Table 1.

Frequencies within challenge domains and related sub-themes

	Definition	Frequency
Screening intake
1. Mistrust of informal health providers	Patients tend to have negative biases towards healers	40
1.1 Belief system	Patients’ belief systems are in opposition to those of healers	14
1.2 Secondary gain	Patients assume that healers make some form of material gain	7
1.3 Mental health credentials	Patients believe healers lack the necessary credentials	11
1.4 Suggestions	Informal Health Providers (IHPs) made suggestions as to how to break these biases	10
2. Cultural misunderstanding and stigma of mental health	General misunderstandings and often negative associations about mental health	37
2.1 Lack of knowledge	No knowledge about mental health	12
2.2 Stigma around mental disorders	Negative beliefs about mental illness	7
2.3 Social support	Partly because of stigma, families and friends do not support the mentally ill	16
2.4 Fear of treatment	Fears about the hospital testing and procedures for mental disorders	5
2.5 Suggestions	IHPs provided opportunities that can be used to reduce these negative perceptions	12
Between screening and treatment
3. Resource barriers	Lack necessary resources (financial, time, etc.) to travel to hospital for treatment	61
3.1 Patient resources	Patients lack funds to pay for public transport to the hospital, or for food (requiring work at time of appointment)	38
3.2 IHP resource barriers	IHPs lack resources for themselves and for supporting their patients	33
3.3 Suggestions	IHPs suggest ways of dealing with the above barriers	10
4. Resistance to treatment	Patients resist treatment in multiple ways (e.g. illness denial, refusal to go to hospital, substance addiction)	25
4.1 Suggestions	IHPs identify ways of strengthening the willingness of patient referral for those suffering from mental illnesses	11
5. Limitations of the referral system	Lack of recognition on the limit of IHPs’ role in the task-sharing model, resulting in responsibilities outside their role as referrers	25
5.1 Suggestions	IHPs emphasized the need for specialized training such as counselling to know how to motivate patients who have lost hope, to seek further treatment without being accompanied by IHPs	5
During treatment
6. Treatment infrastructure issues	Many logistical challenges are faced upon arrival to the hospital	39
6.1 Procedural issues	Some untrained hospital staff often do not recognize referral forms	24
6.2 Drug availability	Drugs are often unavailable at the hospital and patients are forced to purchase elsewhere	9
6.3 Limited medical staff	There are often limited medical staff and long queues at the health facilities	6
6.4 Suggestions	IHPs suggested how to improve infrastructure issues	5