Barriers and Facilitators for Accessing Mental Health Care and Support for Adolescents in India - A Systematic Review.

Background: Mental health issues among adolescents are a significant public health concern globally. Overall, the unmet need for mental health care is high across the globe in different socio-demographic and ethnic populations. There have been efforts to understand the barriers to reducing the treatment gap globally and in India. It is evident that in different populations and countries, there are variations in barriers to accessing mental health care. A systematic understanding of barriers and facilitators to accessing care would be the first step toward bridging the gap in mental healthcare needs. This systematic review seeks to identify the factors that either enable or hinder adolescents in accessing care for their mental health concerns in India. Methodology: The electronic search was conducted in March 2023 on two databases: PubMed and Google Scholar. A detailed search strategy with relevant search terms was developed. The search yielded 1402 articles, which were further screened using inclusion and exclusion criteria. A total of 242 such articles were thus screened for abstract, of which 26 articles were screened for full paper, and finally, five articles were included in the review. Results: Barriers and facilitators to access to care are represented using the ecological model of behavior change. Facilitators at each level of this model help a person move closer to accessing health care, while barriers at each level take a person away from accessing health care. At the individual and interpersonal level, factors such as knowledge, awareness, and willingness to seek care, and treatment are predominant factors. At the institutional level, i.e., at the school level, awareness among teachers is an important facilitator, whereas stigma is a crucial community-level barrier to accessing health care. Most facilitators and barriers identified during this systematic review are related to policy-level issues such as quality of health care and Human Resource (availability, training, etc.), healthcare setup, Health Care Funding, etc. Conclusion: Evidence for access to mental healthcare-related barriers and facilitators for adolescents in India is very scanty. More research is needed to understand these aspects from varying socio-cultural and demographic backgrounds.