Exploring the barriers and facilitators of mental health service utilization at primary health care facilities in Syangja district Nepal: Perspective of patients and health service providers

Background: Access to and use of mental health services remain limited in low- and middle-income countries. This insufficient utilization presents a significant challenge to the proper management and treatment of mental illness. Identifying the reason behind the low utilization of mental health services at primary health facilities is very important for strengthening mental health services and their utilization at the primary health care level. Thus, this study aims to explore the barriers and facilitators of mental health services utilization at PHC facilities in the Syangja District of Nepal. Methodology: A cross-sectional qualitative study was conducted in Syangja district, Nepal between February and March 2025. A total of 22 interviews were conducted including 7 in-depth interviews with patients and 15 key informant interviews with health service providers. These interviews were carried out across five primary health care facilities and four local government units via validated interview guidelines. The participants were selected via purposive sampling. The interviews were conducted in the Nepali language, transcribed and then translated into English. Thematic analysis was carried out via NVivo software following the framework of Braun and Clarke. Results: The present study identified various facilitators that enable mental health service utilization such as sympathetic behavior of health workers, positive treatment experiences, support from family and the community, the close proximity of PHC facilities and the availability of free psychotropic medication. However, significant barriers persist such as stigma, lack of mental health awareness, traditional practices, lack of trained manpower, limited private space, frequent stockout of medicines and insufficient budget allocation. The strategies proposed by participants included increasing awareness through mass media, training multiple staff in mental health, ensuring consistent medicine availability and appointing mental health focal persons. Conclusion: There are various interwoven factors like facilitators and barriers that influence mental health services utilization in PHC facilities. This study highlights the urgent need for increased awareness, reduced stigma, trained manpower and consistent medicine supplies to improve mental health service utilization at primary health care facilities.