# Exploring barriers and facilitators of mental health care in Sudurpaschim Province, Nepal: a socioecological qualitative study of patients with depression and anxiety and health care professionals

## TL;DR

This study explores what helps or hinders mental health care access in Nepal, focusing on patients and professionals in Sudurpaschim Province.

## Contribution

The study uses a socioecological model to identify multi-level barriers and facilitators to mental health care access in a specific region of Nepal.

## Key findings

- At the individual level, education and media exposure help, while unawareness and medication side effects hinder mental health care access.
- Community stigma and misconceptions are major barriers, while community involvement and awareness help improve access.
- At the policy level, political indifference and low budget allocation hinder progress, despite existing policies.

## Abstract

The mental health burden and associated costs are considerable, which is posing challenges for public health delivery systems because of the increased treatment gap, especially in low- and middle-income countries. It is therefore important to investigate the factors influencing access to mental health care from the perspectives of different stakeholders to gain meaningful insights. This study was conducted to assess the existing barriers and facilitators using a socioecological model.

A qualitative study involving in-depth interviews (IDIs) and focus group discussions (FGDs) at health care facilities was conducted with 24 service users (diagnosed with depression and anxiety) and 21 health care professionals. Thematic analysis was performed and presented using a socioecological model to enhance clarity and impart recommendations.

The results suggest that there are four levels of persisting impediments and facilitators while accessing mental health care in Sudurpaschim Province: (1) Individual level- education, exposure to mass media and women’s empowerment (facilitators) but unawareness and side effects of medication (barriers); (2) Community level: community involvement and awareness (facilitators) while stigma, discrimination, misconceptions, and adverse environments (barriers); (3) Organizational level: psychosocial counselling and effective communication (facilitators) while limited accessibility and availability of MHS (barriers); and (4) Policy level: existing policy and strategies (facilitators) while political indifference, implementation gap and low budget allocation (barriers).

This qualitative study presents a complex, interconnected set of multi-layered barriers and facilitators influencing access to mental health care in Sudurpaschim, Nepal. From the socioecological view, the findings suggest that a comprehensive approach that integrates efforts across all levels are equally essential to effectively address these barriers and facilitators.

The online version contains supplementary material available at 10.1186/s12913-025-12983-4.