221 General Discussion and coverage are all interconnected but remain separate levers. Acting on each one of these potentially initiates a process towards better and more equitable utilisation of mental health support. Still, this process is complex and encompasses several steps that must be additionally targeted or monitored. A practical example of this recommendation can be observed in Chapter 4, where changes in eligibility to supported housing only partially led to changes in access (admission) to housing facilities. This might have been due to additional criteria to be admitted in supported housing facilities, waiting lists and/ or cost-sharing associated with service use. Dealing with these potential barriers requires action beyond granting eligibility, respectively on the levers of availability and coverage. Down the road towards promoting equitable mental health care use, a second recommendation relates to the link between access and utilisation of care and their distributional effects. While most policy efforts have been targeted at promoting equitable access to mental health services, our findings demand that extra attention is paid to what happens beyond access to care, along the treatment pathway. Chapter 2 is the first paper to quantify this challenge. Together with other literature, our findings suggest that inequalities in treatment are not disorder- or therapeutic-specific but instead driven by standard features of the mental health treatment process. While additional research is conducted to understand the exact mechanisms behind the disparities, policy action should be considered as of now. Initial actions could include expanding policy focus from access care to the entire treatment pathway, and calling for increased practitioner awareness of how individuals of different socioeconomic statuses interact with the system. A last recommendation relates to financial barriers. While these are probably the most studied and addressed cause of inequalities in health care, this thesis reinforces their persistent effect, even in a country with extensive health care coverage and social protection. Notably, the impact of financial barriers might not necessarily run towards inequalities through material pathways. Researchers need to understand better the reasons for lower-income individuals to forego care, which might not always be related to budget constraints or liquidity problems. In examining these mechanisms, it will be essential to recognise the intersection of income with other sociodemographic and socioeconomic characteristics. While Chapter 3 identified fundamental differences by gender, most vulnerable groups might also result from the intersection of different factors, such as education or ethnicity. Protection mechanisms promoting equitable access to care should consider developmentally sensitive phases of the life course, such as youth, and be based on the individual need for treatment. Furthermore, Chapter 2 suggests that these mechanisms must go beyond facilitating access to care and be available throughout the treatment process, during which mental health inequalities might widen. 7
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