Scoping review maps mental health care access across life stages

A scoping review found that patient-centered access to mental health care is shaped by different barriers and service interfaces among pregnant and postpartum people, children and adolescents, and older adults. Researchers synthesized the evidence through the Levesque patient-centered access framework, which links five dimensions of health services with five corresponding abilities in populations, ranging from recognizing a need for care to engaging with it. The direct evidence was limited: only 10 of the 37 included sources addressed one of the three selected life-course stages, and the findings were too heterogeneous to estimate how common particular barriers were or to rank their importance.

The authors searched PubMed and Web of Science through 1 August 2026, supplementing those searches with records identified through four Elicit reports used for semantic retrieval, preliminary screening, and draft extraction. Screening produced reported totals of 367 records and 70 full-text articles. The final evidence map comprised 37 sources, including 23 empirical studies, 11 reviews, one study protocol, and two conceptual sources. Only five perinatal sources—three empirical studies and two reviews—provided direct evidence about pregnant and postpartum people; four empirical studies focused on children and adolescents aged 0–17; and one empirical study concerned adults aged 65 or older. The remaining 27 sources were classified as adjacent or contextual and were not used to support direct comparisons across the populations.

Across the directly relevant studies, reported access problems occurred both before formal contact with mental health services and after care pathways had been entered. Before contact, difficulties included recognizing the need for care and reaching services. Along the pathway, studies reported obstacles in referral navigation, cultural acceptability, workforce capacity, affordability, and continuity. The role of gatekeepers and the configuration of interfaces between services varied by life-course stage, indicating that a nominally similar service could function differently for different groups. These observations describe mechanisms and access problems identified in the included literature; they do not provide population-level estimates of prevalence or proof that any one barrier causes a particular outcome.

The review also found that the paired structure of the Levesque framework was not consistently represented in measurement. The framework is designed to connect service-side characteristics with population-side abilities, but relatively few validated measures linked both sides in the same way. This makes it difficult to determine whether an apparent access problem arose from service organization, an individual’s ability to recognize or pursue care, or the interaction between them. The appraisal further identified limitations involving representativeness, control of confounders, integration of mixed-methods results, and the procedures used in reviews. Incomplete documentation of the screening process also reduced auditability, even though two reviewers independently appraised empirical studies and reviews using the Mixed Methods Appraisal Tool 2018 and the JBI review checklist.

Agreement between the reviewers was high before their conference: 95.2%, or 297 of 312 item pairs, with a descriptive pooled κ value of 0.895. That agreement supports the consistency of the appraisal, but it does not remove the weaknesses found within the underlying evidence. The authors therefore characterize the map as exploratory rather than a prevalence estimate or a comparison showing which age group has the greatest access problems. They call for research that strengthens measurement across both sides of the framework, reports results more clearly by age and life stage, uses longitudinal designs, and evaluates interventions at the level of complete access pathways. The review was prepared as open-access research in BMC Health Services Research, and the supplied version states that it was shared before the final Version of Record and remains subject to further edits.

Subject of Research: Patient-centered mental health care access at three selected life-course stages

Article Title: Patient-centered access to mental health care at selected life-course stages: a scoping review using the Levesque framework

Article References: Cwik, J. C., Hess, M., Kardys, C., Plieger, T., Walker, A., Weyermann, M., Frieß, J., Hilbrand, L., Rohrbach, B., & Breil, B. (2026). Patient-centered access to mental health care at selected life-course stages: a scoping review using the Levesque framework. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15895-z

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15895-z

Keywords: mental health access, patient-centered care, perinatal mental health, adolescent health, older adults, health services research, scoping review, Levesque framework, care pathways, Patient-centered, access, mental