Facilitators and barriers in access to mental health services for women with depression in Karachi, Pakistan
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BACKGROUND: Women in Pakistan experience a high prevalence of depression; yet make negligible use of mental health services. Information about the barriers and facilitators to mental health services for women is scarce. The present study explored the barriers and facilitators in accessing mental health services and potential strategies to increase the access for women in Karachi. METHODS: A qualitative study was conducted with the help of 78 interviews. Women from primary care were screened for depression and thirty in-depth interviews were conducted with those who were not accessing mental health services. Twenty-nine interviews were conducted with women accessing mental health services for depression at mental health clinics. Nineteen key informant interviews were conducted with various stakeholders. Interviews were transcribed verbatim and coded for thematic analysis. RESULTS: Themes elicited were categorized into family and household, health services, and socio-cultural levels. At family and household level, lack of awareness, normalization of depression, lack of empowerment, burden of looking after children and threats of divorce discouraged women from seeking professional care. Stigma, discouragement to seek mental health care and religious interpretations of depression were reported as broader socio-cultural issues, driving many to visit faith healers instead. Gaps in medical education, general practitioners’ case overload, and poor quality of health care, gender bias, poor resource allocation and dearth of referral systems were highlighted as barriers at health services level. For facilitators themes of awareness, concern for children, the severity of the symptoms, family support, receiving a referral, affordability and organizational support were identified as factors that enabled women to access services. Both women and key-informants suggested that providing community-based interventions could be a viable option to increase the access. CONCLUSION: Study findings suggest that providing mental health services in communities, and reforming medical education through the training of health workers can improve access to mental health services for women. An intervention is proposed to provide mental health services through community based lady health workers in Karachi. This may provide more accessible, and potentially cost effective, mental health services to better address the mental health needs of the population.
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