024;23(3):364-386. https://doi.org/10.1002/wps.21230
22. Comprehensive Mental Health Action Plan 2013–2030”. Ženeva: WHO, 2013.
23. Švab V, Makivić I. Ocena stanja na področju storitev za duševno zdravje (Elektronska izd.). Nacionalni inštitut za javno zdravje. 2023. https://nijz.si/wp-content/ uploads/2024/02/Ocena-stanja-na-podrocju-storitev-za-dusevno-zdravje.pdf.
24. Mental Health Act. Uradni list RS, št. 77/08, 46/15 – odl. US in 44/19 – odl. US. Article 4.
25. Možina M, Okorn I. Challenges of the development of mental health care in Slovenia. JoGHNP. 2022; e2022001. https://doi.org/10.52872/001c.31788
26. Palinkas LA. Qualitative and mixed methods in mental health services and implementation research. J. Clin. Child. Adolesc. Psychol. 2014;43(6):851-861. https://doi.org/10.1080/15374416.2014.910791
27. Badu E, O’Brien AP, Mitchell R. An integrative review on methodological considerations in mental health research – design, sampling, data collection procedure and quality assurance. Arch. Public Health. 2019;77:37. https://doi.org/10.1186/s13690-019-0363-z
28. Bearman M. Focus on Methodology: Eliciting rich data: A practical approach to writing semi-structured interview schedules. A Multi-Professional Journal. 2019;20(3):1-11. https://doi.org/10.11157/fohpe.v20i3.387
29. Samsi K, Manthorpe J. Interviewing people living with dementia in social care research. Methods Review. 2020. https://sscr.nihr.ac.uk/research/methods-scoping-reviews/qualitative-research-interviews-dementia/
30. O’Reilly M. Social media and adolescent mental health: the good, the bad and the ugly. J. Ment. Health. 2020;29(2):200-206. https://doi.org/10.1080/09638237.2020.1714007
31. Braun V, Clarke V. Using thematic analysis in psychology. 2006;3(2):77-101. https:// doi.org/10.1191/1478088706qp063oa
32. Then KL, Rankin JA, Ali E. Focus group research: what is it and how can it be used? Can. J. Cardiovasc. Nurs. 2014;24(1):16-22.
33. Zupančič V, Pahor M, Kogovšek T. Focus Group in Community Mental Health Research: Need for Adaption. Community Ment. Health J. 2019;55(1):168-179. https://doi.org/10.1007/s10597-018-0271-7
34. Westland H, Vervoort S, Kars M, et al. Interviewing people on sensitive topics: challenges and strategies. EUR J. Prev. Cardiol. 2025;24(3):488-493. https://doi.org/10.1093/eurjcn/zvae128
35. O’Reilly M, Kiyimba N. Advanced qualitative research: A guide to using theory. London, United Kingdom: Sage. 2015.
36. Bossert J, Dürsch H, Korus B, et al. Scoping review of qualitative evaluation methods for mono- and interprofessional consultations – what needs to be known and considered? Nursing: Research and Reviews. 2024;14:103-115. https://doi.org/10.2147/NRR.S443400
37. World Health Organization, World Organization of Family Doctors (Wonca). Integrating mental health into primary care: a global perspective. 2008. Retrieved from: https://iris.who.int/bitstream/handle/10665/43935/9789241563680_eng. pdf?sequence=1.
38. Zaviršek D, Djokovič N, Radešić L, et al. Romske družine: priročnik za razumevanje etične prakse v socialnem delu in drugih pomagajočih poklicih v podporo slovenskim Rominjam in Romom [Roma families: a handbook for understanding ethical practice in social work and other helping professions in support of Slovenian Roma men and women]. Ljubljana: Društvo Mozaik – društvo otrok. 2019.
39. Souza R. “I’ve thought about this, trust me”: Understanding the values and assumptions that underlie prescription stimulant misuse among college students. IJoC. 2015;9: 187-1205. https://ijoc.org/index.php/ijoc/article/view/2610/1361
40. Spurrier A, Osborne H, Retter S, et al. Mental health in nursing. JSRIUE. 2024;6(2). Fall Issue. https://scholarworks.iu.edu/journals/index.php/jsriue/article/view/37782
41. Wainberg ML, Scorza P, Shultz JM, et al. Challenges and opportunities in global mental health: a research-to-practice perspective. Curr. Psychiatry Rep. 2017;19(5):28. https://doi.org/10.1007/s11920-017-0780-z
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