Table 2.

Dimensions of access and patient-reported barriers to mental healthcare

Dimensions	Definition	Subthemes	Patient-reported barriers	Patient-reported facilitators
Accessibility	Services are offered within a reasonable proximity to patient in terms of time and distance.	Differences in distance to providers Transportation	Distance to mental health specialists/resources Lack of mobility Severe chronic illness	Local mental health services Social support
Availability	Services physically exist, are inadequate supply and can meet the volume and needs of the patients served.	Identifying brick-and-mortar facilities and workforce	Difficulty establishing long-term relationships with providers Lack of facilities offering mental health services	Dedicated mental health facilities PCP manages mental healthcare
Affordability	Cost to consumer and the financial viability of service provider. Includes payment from multiple funding streams.	Insurance policy for mental health services and treatments Out-of-pocket cost	Lack of mental health parity Pharmaceuticals not covered High co-pays	Complete and ongoing coverage for services
Accommodation	Clinic operations are organised such that patients can utilise services easily; services are easy and convenient to obtain and use.	Communication with the patient Processes for initiating and changing treatment	Communication channel incompatible with patient Waiting lists/waiting times Crisis care unavailable Difficulty receiving referrals	Routine screening and monitoring procedures PCP makes referral to a specific mental health provider
Acceptability	Patient attitudes about the personal and practice characteristics of a provider or qualities of a healthcare service.	Quality of the patient-provider relationship Quality of the healthcare service	Provider ‘doesn’t listen’  Disruption of long-term clinical relationships  Unpleasant medication side-effects	Non-judgmental listening Joint decision-making Minimal medication side-effects
Awareness	Patients can identify that some form of services exist, can be reached, and have an impact on the health of the individual.	Mental health literacy Understanding of the mental health system	Inability to locate resources Poor health literacy Poor knowledge of mental health system	PCP educates patient on diagnoses, treatments and options

PCP, primary care physician.