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Globally, there exists a persistent and significant gap between individuals who require mental health care and those who actually receive it. This treatment gap is particularly stark in low- and middle-income countries (LMICs), where it is estimated that over 75% of individuals who could benefit from mental health services do not access them. Within these settings, underserved and underprivileged communities face a disproportionate burden, not only of mental ill health but also of unmet need for care.
Multiple barriers impede access to mental health care in these populations:
Addressing these disparities is a global priority. Policies at both international and national levels now increasingly advocate for the scale-up of evidence-based treatments (EBTs) in underserved communities. However, despite efforts to expand availability, studies indicate that services provided to these communities are often of suboptimal quality and may not adhere to evidence-based standards⁶,⁷. Compounding this, traditional beliefs and spiritual interpretations of mental distress continue to influence care-seeking behaviour, with many individuals turning first to religious or traditional healers rather than formal health providers.
Bridging the gap in access and quality of care is not merely a clinical imperative but a moral and developmental one. Integrated, community-centred approaches are vital to ensure that mental health care is accessible, appropriate, and effective for all segments of society.
The Situation Analysis for Nigeria
Mental health is an integral component of overall health and well-being, yet it remains a neglected public health priority in Nigeria. A combination of systemic challenges including limited service availability, insufficient legislation, inadequate financing, poor research investment, workforce shortages, and lack of integration with primary health care continues to hinder progress in meeting the country’s mental health needs.
Current estimates suggest that more than 60 million Nigerians live with one form of mental illness or another. Despite this high prevalence, over 85% of individuals in need do not receive formal mental health care. The ratio of psychiatrists to the population is alarmingly low, with fewer than 200 psychiatrists serving a population exceeding 240 million a ratio of roughly 1 to 1.2 million compared to the World Health Organization’s recommendation of 1 to 10,000.
Other structural impediments include:
These gaps underscore a profound inequity in mental health service delivery, disproportionately affecting the poor and underprivileged. Without deliberate and strategic interventions, these disparities will persist, worsening outcomes and impeding national development. Hence, integrated, equity-focused mental health strategies are critical to ensuring that all Nigerians regardless of geography or socio-economic status can access the care they need.
Impact of Inadequate Mental Health Care Access on the Underprivileged
The lack of adequate mental health care services can have severe and wide-ranging consequences, particularly for underprivileged and marginalised populations. These impacts manifest at both individual and societal levels, including:
In underserved communities, these consequences are amplified by a lack of support systems, pervasive stigma, and low levels of mental health literacy. Consequently, the neglect of mental health in these populations does not only result in avoidable human suffering but also hampers social and economic development.
Promoting Mental Health Wellness in Underserved Populations
Promoting mental health wellness in underserved communities requires a multifaceted approach that includes advocacy, education and awareness campaigns, as well as the establishment of robust support systems.
a. Advocacy
While health and patient advocacy are focused on helping patients on an individual basis, public health advocacy, on the other hand, is aimed at helping entire patient populations within local neighbourhoods, certain demographic groups, or entire regions. Public health advocates may also focus on specific groups affected by issues such as substance use disorders, mental disorders, or chronic diseases such as heart disease and diabetes. High-level advocacy is usually directed towards achieving policy changes that can improve the overall health of society.
b. Education and Awareness Campaigns
Education and awareness campaigns play a vital role in enhancing understanding of mental health issues and reducing stigma. Health education activities aim to inform individuals and communities about mental health conditions, their causes and prevention, available resources, and the importance of seeking help. Awareness campaigns, on the other hand, often utilise various platforms such as social media, community events, and workshops to reach diverse audiences with key information or messages. These campaigns are effective in encouraging individuals to prioritise their mental health and seek assistance when needed, while also fostering an understanding of mental health conditions and making it easier for individuals to discuss their experiences openly.
c. Entrenching Support Systems for Underserved Communities
Support systems are essential for providing and maintaining assistance to individuals in underserved communities on an ongoing basis. These systems can include peer support groups facilitated group sessions led by individuals who have experienced similar struggles; mental health hotlines that provide confidential support and access to professional services; the establishment of community centres that utilise local resources to offer counselling and therapy services, thereby fostering connection within the community; and outreach programmes that provide education and care services to community members in their homes.
These networks are designed to create a supportive environment conducive to mental wellness by empowering individuals with a safe space to share their experiences. They also provide favourable pathways for recovery and wellness. Investing in education and support initiatives is therefore vital for enhancing mental health care in underserved communities, ultimately contributing to healthier and more resilient populations.
