198 Chapter 7 This thesis sought to produce evidence to inform policy in reducing inequalities in mental health care and outcomes. This was primarily achieved by addressing two different knowledge gaps. The first research question, descriptive by nature, aimed to complement the existing knowledge about inequalities in the mental health field. This body of evidence is extensive concerning inequalities in mental health status and access to mental health care but extremely limited regarding inequalities in mental health treatment and patient outcomes. The second research question focused on identifying mental health related interventions, programs and policies that impact the existing inequalities. To address this question, we relied on quasi-experimental methods to causally evaluate the interventions. We have conducted the evaluations applying an equity lens by measuring differential effects by socioeconomic status or focusing on interventions that impact vulnerable groups. This Chapter first describes how the main findings of Chapters 2 to 5 answer each research question, followed by methodological considerations arising from the research conducted, including the conclusions of a peer-reviewed opinion piece presented in Chapter 6. In this opinion piece, I reflect on the challenges faced by (junior) researchers to conduct quasi-experimental work. Given the policy focus of the thesis, the Chapter continues by presenting a set of reflections on conducting interdisciplinary research with societal impact. These reflections relate to PhD trajectory experiences that despite not represented in any of the peer-reviewed Chapters have substantially shaped my research profile and informed the thesis´ recommendations. Such recommendations on future directions for research and policy close the Discussion of this thesis, and are purposely presented together to bridge the two domains. MAIN FINDINGS AND INTERPRETATION Characterize disparities in the provision of care to people with mental health conditions Chapter 2 described the differences by household income quintile in four stages of the mental health treatment pathway. It covered the entire population of patients initiating specialist mental care in the Netherlands between 2011 and 2016. Our findings show gradients favourable to higher-income patients across the four stages studied, revealing that income disparities persist beyond access to care throughout the treatment pathway. First, and regardless of the type of disorder, lower-income patients started treatment in greater disease severity, as measured by therapist-assessed GAF score. Second, lowestincome patients received slightly less treatment minutes when adjusting for their initial need, captured through diagnosis and initial disease severity. Third, lower-income patients experienced a substantially lower likelihood of improving their functioning at the end of the first treatment course, compared to higher-income patients with similar need and treatment minutes. And last, lower-income patients were more likely to receive
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