Migration flows are the movement of people from one geographical area to another, which may occur within the same country (internal migration) or between different nations (international migration) (Czaika and De Haas, 2014). These migratory flows can be motivated by various factors, such as economic factors, whereby people move in search of better job opportunities, better economic conditions or greater economic stability (Dustmann and Görlach, 2016); social factors, involving the desire to reunite with family or to join communities with cultural affinities (Boccagni and Baldassar, 2015); political factors, which involve people leaving their country due to political persecution, discrimination or human rights violations (Crawley and Skleparis, 2018); and environmental factors, which involve migration caused by natural disasters, climate change or environmental degradation that make living in certain areas unfeasible (Castles and Miller, 2009; Cattaneo et al., 2019). Massey et al. (1998) explore the factors that determine the phenomenon of migration flow. Push and pull factors are key concepts in the study of migration and describe the forces that encourage people to leave their country of origin (push) and those that attract them to a new country of destination (pull) (Van Hear et al., 2018; Carling and Collins, 2018).

Push factors are unfavorable elements or difficult conditions in countries of origin that push people to leave their homeland (Castles et al., 2014). Some of the main ones are economic instability and poverty, such as unemployment and low wages, as a lack of job opportunities and low wages drive many individuals, especially young people, to seek better economic prospects abroad (Docquier et al., 2014); or famine and scarce resources, as in regions affected by a lack of resources or infrastructure, such as drinking water and sanitation, the quality of life is drastically reduced, which can push people to emigrate (Adger et al., 2015). In addition, conflicts and persecution, such as wars and violence, can be encountered. Civil wars, ethnic conflicts and armed uprisings force many people to leave their countries for safety (Adhikari, 2013).

When we talk about ethnic minorities, we mean a non-dominant group which is usually numerically less than the majority population of a State or region regarding their ethnic, religious or linguistic characteristics and who (if only implicitly) maintain solidarity with their own culture, traditions, religion or language (European Migration Network, 2019). Furthermore, ethnicity is a socially constructed concept and it is not biologically determined, but rather the result of historical, social and cultural processes. It is fluid and subject to change over time, it is often based on the individual’s self-identification, it can vary greatly within the same population. By the word “ethnic,” we mean the cultural group to which one belongs, and not the reification of belonging (Eriksen, 2010; Jenkins, 2008; Wimmer, 2013). Political, religious or ethnic persecution sees people belonging to persecuted political, religious or ethnic groups often forced to flee in order to avoid stigma, discrimination, arrests or even violence (Schmeidl, 2019). We use stigma concept as a mark of shame, disgrace or disapproval that results in an individual being rejected, discriminated against and excluded from participating in a number of different areas of society (World Health Organization/Europe, 2008). At the same time, for discrimination we refer to unfavorable or unjust treatment of a person or group based on protected characteristics such as race, color, nationality, sex, sexual orientation, age, disability, religion, or other categories specified by law (European Union, 2000; United Nations, 1965). In institutional terms, discrimination occurs when an individual or group is treated less favorably than others in comparable situations, without an objective and reasonable justification (International Labour Organization, 1958). In this research we use also the discrimination perception, that refers to an individual’s or group’s subjective awareness or belief that they have been treated unfairly or unfavorably due to their membership in a specific social group (Pascoe and Smart Richman, 2009).

These factors also include environmental degradation and natural disasters (Cattaneo et al., 2019). Pull factors, on the other hand, represent the favorable conditions in destination countries that attract people to emigrate (Carling and Collins, 2018).

Some of the main ones are economic and labor opportunities: countries with strong and diversified economies offer more employment opportunities, often with higher wages and better working conditions, and the presence of stable markets and opportunities for professional advancement exerts a strong attraction on migrants (Borjas, 2014; Kerr et al., 2017). In addition, nations with stable governments, low crime and respect for human rights are desirable places for those fleeing dangerous conditions and the guarantee of rights and justice attracts migrants seeking a pro-life and dignity (Ramos, 2018). Quality of life and social services are a significant pull factor, as the presence of quality schools and universities, efficient hospitals and accessible healthcare systems attract people eager to improve their lives and those of their families (Beine et al., 2014; Tani, 2017). With access to care, we mean the opportunity to identify health care needs, to seek health care services, to reach, to obtain or use health care services, and to have these needs fulfilled (Levesque et al., 2013). The interaction between push and pull factors plays a key role since these factors do not act in isolation, but are often interconnected (Van Hear et al., 2018). Migration flows can have economic, social and cultural impacts on countries of origin and destination, influencing aspects such as the labor market, demographics and local culture (Dustmann et al., 2016; Vertovec, 2019).

