“Although I’m mentally ill, that doesn’t mean that I’m not also physically ill” – barriers, facilitators and diagnostic overshadowing in healthcare for individuals with lived experience of mental ill-health

Background People with lived experience of mental ill-health (PWLE) face inequities in health care, including experiences of stigma and discrimination due to mental ill-health, as well as diagnostic overshadowing. This study aimed to investigate facilitators, barriers, and experiences of diagnostic overshadowing of PWLE within four European health care systems (Austria, Greece, Poland, and Spain). Methods This qualitative interview study included PWLE and other relevant stakeholders ( N = 85) with an age range from 22 to 76 years ( M = 47.01, SD = 12.95). Semi-structured interviews were transcribed verbatim and thematically analysed. Results The analyses revealed three themes: (1) “Factors located within the health care system,” (2) “Factors in regard to the personal situation,” and (3) “Impact of diagnostic overshadowing on health.” The results indicated that experiences of not being taken seriously and issues of stigma and discrimination in the health care setting were recognized across all countries. Additionally, self-stigmatization was mentioned as an additional burden. Conclusion These findings show the limitations in access to and utilization of health care services by PWLE across different health care systems. Additional efforts are needed to improve access and utilization of physical health care for PWLE to promote equity in health care and, ultimately, health.