Table 2 Showing barriers to access mental health care services cited by study participants from the 3 countries
Barrier | Nepal | Liberia | Uganda |
|---|---|---|---|
Lack of awareness | ✓ | ✓ | ✓ |
Economic burden | ✓ | ✓ | ✓ |
Familial | |||
Delay in family decision for seeking care | ✓ | ||
Myths and misconception regarding mental health problems | ✓ | ✓ | |
Social stigma and discrimination | ✓ | ✓ | ✓ |
Lack of social support | ✓ | ||
Poverty | ✓ | ||
Unwillingness of patients to take prescribed medicine (e.g. due to fear of side effects, severity of illness, and lack of support at home) | ✓ | ||
Low regard of the mentally ill: negligence of caregivers/family members/community members (considered useless) | ✓ | ||
Recurrence of the illness | ✓ | ||
Systemic | ✓ | ||
Inaccessible mental health services due to geographical constraints | ✓ | ✓ | ✓ |
Negative attitudes of health workers | ✓ | ✓ | ✓ |
Lack of patient follow-up | ✓ | ||
Lack of mental health medicines, | ✓ | ✓ | ✓ |
Change of service providers | ✓ | ||
Inadequate mental health specialists | ✓ | ✓ | ✓ |
Overcrowding at the health facilities | ✓ | ||
Long distances to the health centers | ✓ | ✓ | |
Fear of PLWSMDE by other patients and caregivers at the health centre | ✓ | ||
Community | ✓ | ||
Traditional beliefs about mental illness (witchcraft, curses, incurable), leading to preference for traditional remedies | ✓ | ✓ | |
Lack of awareness | ✓ | ✓ | ✓ |
Economic burden | ✓ | ✓ | ✓ |
Lower cost of services and more flexible terms offered by traditional healers | ✓ | ||
Unwillingness of some patients to go the health centers, sometimes due to lack of insight | ✓ | ||