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Table 2 Summary of barriers and strategies

From: Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study

Barriers

Recommended strategies

Specific interventions

Theme I: Availability

Absence of mental health services

Making the service locally available

Integration to primary care

Absence of psychotropic medications

Ensure availability of medications

Include psychotropic medications in the drug list

Theme II: Affordability and accessibility

Inability to cover treatment related costs

Providing cheaper treatment

Financial support to ā€˜poorest of the poorā€™

Subsidising mental health treatment

Longer distance travelled to access services

Establishing the service within reach

Facilitate emergency transportation

Plan outreach mental health service

Indirect expenses of seeking care

Ā 

Interventions to improve household income

Theme III: Acceptability and adequacy

Causal attribution: attribution to some evil spirits

Raise awareness

Involving HEWs in raising awareness and initiating discussions

Engaging religious leaders in awareness raising

Lack of trust in modern medication

Raise awareness

Involving service users who recovered

Telling success stories of those treated

Lack of awareness (the belief that mental illnesses are not curable)

Raise awareness

Engage traditional healers in educating the community

Amplify success stories from treatment

Engage service users who recovered in assisting HEWs in their awareness raising endeavours

High regard given to traditional healing

Raise awareness

Train traditional healers on detection of core symptoms of mental disorders

Create referral linkage framework

Work with church leaders

Mainstream mental health contents in community conversations

Concerns about quality of the service

Supervision

Supportive supervision by psychiatric nurses

Telephone consultations