A scoping review to identify opportunities and challenges for communities of South Asian (SA) origin in accessing mental health services and support in high- income countries

Introduction: Communities of South Asian (SA) origin in high-income countries experience the highest prevalence of mental health (MH) disorders amongst culturally and linguistically diverse (CALD) community groups. Emerging evidence highlights community experiences of socio-cultural and systemic challenges to MH care access; however, there is no comprehensive qualitative evidence regarding these opportunities and challenges. To address this knowledge gap, this review aimed at exploring the lived experiences of SA CALD communities through opportunities and challenges experienced in accessing MH care across four high-income nations (the United Kingdom, Australia, the United States, and Canada). Methods This scoping review followed reporting guidelines for scoping reviews outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted to identify studies published in English between 2000- January 2023 in three electronic databases: PubMed, Web of Science, and Scopus. The search strategy included keywords related to SA CALD communities, MH and access to health care in four high-income countries. Extracted qualitative data were analysed using a thematic analysis approach. Results Analysis of the data from 25 eligible studies across all four high-income identified interlinked opportunities and challenges informing their ability to access MH care that supports their needs. Findings have been structured according to the five dimensions of accessibility of services (1) approachability, 2) acceptability, 3) availability and accommodation, 4) affordability, and 5) appropriateness). Our study identified myriad challenges faced by SA CALD communities in four high-income nations, including inflexible accessibility to diverse MH care, difficult family dynamics, stigma and acculturative issues hindering MH care usage and poor MH care experiences informing perceptions of MH care and re-engagement. Conclusion The research finds that access to MH care for CALD communities requires a comprehensive and nuanced framework that addresses population-specific factors. Recommendations include increasing cultural safety, facilitating flexible models of care and service delivery in practice alongside policy and funding reflective of systemic MH care access issues, and implementation research to assess the effectiveness of such recommendations.