TABLE 2.

Barriers and Facilitators of Mental Health Care

	Barriers	Facilitators
Institutional/administrator	Insufficient funding for treatment of MH problems in primary care Lack of integration of MH and primary care services Language issues—lack of bilingual providers/translators Lack of culturally informed MH resources for immigrant and non English-speaking patients Patients will not always accept referral to MH provider Turnover in MH providers Dissatisfaction with psychiatric referral outcomes Restrict scope of MH problems they will manage (severity, length of treatment)	Having MH providers within the same clinic Low turnover of staff at the primary care clinic Recognition that MH problems are a reality of primary care Government policies that encourage the integration of MH and primary care Recognition that MH problems have direct impact on socioeconomic functioning “One-stop shopping” or “medical home” is favored Trust in the clinics established at the community level
Clinical/clinician	Perceived social stigma of MH problems and treatment Previous negative experiences with MH care Time constraints in primary care visits Provider reluctance to manage MH problems Complexity/acuity of comorbid medical problems can overshadows other problems	Good relationship with primary care provider On-site MH providers helps them refer patients Acceptance that primary care practice includes addressing MH problems Setting modest goals for helping with MH problems Provider comfort level with MH issues

Administrators (three of six participants) who also performed clinical duties were categorized with the administrator group.

MH indicates mental health.