Different service characteristics are known to influence mental health care delivery. Much less is
known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care
to socially marginalized groups.
The objectives of this work were to assess the organisational characteristics of services providing mental health care
for marginalized groups in 14 European capital cities and to explore the associations between organisational
quality, service features and country-level characteristics.
617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index of
Service Organisation (QISO) was developed and applied across all sites. Service characteristics and country level
socioeconomic indicators were tested and related with the Index using linear regressions and random intercept
The mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) in
Ireland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristic
significantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inversely
associated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, with
GDP explaining 12% of this variance.
Socioeconomic contextual factors, in particular the national GDP are likely to influence the
organisational quality of services providing mental health care for marginalized groups. Such factors should be
considered in international comparative studies. Their significance for different types of services should be explored
in further research.
Mental health services, Quality index of service organization, Socially marginalized groups,
2014. Art. no. 49- p.
Mental health services, Quality index of service organization, Socially marginalized groups, Multi-level analysis