Ambrosini (2017) investigates in depth the social, economic and political implications of this phenomenon. In particular, he analyses the concept of integration and inclusion: he highlights how irregular migrants contribute to the host society in many ways, despite the fact that their position is often invisible or marginal. Many work in sectors such as domestic care and services, becoming an integral part of the informal welfare system (Ambrosini, 2013; Lutz, 2011). On the other hand, community relations see irregular migrants, who often face obstacles to inclusion, create networks of solidarity within migrant communities and sometimes even with the local population, giving rise to forms of mutual support (Ryan et al., 2008; Bloch et al., 2014). On the economic front, they make an informal economic and labor contribution; indeed, the presence of irregular migrants is significant in economic sectors such as agriculture, construction and personal care (Reyneri, 2004; Triandafyllidou, 2010).

Today, globalization and digitization have led to a view of culture as constantly fluid, hybrid and plural. Culture is now understood as a network of dynamic and interconnected meanings, which are transformed through migration, multiculturalism and interaction between different cultures (Baldwin et al., 2006; Spencer-Oatey and Franklin, 2012; Matsumoto and Juang, 2017). Ethnic minorities may have a strong and unique identity, and often maintain their cultural practices despite the pressure to assimilate into the dominant culture. However, these communities may face challenges related to discrimination, marginalization and unequal access to rights and resources.

The mental health of ethnic minorities in Europe is a complex issue, influenced by a range of social, economic and cultural factors. People from ethnic minorities often face additional challenges that may negatively affect their psychological well-being (Bhugra et al., 2011).

With regard to mental health care, minority populations face many difficulties in accessing services, including linguistic, cultural and economic barriers (Priebe et al., 2012). To address these challenges, there is a growing awareness of the need for culturally competent mental health services (Bhui et al., 2015). These services aim to understand and respect the specific experiences and perspectives of different communities.

The European Union has recognized the importance of this issue by launching various projects to improve mental health care for minorities. A significant example is the PROMO project (Best Practice In Promoting Mental Health In Socially Marginalized People In Europe), which sought to identify and promote best practices in this field (Priebe et al., 2013).

Finally, it is important to note that refugees and asylum seekers are a particularly vulnerable group, often requiring specific support for trauma and post-traumatic stress (Fazel et al., 2005).

Some of the main aspects linking mental health and ethnic minorities in Europe include, first of all, significant discrimination, which has a direct impact on their mental health. Structural racism and everyday incidents of discrimination can cause chronic stress, anxiety, depression and post-traumatic stress disorder (Williams and Mohammed, 2009). Continued exposure to these forms of oppression can lead to feelings of exclusion, alienation and social isolation. In addition, we can find other factors that result in barriers to accessing mental health services, such as language, cultural, economic and migration experience barriers (Marmot et al., 2010). In order to better understand the relationship between discrimination and the perception of discrimination, and to fully grasp the participants’ point of view, we used the interactionist perspective as a framework. The interactionist perspective offers a powerful framework for social research (Blumer, 1969; Mead, 1934; Iudici, 2015; Iudici and Fabbri, 2017; Iudici et al., 2020b). This perspective focuses on how individuals create and negotiate meanings through social interactions. According to symbolic interactionism, social reality is constructed through the interpretation and negotiation of shared symbols and meanings (Goffman, 1959; Berger and Luckmann, 1966).

In a research context, the interactionist approach emphasizes the importance of understanding individuals’ subjective experiences and how these are shaped by social interactions (Denzin, 2001). Researchers adopting this framework focus on observing and interpreting interaction processes, paying particular attention to the language, text, gestures, and symbols used by participants (Charmaz, 2014; Iudici and Gagliardo Corsi, 2017).

Methodologically, interactionism favors qualitative approaches such as ethnography, in-depth interviews, and discourse and text analysis (Atkinson and Housley, 2003; Iudici et al., 2020a). A key aspect of this approach is the recognition of the participants, but also researcher’s, active role in the research process (Holstein and Gubrium, 2008; Snow, 2001; Strauss, 1993).

The main objective is to highlight how the treatment in Mental Health Services is configured from the perspective of users belonging to ethnic minorities. Our interest is to highlight how users perceive the clinical intervention implemented by the services.

