Socioeconomic inequalities drive significant gaps in access to mental health care across the European Union

A new study presented today at the European Psychiatric Association Congress 2025 reveals significant socioeconomic inequalities in unmet needs for mental health care across European Union countries, with financial barriers disproportionately affecting lower-income populations.

Across Europe, millions of people are affected by mental health conditions. OECD figures from 2018 suggest that around 17% of EU citizens live with a mental health condition. The economic burden of mental health is vast—mental ill-health is estimated to cost Member States over 4% of GDP per year.

This retrospective, cross-sectional study highlights the varying impact of income, education, and urbanization on unmet mental health care needs, underscoring the need for targeted policy interventions.

The research, led by João Vasco Santos from the University of Porto, analyzed data from the 2019 European Health Interview Survey across 26 EU countries. The study focused on self-reported unmet needs for mental health care due to financial reasons, examining inequalities based on income, education, and degree of urbanization.

Key findings from the study include:

• The proportion of self-reported unmet need for mental health care ranged dramatically, from 1.1% in Romania to 27.8% in Portugal, with a median of 3.6%.
• Nearly all countries showed a higher share of unmet need among inhabitants with the lowest income quintile. Greece exhibited the highest income-related inequality, with a ratio of 23.8.
• 15 out of 26 countries showed that less-educated inhabitants had higher unmet needs, with the most significant disparity observed in Bulgaria.
• Rural areas generally reported lower unmet needs for mental health care, with Romania showing the highest rural-urban ratio.

“This study highlights the substantial and wide socioeconomic inequalities in unmet mental health care needs across the EU,” stated João Vasco Santos, University of Porto and Lead Researcher.

“While income inequality consistently impacts access, the role of education varies, and rural areas often report higher unmet needs. Policymakers must prioritize strategies to ensure access to mental health services, enhance mental health literacy, and improve service availability for vulnerable populations.”

Dr. Julian Beezhold, the Secretary General of the European Psychiatric Association, commented, “This research provides critical insights into the disparities in mental health care access across the EU, revealing a complex interplay of socioeconomic factors that influence an individual’s ability to seek and receive necessary care. It reinforces the importance of addressing these multifaceted socioeconomic factors, not just income, but also education and geographical location, to ensure truly equitable mental health services for all citizens.

“Furthermore, it highlights the urgent need for robust public health strategies that not only focus on increasing service availability, but also on dismantling the systemic barriers that prevent vulnerable populations from accessing those services. This includes tackling stigma, promoting mental health literacy, and fostering culturally sensitive approaches that resonate with diverse communities within the EU.”

Provided by
European Psychiatric Association

A new study presented today at the European Psychiatric Association Congress 2025 reveals significant socioeconomic inequalities in unmet needs for mental health care across European Union countries, with financial barriers disproportionately affecting lower-income populations.

Across Europe, millions of people are affected by mental health conditions. OECD figures from 2018 suggest that around 17% of EU citizens live with a mental health condition. The economic burden of mental health is vast—mental ill-health is estimated to cost Member States over 4% of GDP per year.

This retrospective, cross-sectional study highlights the varying impact of income, education, and urbanization on unmet mental health care needs, underscoring the need for targeted policy interventions.

The research, led by João Vasco Santos from the University of Porto, analyzed data from the 2019 European Health Interview Survey across 26 EU countries. The study focused on self-reported unmet needs for mental health care due to financial reasons, examining inequalities based on income, education, and degree of urbanization.

Key findings from the study include:

• The proportion of self-reported unmet need for mental health care ranged dramatically, from 1.1% in Romania to 27.8% in Portugal, with a median of 3.6%.
• Nearly all countries showed a higher share of unmet need among inhabitants with the lowest income quintile. Greece exhibited the highest income-related inequality, with a ratio of 23.8.
• 15 out of 26 countries showed that less-educated inhabitants had higher unmet needs, with the most significant disparity observed in Bulgaria.
• Rural areas generally reported lower unmet needs for mental health care, with Romania showing the highest rural-urban ratio.

“This study highlights the substantial and wide socioeconomic inequalities in unmet mental health care needs across the EU,” stated João Vasco Santos, University of Porto and Lead Researcher.

“While income inequality consistently impacts access, the role of education varies, and rural areas often report higher unmet needs. Policymakers must prioritize strategies to ensure access to mental health services, enhance mental health literacy, and improve service availability for vulnerable populations.”

Dr. Julian Beezhold, the Secretary General of the European Psychiatric Association, commented, “This research provides critical insights into the disparities in mental health care access across the EU, revealing a complex interplay of socioeconomic factors that influence an individual’s ability to seek and receive necessary care. It reinforces the importance of addressing these multifaceted socioeconomic factors, not just income, but also education and geographical location, to ensure truly equitable mental health services for all citizens.

“Furthermore, it highlights the urgent need for robust public health strategies that not only focus on increasing service availability, but also on dismantling the systemic barriers that prevent vulnerable populations from accessing those services. This includes tackling stigma, promoting mental health literacy, and fostering culturally sensitive approaches that resonate with diverse communities within the EU.”

Provided by
European Psychiatric Association