Table 2.

Summary of barriers experienced by people with SMD

	Engaged	Disengaged	Non-Engaged
Poverty	Difficulty to maintain ongoing access to treatment (not being able to cover cost of treatment)	Difficulty to maintain ongoing access to treatment	Inability to initiate treatment due to lack of money for direct and indirect costs of treatment
	Difficulty to obtain poverty certificate	Difficulty to obtain poverty certificate	Lack of social support (inability to reciprocate)
		The pressure to maintain dignity
		Concealing poverty
Medication-related barriers	Unreliable medication supplies	The belief that holy water and modern medication should be mutually exclusive
	Medication side-effects	Intolerable medication side-effects
		Lack of some medications
		Ineffective medications
Long-term care	Medication-side-effects from prolonged use	Stigma of long-term engagement with care	Presence of other co-morbid illnesses
	Declining social support over years	Looking for cure	Having physical disability
	Presence of other co-morbid illnesses	Low personal autonomy	Having severe functional impairment
		Presence of other co-morbid illnesses
The nature of SMD	The challenge from co-morbid alcohol use	The challenge from co-morbid alcohol use	The challenge from co-morbid alcohol use
	Wish to discontinue treatment to use alcohol (although engaged)	Lack of help for families when service users are uncooperative	Severity of the illness
	Spontaneous improvement	Premature discontinuation of medication to use alcohol	Not wanting treatment
			Violence towards others