Barriers and facilitators to mental health care: A systematic review in Pakistan

Abstract

It is well documented that there is a shortage of mental health care providers, mental health literacy, and underutilization of mental health services in Pakistan. This systematic review aimed to assess the available evidence on factors hindering and/or facilitating access to care among people with mental health issues, health care providers, carers, or any other population group (e.g., students, teachers) in Pakistan. Thirteen published studies of barriers and facilitators in Pakistan were identified through nine electronic databases: Ovid MEDLINE, Ovid Embase, Ovid Emcare, CINAHL plus, Proquest Central, PsycInfo, Scopus, Pubmed, and ScienceDirect. Thematic analysis revealed that factors facilitating access to mental health services were trust in the effectiveness of mental health services and acknowledging the seriousness of the problem. However, factors hindering the access were financial issues/constraints, personal issues/other priorities, stigma, low mental health knowledge, side-effects/dissatisfaction from previous treatments, time and distance constraints, reliance on traditional/religious healers, and lack of social (i.e., family and peers) support/encouragement. Findings suggest the need for reducing barriers to and enhancing facilitators of seeking mental health services. To improve help-seeking, the focus of strategies should be on enhancing mental health literacy, lowering stigma, and increasing trust in mental health services' effectiveness.

Implications of rehabilitation

• What is known about this topic? There is a scarcity of empirical evidence on mental health and its correlates in Pakistan-a developing country and mental health services are restricted to psychiatry departments of teaching hospitals or in privately run clinics.

• There is a scarcity of psychiatrists in rural areas having 60% population and there is a need for recognizing facilitators and reducing barriers to reasonable mental health care is crucial.

• What the paper adds: Factors facilitating access to mental health services were trust in the effectiveness of mental health services and acknowledging the seriousness of the problem.

• Factors hindering the access were financial issues/constraints, personal issues/other priorities, stigma, low mental health knowledge, side-effects/dissatisfaction from previous treatments, time and distance constraints, reliance on traditional/religious healers, and lack of social (i.e., family and peers) support/encouragement.

• This recognition can help to design adequate programs and policies for people with mental health issues.

• There is a need to raise public awareness of the importance of seeking mental health services as well as for designing, testing, and executing strategies to reduce self and social stigma related to mental health problems.

Keywords:

• Barriers
• facilitators
• mental health services
• systematic review
• psychotherapy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors (i.e., FRC, NK, and KM) have contributed equally to this work. KM and FRC conceived the idea of this paper, supervised the entire process, and added important intellectual content. KM and NK contributed substantially to the manuscript write-up. FRC formulated search strategy, carried out a search across databases, performed data extraction and formulated themes. KM checked the search strategy, extracted data and themes. FRC and NK reviewed and provided feedback for improvements. All authors have also agreed to be accountable for all aspects of this manuscript in ensuring that questions related to the accuracy or integrity of any part of this manuscript are appropriately investigated and resolved.