The results emerged from a meticulous review and analysis of the selected articles. The articles were studied to draw up a table containing the results from each. The two main results were selected based on the frequency with which they were repeated in all the articles. Therefore, the two macro categories emerged as the most frequently cited and reported by users belonging to ethnic minorities. The results were broadly subdivided into the following macro-categories: (1) difficulties to access to services and (2) the perception of unequal or inappropriate treatment.

In the first category, we have grouped together the processes that lead to non-use of services, i.e., barriers that prevent access to services. In the second category, we have grouped together the theories and experiences of minorities with regard to the actual treatment offered by the services.

As a result of the categories and the presentation of the results, it was possible to identify a diversity of criticalities reported by minority users. The issue of discrimination emerges clearly from the very first moment when people from ethnic minorities contact mental health services. From an interactionist perspective, we focused our attention on the voices of ethnic users, who report distrust regardless of admission (Memon et al., 2016).

The lack of trust manifests despite users achieving treatment at certain services for various reasons, such as increased experience of unfair treatment, distrust of health care based on personal experiences of racial discrimination, or distrust based on hearing about others’ bad experiences with mental health services. Unfair treatment as a latent element most often referred to interactive issues such as not feeling heard. This influences a significant under-representation of minority patients in clinical services (Bhui et al., 2003).

Recent studies have highlighted the need for a comprehensive approach to address these issues. Evangelidou et al. (2023) points out the need for a public health paradigm shift that actively engages both vulnerable migrant refugees (VMR) and professionals in decision-making processes to enhance access and promote health strategies. This approach aligns with recommendations for both “upstream” measures (such as data collection and governance) and “downstream” measures (like improving access to health services and responsiveness to migrants’ needs). A “Road Map” has been proposed that emphasizes both “upstream” measures (data collection, governance, intersectoral action on social determinants of health) and “downstream” measures (access to health services, responsiveness to migrants’ needs, attention to vulnerable groups). Importantly, migrant status can have both direct and indirect effects on health, often mediated by socioeconomic position (SEP). Nordström et al. (2020) emphasizes the urgent need to implement solutions to migrants’ health inequalities, addressing socioeconomic inequities and those related to migration and ethnicity in tandem, rather than as separate issues.

One of the assumptions of the interactionist approach reports that constructive and interpretative acts of events depend on the relationships in place, the context and the related roles, rules and value judgments (Burr, 2015; Turchi et al., 2023; Hacking, 1999). This perspective emphasizes the importance of social interactions and ethnic context in shaping individuals’ perceptions and experiences of mental health services (Kirmayer et al., 2018; Turchi et al., 2019).

Evagora-Campbell et al. (2022) notes a paucity of research addressing the structural determinants of health inequities in labor migrants, despite the rise in international migration. This gap in research underscores the need for the academic community to pay greater attention to structural determinants of health, which often requires cross-disciplinary and cross-sectoral collaboration.

The construction of relationships with people and the healthcare context can become critical to such an extent that not only do they fail to establish positive relationships with the appropriate personnel, but also lead to users not feeling listened to and understood regarding their difficulties and discomforts. It seems of paramount importance to understand the reasons for inequalities in the way users are received and treated to resolve them. Ethnic minorities are often faced with substantial unmet treatment needs (Alegría et al., 2017). Ethnic Minorities who eventually access services may not be fully representative of their minority group as a whole. For example, patients who access services may be those who accept the “western” view of how to overcome mental health problems, whereas people who do not access treatment may have a different view of treatment and may respond differently to the mental health resources offered (Kirmayer and Ryder, 2016).

There is a need for public health professionals to work to reduce inequalities in access to services. The interactionist approach brings back the pivotal point of understanding the other’s world, of remaining as close as possible to the text produced by the patients as in the configurations or interpretations of reality there are not things or objects, but entities that acquire meaning through the use of language. Attention to detail in planning, the use of relevant incentives and targeted community outreach efforts seem to be helpful in engaging ethnic minorities in clinical settings. Ethnic modifications to empirically supported treatments, such as cultural matching with the therapist, the use of a culturally sensitive therapist, the use of culturally appropriate examples, or the use of culturally rooted strategies have been suggested as relevant strategies that may contribute to improved help-seeking and treatment compliance (Benish et al., 2011).

Possible explanations for the under-representation of ethnic minorities in mental health services include the perception of some symptoms or disorders as being of little harm, which does not prompt users to seek help despite their symptoms. Alternatively, the embarrassing and sometimes taboo nature of symptoms may be associated with higher levels of shame and stigma in some ethnic groups due to the way they perceive psychiatric services, making it more difficult for people to actually seek help.

