Indicators of inequality in child and adolescent mental health services: Poland and Netherlands

Background

Child and adolescent mental health services (CAMHS) remain one of the most under-resourced domains of European healthcare, with access inequalities shaped by systems and contextual factors. Poland and Netherlands represent contrasting health systems in terms of finance models and levels of decentralisation what makes their comparison analytically valuable. This study aimed to identify and operationalise indicators of inequality in CAMHS access through a literature review, and empirical validation using a Delphi study.

Methods

A literature review yielded 73 items characterizing CAMHS access created based on the Donabedian framework on healthcare quality across five access domains (approachability, acceptability, availability, affordability, appropriateness). They were transferred into 24 indicators, grouped into 5 categories: Geographic, Equity, Workforce, Care Continuity & Governance. A two-round Delphi Study was conducted with 14/11 stakeholders in Poland and 11/10 in the Netherlands. Strong consensus was operationalized at level: ≥70%.

Results

Approachability was the most items-rich domain (23 items), driven by workforce indicators. Availability included 17 items, dominated by continuity-of-care indicators. Acceptability, with 14 items, and Affordability with 9 items highlighted equity issues. Appropriateness with 10 items was concentrated on governance and quality improvement. Strong consensus was reached in 36 items in Poland and 46 items in Netherlands. The largest cross-country divergences were observed in the geographic and equity indicators of access. Service proximity received the least favourable opinions in Poland, while equity indicators showed the least favourable opinions in the Netherlands The indicators care continuity & coordination confirmed gaps in both countries.

Conclusions

Structured indicator frameworks derived from literature and expert consensus can effectively map CAMHS access inequalities across diverse health systems.

Key messages

• A framework of 24 indicators, grouped in 5 categories across 5 access domains was developed and validated, providing a replicable tool for benchmarking CAMHS equity across countries.

• Stakeholders in Poland and the Netherlands highlighted strong gaps within care continuity & coordination, what indicates the need of targeted policy action in both health systems.