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 | ✓ | ||