Towards the development of actionable recommendations for improving mental healthcare access for migrants: a qualitative study in Munich, Germany

BACKGROUND: The experience of migration is often associated with stressors affecting mental health. Furthermore, migrants face barriers to accessing mental healthcare. This study aims to explore the determinants influencing mental healthcare access for migrants in Munich, Germany, and to serve as a starting point for developing recommendations for action. METHODS: The qualitative study examined the perspectives of migrants and health professionals. Former were derived from a secondary analysis of interview data collected in the SonarGlobal project in 2021. Semi-structured interviews with health professionals were conducted in 2023. Data from both groups were analysed iteratively using a shared coding structure for content analysis. Levesque et al.'s framework guided the analysis of healthcare access and was adapted by schematizing the results. The adapted framework served as the basis for developing action-oriented recommendations based on migrants' suggestions, refined and completed by health professionals' data. Recommendations for improving migrants' access to mental healthcare were organised thematically and then assigned to the levels of integrated care according to Valentijn et al.: micro, meso and macro. RESULTS: The study included 24 migrants of SonarGlobal and seven health professionals. The dimensions of mental healthcare access encompassed: (1) perceiving mental health problems; (2) ability to seek mental healthcare, including knowledge about the new healthcare system and social support; (3) acceptability of mental health services, involving provider identity and gender; (4) availability and affordability of mental health services, including insurance coverage, bureaucratic processes, and capacity and geographical distribution of services; (5) appropriateness of mental health services with providers' and patients' understanding of mental healthcare, and providers' competence and capacity. Language exhibited a strong interplay across all dimensions. The analysis yielded 17 recommendations. Macro-level recommendations address discrimination and inequality. Meso-level recommendations included enhancing care capacity and coordination, training healthcare workers, and eliminating language barriers. Micro-level recommendations included activities to promote mental health. CONCLUSIONS: The determinants of migrants' mental healthcare access are shaped by intersecting vulnerability mechanisms and systemic barriers. Improving access requires actions on micro, meso and macro level of care. This study's recommendations offer a starting point for developing comprehensive, evidence-based strategies to ensure equitable mental healthcare access for all.