ENTITLED: Elucidating the iNequaliTy gaps in burdens and access to mental health and substance use services in Sweden using IntersecTional and impLementation rEsearch Designs

Problem and questions

ENTITLED operates on the foundational belief that health is a fundamental human right. The project is guided by the promise of SDG 3.8 — to “achieve universal health coverage, including financial risk protection” — and by the principle of leaving no one behind, which embeds health equity and social justice at its core. Access to healthcare is regarded as both a cornerstone of equality within the health system and a key pillar of social justice.

The overarching objective of ENTITLED is to examine trends and disparities in the prevalence of common mental disorders (CMD) and substance use disorders (SUD), as well as the utilisation of related services across diverse social groups. The project also seeks to identify and propose intervention strategies to address unmet needs in mental health and substance use services.

Bringing together a multidisciplinary team with expertise in clinical research, public health, epidemiology, and social work, ENTITLED addresses the following key questions:

1. What are the prevalence estimates and trends of CMD and SUD between 2015 and 2024?
2. Do inequalities exist in CMD and SUD prevalence across different social groups, and what are the levels and causes of unmet needs for mental health and substance use services among at-risk and vulnerable populations?
3. What facilitators and barriers influence the provision of — and access to — adequate mental health and substance use services for individuals in vulnerable situations?

Design and methods

ENTITLED is a mixed-methods project consisting of three interlinked studies that integrate longitudinal quantitative analyses with in-depth qualitative research.

• Study 1: A time-series analysis will examine trends in the prevalence of common mental disorders (CMD) and substance use disorders (SUD), as well as the utilisation of related services in Sweden from 2015 to 2024, including potential interruptions caused by the COVID-19 pandemic.
• Study 2: A cross-sectional analysis will assess unmet needs among individuals requiring mental health and substance use services and identify populations in vulnerable contexts using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA).
• Study 3: In-depth interviews with individuals with lived experience of CMD and SUD, along with focus group discussions with service providers, will explore the facilitators and barriers that influence the provision of and access to adequate mental health and substance use services.
  
  These three studies are complementary and together provide a comprehensive understanding of inequalities in mental health and substance use care across the Swedish population.

Societal relevance and utilization

ENTITLED members will build strong collaborations and engage with key regional and national actors to enhance the project’s reach and impact. Partners include representatives from regional authorities, Läkemedelsverket, the Swedish Public Health Agency, and the Swedish Association of Municipalities and Regions, as well as NGOs working on mental health and substance use disorders. These partnerships will ensure that the project remains aligned with key stakeholders and grounded in real-world needs.

ENTITLED aims to identify disparities in mental health and substance use services and to inform equitable, culturally competent interventions and policies that guarantee timely, high-quality care for all. By contributing to the development of inclusive healthcare policies that promote equal access to services, ENTITLED supports the 2030 Agenda for Sustainable Development and its vision of leaving no one behind.