Patient-centered access to mental health care at selected life-course stages: a scoping review using the Levesque framework.

BACKGROUND

The Levesque patient-centered access framework links five service dimensions with five corresponding population abilities, from recognizing need to engaging with care. We synthesized its substantive applications to mental-health access among pregnant and postpartum people, children and adolescents aged 0-17 years, and adults aged 65 years or older.

METHODS

We conducted a framework-guided scoping review with descriptive evidence mapping and narrative synthesis. Four Elicit reports supported semantic retrieval, preliminary screening, and draft extraction; PubMed and Web of Science searches supplemented identification through 1 August 2026. One reviewer determined eligibility, evidence roles, and framework coding; a second independently checked extracted data against full texts. Two reviewers independently appraised empirical studies and reviews using MMAT 2018 and the JBI review checklist. Direct population-specific evidence was distinguished from adjacent and contextual sources. Reporting was guided by PRISMA-ScR and GAMER.

RESULTS

Reported screening totals were 367 records and 70 full texts. The final map contained 37 sources: 23 empirical studies, 11 reviews, one protocol, and two conceptual sources. Ten sources provided direct evidence: five perinatal sources (three empirical studies and two reviews), four youth empirical studies, and one older-adult empirical study. The other 27 sources did not support direct cross-population claims. Preconference appraisal agreement was 95.2% (297/312 item pairs; descriptive pooled κ = 0.895). Appraisal identified limitations in representativeness, confounder control, mixed-methods integration, and review procedures. Reported barriers included difficulties before formal service contact, alongside problems in referral navigation, cultural acceptability, workforce capacity, affordability, and continuity. Gatekeepers and service interfaces varied across life-course stages. Validated measurement linking service dimensions and population abilities was limited. Incomplete screening documentation restricted auditability.

CONCLUSIONS

The framework offers a comparative vocabulary for examining access pathways and population-specific mechanisms. Findings from this small, heterogeneous evidence base are exploratory, not estimates of barrier prevalence or relative importance. Research should strengthen paired measurement, age-specific reporting, longitudinal designs, and pathway-level intervention evaluation.

CLINICAL TRIAL NUMBER: not applicable.