Barriers and Facilitators to Accessing Mental Health Services for Adults in Sub-Saharan Africa: A Systematic Review

Abstract

In Sub-Saharan Africa (SSA), despite a high prevalence of mental health conditions, less than 10% of those living with mental illness access professional mental health services (MHS). This systematic review aimed to identify, appraise, and synthesise studies conducted in SSA seeking to understand the barriers and facilitators to accessing MHS for adults in SSA. A systematic search of PsycINFO, MEDLINE, and CINAHL databases was conducted using key terms (Barriers, Facilitators, Access, Mental Health Services, and Sub-Saharan Africa) with 16 studies meeting the eligibility criteria for inclusion. The quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP) and Joanna Briggs Institute (JBI) Critical Appraisal tools based on the articles’ study methodology. Data from the included studies were extracted using a standardised proforma and grouped into source details, methodology, participants’ characteristics and the main finding(s). A narrative synthesis was adopted to systematically summarise and evaluate included studies. Only nine of 46 Sub-Saharan African countries were represented in the included studies. Barriers included lack of or little knowledge of mental disorders and professional services; negative attitudes held towards mental health services; cultural and religious beliefs leading to over-reliance on traditional and spiritual interventions; and stigmatising beliefs that included self-stigmatisation, stigma and discrimination from family, the community, and healthcare providers. Facilitators to accessing mental health services were more limited and included awareness of mental disorders and the services offered; social support and acceptance by family members and the community; and the availability of community-based mental health services. This systematic review identified barriers such as limited knowledge, stigma, and reliance on traditional interventions inhibiting access to mental health services in Sub-Saharan Africa. The region's limited representation and scarcity of facilitators highlights an urgent need for targeted interventions to improve mental health accessibility.