Barriers and Facilitators to Accessing Adolescents’ Mental Health Services in Karachi: Users and Providers Perspectives

Abstract

Abstract Background: Adolescent mental healthcare (MHC) is driven by numerous factors, and adolescents occasionally seek professional help for mental health issues due to several reasons. The reasons become more complex within low- and middle-income countries; therefore, this study aims to enhance the understanding of perceived barriers and facilitators to accessing mental health services among adolescents aged 10 to 19 years old from the perspective of users and providers. Method: Semi-structured interview guide was developed using Andersen’s health service utilization model. In-depth interviews were conducted with healthcare providers (n=21) and parents of adolescents (n=19) in psychiatry departments of public and private tertiary care hospitals in Karachi. Inductive thematic analysis technique was used to identify themes from the data and further themes were developed. Result: The findings revealed a consensus of mental health providers (MHPs) and users in all three categories of the Andersen model and consider the MHC access and utilization for adolescents because of compulsion rather than personal health choices. Within pre-disposing, need, and enabling factors; the study participants highlighted a unique perspective; users regarded frequent migration, daily wage loss, and women's societal status as barriers while the need for marriage and patient willingness were stated as facilitators. Likewise, MHPs indicated societal tolerance, the burden on the health system, and the absence of CAMH services as major gaps in service delivery. Conclusion: Service utilization is mostly facilitated by the severity of illness instead of individual personal choices, health beliefs, accessibility, and affordability. It is therefore imperative to prioritize adolescent MH through mental health promotion and prevention approaches. and address service delivery gaps to prevent treatment delays via task shifting and capacity building of the health workforce.