Examining barriers to access mental health services among patients with mental health issues in SAARC nations: A systematic review and meta-synthesis of qualitative studies.

Abstract

Background: Inspite of high prevalence of mental illness in developing countries, access to health care for addressing mental health issues has several existing barriers at different levels leading to disproportionate adverse health outcomes, summarised as the three Ds of death, disability, and health-economic deficit. This study aims at examining the perspectives of patients with mental illness on barriers to access mental care.

Methods: In this study, we searched EMBASE, PubMed, Scopus and PsycNet databases. Database search examined qualitative articles on barriers to access mental health care published from January, 2013 to January, 2023. Papers appropriate for inclusion were selected in the South Asian Association for Regional Cooperation (SAARC) nations, employed qualitative methodologies, and focused on patients, caregiver, or healthcare practitioners' perspective on challenges to access care. The Mixed Methods Appraisal Tool (MMAT) - Version 2018 was used to assess quality.

Results: Out of 351 papers, only 24 met the inclusion requirements. A multilevel conceptual framework guided the reporting of emergent themes. Patient with mental disorder experienced four levels of barriers while receiving mental health services: 1. sociocultural (family support, community support networks, and cultural attitudes), 2. organizational (organizational characteristics, service access, and inadequacy of resources), 3. structural (poor implementation of existing policy) and 4. individual levels (knowledge, attitudes, and individual characteristics).

Conclusions: Complex, interlinked, multilevel barriers existed while accessing MHS for patient in SAARC nations. To improve access to MHS, multilevel solutions ought to tackle individual, organizational, societal, and structural barriers at various phases of the care pathway is imperative.