Lebanese and Syrian refugee parents' experiences of accessing mental health care for their children in Lebanon: Findings from a qualitative study.

Globally, more than 250 million children and adolescents experience mental health (MH) disorders. The estimated 43 million children forcibly displaced at the end of 2022, most commonly displaced to neighbouring low-and-middle-income countries where health and social protection systems are under-resourced, are at especially high risk of developing MH problems. In such settings, host community and refugee parents must often navigate complex pathways to attain the care their children need. Lebanon has experienced multiple crises and now hosts over 1 million refugees from Syria. We explore Lebanese and Syrian refugee parents' experiences of seeking MH care for their children in Lebanon. This study is part of a larger study qualitatively assessing how Syrian refugee and host populations pay for and access MH services. As part of this study, we conducted a narrative enquiry comprising 10 interviews with purposively selected Lebanese and Syrian parents of children with mental health problems, living in the Greater Beirut and Mount Lebanon area. Data were analysed collaboratively and inductively. Parents reported that the decision to seek MH services for their children commonly followed an acute event, encouragement by family members, or advice from health and child protection organisations. Many described how, even though stigma associated with MH is decreasing in Lebanon, it persists among some communities and creates significant barriers to accessing care, with parents often concealing their care seeking activities. Parents followed a range of pathways to access care, often encountering financial and accessibility barriers. The economic and COVID-19 crises in Lebanon have exacerbated their problems, affecting Lebanese and Syrian families alike. However, Syrian parents needed more support for their children's basic and educational needs, vital aspects of maintaining their MH and wellbeing. All parents stressed how important it was for MH services to provide comprehensive family support, preserving parents' dignity, and building trust with both parents and children. They also recommended integrating life skills, recreational activities, and assistance with basic needs into MH services and preferred counselling and psychotherapy over medication. We conclude that Lebanese and Syrian parents in Lebanon face multiple challenges obtaining care for children with MH concerns, a situation exacerbated by the many crises facing Lebanon. Lebanon's health financing system needs urgent reform to improve MH services to host-community and refugee populations, while governmental and humanitarian stakeholders must seek to deliver cross-sectoral holistic services to children and their families, avoiding the siloed approach that focuses only on children's MH in isolation from family and social environments.