It is also possible that the explanatory models (i.e., the patient’s understanding of the illness) of minority patients are different and need to be further investigated (Kleinman and Benson, 2006). Some ritualistic behaviors may not be considered as clinical problems. Additionally, individuals from ethnic minorities may be more likely to seek help from resources other than mental health services (e.g., elderly relatives, religious institutions or communities) or the way in which they come into contact with services may vary.

The interactionist approach allows us to broaden the possibilities of understanding while avoiding value judgments specific to European culture and the social context in which we are embedded (Burr, 2015). Roles, rules and value judgments are personal and interpersonal, and enable the decoding of meanings, acts of construction and interpretation of reality (Berger and Luckmann, 1966; Gergen and Gergen, 2012). Such acts also lead the attributions of meaning to be socially constructed.

Ethnic minorities are people who may attribute different meanings to symptoms, disorders or contacts with health professionals than the prevailing population’s way of constructing reality (Kirmayer et al., 2018). Experiences and traditions are different, the way they come into contact with mental health services is different, and to date, this cannot be ignored.

Users report a significant sense of judgment, stigma and discrimination (Memon et al., 2016). The debilitating effects of discrimination go beyond the influence of known risk factors for psychological distress, such as unemployment, being single, having a limited residence permit and even in the presence of personality structures that may increase vulnerability for stress responses and mental disorders (Pascoe and Smart Richman, 2009).

Ethnic minorities tend to be confronted with individuals belonging to their culture, their traditions, and in short, their family or peers. Often, family members report negative experiences and note critical issues when approaching health care facilities. This generates a mechanism of mistrust, lack of trust, and powerlessness that is passed on from generation to generation (Alegría et al., 2016).

Ethnic minority families in Europe are difficult to reach for the prevention and treatment of various psychological disorders (Reardon et al., 2014). It is assumed that one reason for the low engagement of some parents of children in mental health services is their tendency to perceive, in comparison to ethnic majority families, the externalizing and internalizing behavior of children as less problematic.

Religious or traditional values such as collectivism and conformity, rather than individualism and authenticity, may influence the way ethnic minorities perceive atypical behavior or symptoms of children or family members, and the extent to which they feel personally affected by this behavior (Kirmayer and Ryder, 2016). This ethnic difference leads them to be more inclined to focus on adapting to the needs of their relatives, rather than feeling personally oppressed.

Families from ethnic groups who fear stigmatization may be more reluctant to acknowledge that their family members may have behavioral difficulties. Most of the ethnic minorities families analyzed in the studies lived in deprived neighborhoods and had a lower socio-economic status. Socio-economic status often predicted treatment intensity: subjects who were not employed were more likely to receive low-intensity treatment (Delgadillo et al., 2016).

Low income has been linked to a greater need for mental health treatment. Very often, difficulties with communication and language skills, a perceived sense of discrimination, and socio-economic difficulties lead people from ethnic minorities to perceive and report inadequate treatment as a consequence (Sentell et al., 2007).

The fact that ethnic minorities seem to benefit from evidence-based treatments as much as their white counterparts, yet are under-represented in clinical services (de la Cruz et al., 2015), denotes that ethnic minorities face substantial unmet treatment needs. This may further contribute to the socio-economic hardships that some ethnic minority groups already face (Alegría et al., 2017).

In conclusion, addressing the inequalities in access and treatment of mental health services for ethnic minorities requires a multidimensional approach. This approach should take into account cultural differences, socio-economic barriers, and the need to build trust through culturally sensitive practices. By understanding and addressing these complex factors, we can work toward more equitable and effective mental health services for all members of society.

On the basis of the above considerations, it is possible to outline a few points on which future studies should focus, or at least on the changes that scientific research urges in order to achieve an adequate movement to the needs of ethnic minorities in the field of mental health. The cross-sectional designs presented in the research allow us to estimate the effects of historical events such as psychiatric hospitalization on current views such as distrust, but critically we cannot determine the impact of distrust and unfair treatment on subsequent clinical and service utilization outcomes. First and foremost, this represents important initial future work. In fact, there is a strong need for a renewal of resources and tools to design and test interventions aimed at reducing ethnic disparities in the use of mental health services, also considering the unfair treatment patterns within the services reported by the users themselves (Memon et al., 2016).

