17 General Introduction interventions potentially impacting such inequalities. Therefore, this thesis responds to two research objectives: 1. Characterise inequalities in providing care to people with mental health conditions. 2. Identify causal effects of mental health related interventions, programs and policies with impact on the most vulnerable patient groups, using quasiexperimental methods. Chapters 2 to 5 in this thesis answer policy-relevant questions at the intersection between mental health and inequalities. Methodologically, the chapters differ in the evidence they provide, ranging from purely descriptive findings (Chapter 2) to effects obtained from robust quasi-experimental studies (Chapters 3 and 4) but also associations that account for potential endogeneity from time-invariant unobservables (Chapter 5). Chapter 2 describes income inequalities along the mental health treatment pathway in the Netherlands, providing pivotal findings to move policy agendas beyond their usual focus on access to care. Chapter 3 focuses on a crucial timing of individuals’ life course with regards to their mental health treatment: the transition to adulthood. It uses a difference-in-discontinuity design to study whether a 180 euro increase in the Dutch annual deductible was a financial barrier to 18-year-olds accessing mental health care, and whether such an effect differed by youngsters’ household income. Chapter 4 consists of an instrumental variable analysis to study the effects of supported housing, a programme targeted to a highly vulnerable group, both psychosocially and in socioeconomic terms. The study uses a leniency design based on the Dutch institutional feature that centralises all applications in assessors with discretionary power. It studies the effects of supported housing eligibility on health, care, employment and income of the individual and also the parents. Changing country, Chapter 5 examines the relationship between low supply of psychotherapy and high prescription of antidepressants in Portugal. Using a withinbetween random effects model it provides empirical evidence to inform a long-lasting policy discussion on the lack of psychological resources available within the Portuguese National Health Service. Last, Chapter 6 consists of an opinion piece written together with a fellow junior colleague, as we both shared PhD struggles of conducting quasi-experimental studies to inform and evaluate public policy. It reflects on the potential of quasi-experiments in the context of public health research and describes the most common challenges – and potential solutions – to implementing them. Additional considerations about the challenges and opportunities of bringing (interdisciplinary) research and policy together are outlined in the thesis Discussion, in Chapter 7. Beyond the usual conclusions about the PhD work published, the Discussion chapter provides the candidate’s reflections on several PhD experiences that were not translatable into publications. This includes the experience of bridging public health and health economics in an interdisciplinary 1
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