Bridging mental health gaps: realist insights into community support for migrant informal carers

Abstract Background Informal carers with a migration background supporting a relative with a mental illness face barriers like stigma and cultural misunderstandings. The They Aren't Mental?! (TANM) intervention uses community-based peer education via ambassadors to reduce taboos, improve access to care, and enhance social support in informal carers. TANM consists of three peer education sessions about mental health and informal care and optional follow-up support: either 1-on-1 sessions with a family expert-by-experience (FEE) or group-based training on coping with mental illness in the family. This realist evaluation (RE) explored mechanisms through which these outcomes are achieved, and under what conditions. Methods This RE had two phases: Phase 1 developed an Initial Program Theory (IPT) through interviews and a focus group. Phase 2 refined the IPT using data from observations, questionnaires and interviews with target group and ambassadors, and was validated in a focus group with members of the coordinating organizations. We expected the intervention to reduce stigma and improve help-seeking by providing culturally sensitive support in a trusted setting. Results TANM was implemented in communities where stigma on mental health, shame, and mistrust of formal institutions were common. Participants reported reduced taboos, greater awareness of support options, and stronger social support. Expressed needs included cultural sensitivity and emotional support. These outcomes were achieved with mechanisms such as trust-building, personal storytelling, and by creating safe group environments. Ambassadors and the FEE played key roles in translating information, modelling help-seeking behaviors, and guiding participants to appropriate support. Conclusions TANM's strength lies in its cultural embedded peer-led structure and in continuity through trusted community figures. Selecting ambassadors with firm connections with target groups will strengthen trust and improve outcomes. Key messages • Stigma, distrust, and cultural barriers limit access to mental health support for migrant informal carers. • Peer-led, culturally embedded outreach to migrant informal care givers builds trust and enhances access to mental health care.