These operations would in any case lead to an increase in trust in the services and a word-of-mouth of positive experiences passed on from generation to ethnic generation. It should not be underestimated that the anticipation of such issues would guarantee a better quality of service provision, which would better meet the real and felt needs of users, and which would in turn guarantee an improvement in therapeutic collaboration between professionals and patients. In fact, experiences of care and ease of access to care would be a protective element against psychological distress (Alegría et al., 2016).

In the studies exposed through this work, it was found that knowing that support was available and how it could be structured, helped individuals to seek help and access services sooner. Positive and even transformative experiences were attributed to the feeling of being understood, listened to and validated. This can be verified through the ways of curiosity, kindness, flexibility and trust-building that mental health professionals adopted toward ethnic minority patients (Kirmayer et al., 2018).

The awareness and realization that there are inequalities in the way ethnic minorities are treated compared to the prevailing populations highlights that more needs to be done to understand the causes of the known ethnic disparities in the diversification of mental health services, and to implement strategies based on the goal of reducing and eliminating these inequalities (Bhui et al., 2015). The implementation of collaborative mental health initiatives between professional health services and voluntary, community and social enterprise organizations can improve understanding and dispel myths about mental health. It can also increase access to culturally competent professional mental health services, improving satisfaction with mental health care received among black populations (Halvorsrud et al., 2018; Bassey and Zaka, 2024).

When undertaking research that examines mental health by ethnic groups, tracking mental health prevalence and treatment outcomes by precise ethnic groups will greatly assist in monitoring trends in this area and ensuring that progress is made toward a more equitable experience for all (Jongsma et al., 2019). So far, it appears that physicians and politicians have had little information regarding the disparities in diagnosis and treatment of minority groups. For this reason, efforts are needed to ensure sensitivity to different cultural values regarding mental health and to encourage recognition of the symptoms and help-seeking behavior of these populations, taking into account the fact that different cultural values take on different entities and guises than the prevailing culture of a given country (Kirmayer and Ryder, 2016).

It is of paramount importance to understand whether there are differences in mental health beliefs and treatment preferences between different ethnic groups, as strategies that work for the Italian population, may not be functional and effective for minority populations. Politicians and doctors should be well aware of this. Differences exist and partly explain the gap in mental health care and treatment. However, if differences in illness perception and help-seeking behavior are minimal or do not exist, then it becomes crucial to search for, understand and eventually eliminate the barriers to more equitable care (Rathod et al., 2018). Further studies should focus on the reasons for these ethnic inequalities in order to ensure good quality mental health care for all ethnic groups.

Overall, perceived ethnic discrimination was found to negatively influence psychological distress even controlling for known social factors, migration-related factors and personality traits associated with distress (Pascoe and Smart Richman, 2009). The results suggest several important directions for the development of future practices, policies and research. High quality services are the result of community involvement, understanding the needs and wishes of patient or client populations and adapting to their needs as far as possible in each service encounter (Kirmayer et al., 2018). Similarly, policies should be congruent with the needs of the people involved and should be informed both by impacts on individuals and by a macroscopic understanding of local communities as a whole.

The moderating role of acculturation could be explored to a greater extent to gain a more complete understanding of the role of adaptation in health and mental health (Berry, 2019). Variations within groups also appear to support the individualization of services. Exploring what interventions are effective, for whom and what kind of outcomes they influence continues to be important in health and mental health service provision and is critical to establishing cultural competence and promoting health and mental health in our diverse and ethnic societies (Benish et al., 2011; Rathod et al., 2018).

First, this review is limited in its concerns over the scarcity of specific studies involving patients from different ethnic backgrounds. It focuses on research conducted in the Western academic world; when discussing ethnic minorities groups or migrants from unfamiliar areas, there is, thus, the risk of taking many concepts for granted. It is important to underline that most of the studies we examined were conducted in some places in the UE context. This factor may have guided the results and analyses, and therefore, one must tread with caution in generalizing the results, also because these results concern some Services and not a specific European institution. Furthermore, there was considerable variability among the studies included, such as the number of participants, survey methods and evaluation of the interventions. Future studies should aim to investigate the topic under review in different and more specific contexts, e.g., the Italian context.

Further research is needed on young people’s journeys from adolescent to adult services and how inequalities in referral source may impact treatment pathways and patient outcomes. That is a huge issue for people with different background. It is crucial to understand the reasons for these inequalities and resolve them. These may be related to possible referral barriers, obstacles in accurate diagnosis post-referral to mental health services, or differences in beliefs about mental health care and treatment preferences across different ethnic minorities groups.