Barriers and facilitators of mental health help-seeking behaviours among school- going adolescents in Sub-Saharan Africa : a qualitative evidence synthesis

Abstract

Background: The prevalence of mental health problems (MHPs) among school-going adolescents in sub-Saharan Africa (SSA) remains high. However, help-seeking behaviours are disproportionately low in this population. This qualitative evidence synthesis (QES) aimed to identify and integrate existing qualitative findings on the barriers and facilitators of formal and informal MH help-seeking behaviours in this population. The objective was to generate insights from relevant studies and settings to inform the development of effective interventions for culturally grounded public mental health initiatives in schools in SSA. Methods: We conducted a systematic search across five databases (PubMed, CINAHL, Scopus, PsycINFO, ERIC, and Google Scholar) for qualitative studies published until September 2025. Eligible studies were appraised using the Critical Appraisal Skills Program (CASP) checklist. Thematic synthesis was employed to analyse and interpret the findings. Results: Twelve studies met the inclusion criteria. Six key barriers were identified: (1) perceived stigma, (2) gender norms as a barrier to help-seeking, (3) poor mental health knowledge, misconceptions, and awareness gaps, (4) privacy, trust, and confidentiality concerns with MH professionals, (5) lack of accessibility and availability of MH services, and (6) family and parental attitudes, peer influence, and alternative support. Facilitators included (1) mental health education and literacy enhancement, (2) supportive school environment or climate, (3) improved professional services, (4) family, community involvement, and peer support, and (5) improved service accessibility and affordability. Conclusions: This synthesis highlights the significant structural and sociocultural determinants of help-seeking behaviour in school-going adolescents in SSA. The scarcity of qualitative studies in this area underscores a critical gap in the existing literature. Further context-sensitive qualitative research is urgently needed to gain insights into adolescents’ lived experiences with MHPs and to guide responsive school-based mental health interventions