Peer-reviewed article
Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives.
Zainab Mubeen, Zafar Fatmi, Waqas Hameed, Muhammad Asim ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study examined what prevents and enables adolescents aged 10 to 19 in Karachi from accessing mental health services. Researchers interviewed 21 mental health providers and 19 parents to understand their perspectives. The study found that adolescents typically only seek help when illness becomes severe, rather than through preventive care. Both parents and providers identified barriers including poverty, migration, and lack of specialised adolescent mental health services, while severity of symptoms was the main factor driving access to care.
Key points
- Compulsion (severity of illness) is the major driving force for mental healthcare access rather than personal choices or preventive health beliefs
- Parents identified barriers including frequent migration, loss of daily wages, and low societal status of women affecting family healthcare decisions
- Mental health providers highlighted gaps including limited societal tolerance for mental health issues, burden on the health system, and absence of Child and Adolescent Mental Health services
- Both users and providers agreed across all categories of Andersen's health service utilization model on key barriers and facilitators
- Study recommends task-shifting and capacity building of the health workforce to address service delivery gaps and prevent treatment delays
Limitations
The study was conducted only in Karachi's public and private hospital psychiatry departments, so findings may not represent rural areas or other regions of Pakistan. The perspectives of adolescents themselves were not directly included, only parents and providers.
Abstract
INTRODUCTION: Adolescents' Mental Healthcare (MHC) is influenced by numerous factors, and adolescents occasionally seek professional help for mental health (MH) issues. These factors become more complex within low-middle-income countries (LMICs); therefore, this study aims to understand barriers and facilitators to access mental health services among adolescents aged 10 to 19 years old from the perspective of users (parents) and providers (Mental Healthcare Providers - MHPs). METHOD: Using a qualitative exploratory design, a semi-structured interview guide was developed using Andersen's health service utilization model. In-depth interviews were conducted with MHPs (n = 21) and parents of adolescents (n = 19) in the psychiatry department of public and private hospitals in Karachi, from October-December 2021. Data was thematically analyzed using an inductive approach. RESULT: The findings revealed a consensus of users and providers in all three categories of the Andersen model and referred the compulsion as the major driving force to MHC access and utilization rather than personal choices. Within pre-disposing, need, and enabling factors; the 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. Whereas, MHPs indicated societal tolerance, the burden on the health system, and the absence of Child and Adolescent Mental Health (CAMH) services as major gaps in service delivery. CONCLUSION: Service utilization is mainly facilitated by the severity of illness rather than healthy choices and beliefs, and accessibility and affordability. It is therefore imperative to prioritize adolescent MH through promotion and prevention approaches and address service delivery gaps to prevent treatment delays via task-shifting and capacity building of the health workforce.