Difficulties in Accessing Mental Health Services: The Perspective of Users from Cultural Minorities.

Background: Mental health services face significant challenges in providing equitable care to ethnic minority and migrant populations. Despite the right to healthcare, disparities in service use among minority communities reflect not only practical barriers but also deeper issues of cultural compatibility between patients and health systems. Aim: This study aimed to provide a systematic overview of the main difficulties encountered by ethnic minority and migrant people when seeking psychological support from mental health services, with a specific focus on linguistic and communicative barriers and organisational and economic barriers. Methods: A scoping review was conducted using the SCOPUS database, searching for peer-reviewed studies focused on the European context. Studies were included if they addressed ethnic minorities' experiences with mental health services from a user perspective and included primary research of any design. Studies focused exclusively on staff perspectives or not specifically addressing ethnic minorities' help-seeking were excluded. Twenty studies met the inclusion criteria. A qualitative narrative synthesis was adopted, following PRISMA-ScR guidelines. Results: People with an ethnic or migrant background face specific and compounded barriers when seeking mental health support. Two main categories were identified: linguistic and communicative difficulties, including language distance, limited interpreter availability, and the gap between Western biomedical models and cultural frameworks of distress; and organisational and economic obstacles, including poor knowledge of available services, socioeconomic disadvantage, stigma, and institutional distrust. Discussion: These barriers are deeply structural and cannot be addressed through awareness campaigns alone. Increased access to services is not inherently beneficial unless accompanied by a fundamental transformation ensuring that care is culturally appropriate, safe, and genuinely responsive to minority communities' needs. Distrust of mental health services may in part reflect a historically grounded and legitimate response to institutions whose practices have not always served the interests of minority groups. Conclusions: Reducing disparities in mental health care requires multi-level intervention, including inclusive policies, training of culturally competent professionals, and a critical rethinking of the models underpinning mental healthcare care. Future research should attend not only to the quantity of service use among minority populations but to the quality, cultural legitimacy, and safety of the care provided.