Addressing Inequity in Mental Health Care
a. Policy Adaptation
Addressing inequalities in mental health care requires significant shifts in policy and robust advocacy efforts. Health policymakers are increasingly recognising the need to expand access to mental health services for underserved populations. Integrating mental health care into primary care settings is a practical strategy for reducing fragmentation and ensuring holistic service delivery, thereby increasing coverage. The PHC under one roof model ensures that providers are trained to deliver culturally sensitive care devoid of stigma and discrimination. Such efforts help build trust between care providers and communities, translating to better service utilisation and improved treatment outcomes.
b. Innovations for Improving Mental Health Care for the Underserved and Underprivileged
The widespread disparities in access to mental health care highlight the urgent need for equitable solutions tailored to the specific challenges experienced by underserved communities. Improving mental health outcomes and promoting community well-being necessitate the implementation of innovative, context-specific approaches. Two such strategies currently gaining traction as part of an integrated mental health service delivery model for underserved populations in LMICs are:
c. Community-Based Mental Health Programmes
Community-based programmes are essential in improving access to mental health services for underserved populations. These initiatives work by engaging local communities and tailoring interventions to suit their specific cultural and socio-economic needs. Components of such programmes often include educational outreach activities, peer-led support groups, and capacity-building workshops.
Evidence demonstrates that individuals who participate in these community-based interventions often report improved mental health outcomes and a stronger sense of community belonging. These programmes are not only effective in addressing the mental health needs of underserved populations but are also critical in promoting social cohesion and resilience.
Attributes of Community-Based Mental Health Programmes
Community-based mental health initiatives are most effective when they are designed with the cultural, socio-economic, and contextual realities of the target population in mind. Two key attributes that enhance their impact include cultural sensitivity and the contextual tailoring of treatment approaches.
a. Contextualised Cultural Sensitivity in Mental Health Care
Cultural sensitivity is foundational to delivering effective mental health care, particularly within underserved and marginalised communities. It entails the recognition, understanding, and respectful consideration of the diverse ethno-cultural backgrounds, belief systems, and lived experiences of individuals. When mental health professionals demonstrate cultural competence, they are more equipped to align care with the values and worldviews of their clients. This alignment facilitates improved therapeutic rapport, better engagement in the care process, and ultimately, more favourable treatment outcomes.
Empirical evidence supports that culturally attuned services foster trust and client satisfaction, as individuals are more likely to feel heard, validated, and respected. Consequently, they are also more inclined to adhere to treatment plans and maintain ongoing therapeutic relationships.
b. Tailoring Treatment Approaches for Different Communities
Tailored mental health interventions are essential for addressing the nuanced needs of diverse population groups. Effective treatment approaches go beyond generic models by adapting therapeutic techniques, communication strategies, and service delivery mechanisms to reflect the cultural and psychosocial context of the clients.
For example, certain communities may prefer family-inclusive models of care, spiritual counselling, or traditional healing methods alongside clinical interventions. Understanding and respecting these preferences allow mental health practitioners to design integrated care plans that resonate with local values and belief systems.
Such customised approaches enhance the relevance, acceptability, and sustainability of mental health services, particularly among populations that are historically underserved or culturally marginalised. In doing so, they significantly contribute to improving access, utilisation, and treatment efficacy for vulnerable groups.
Addressing Barriers to Accessing Mental Health Services
Despite growing awareness of mental health challenges globally, numerous structural, financial, and cultural barriers continue to hinder access to appropriate care for underserved populations. Prominent among these are economic constraints and the pervasive stigma and mistrust associated with mental illness.
a. Financial Barriers
Access to quality mental health care is often limited by financial hardship, especially in low- and middle-income countries (LMICs), where public health financing is minimal and health insurance coverage is limited or non-existent. Mental health services typically require long-term engagement, making them financially unsustainable for individuals with limited income.
In Nigeria, for instance, the majority of those in lower socio-economic brackets pay for health services out-of-pocket, creating a deterrent to seeking professional mental health support. The absence of universal health coverage or community-based health financing schemes exacerbates these inequities. In contrast, some sub-Saharan African countries have piloted community insurance models and sliding-scale payment options to provide low-cost or subsidised mental health services, demonstrating viable alternatives for improving access in resource-constrained settings.
b. Stigma and Mistrust
Cultural misconceptions, deeply rooted beliefs, and myths surrounding mental illness persist across many African societies, often attributing symptoms to spiritual or supernatural causes. These beliefs foster shame and social alienation, preventing individuals from acknowledging their mental health needs or seeking timely support.
Stigma also extends to those who do seek care, leading to discrimination, rejection, and ridicule. Additionally, historical neglect and negative experiences with public healthcare institutions have generated widespread mistrust, particularly among marginalised groups. These sentiments are often reinforced by stories of poor service delivery, breaches of confidentiality, or dismissive attitudes from healthcare personnel.
This mistrust creates a reluctance to engage with formal mental health systems, even when services are available and urgently needed³. Addressing these barriers requires a systemic approach, encompassing public education, community mobilisation, and reform of care systems to foster equity, cultural competence, and dignity in care provision.
Integrating Telehealth Services into the PHC System
Telehealth refers to the use of electronic information and telecommunication technologies to support long-distance clinical healthcare, professional education, administrative health functions, and public health activities. These technologies facilitate remote access to healthcare services and include devices such as computers, smartphones, and tablets, supported by internet platforms, video conferencing, store-and-forward imaging, streaming media, and both wired and wireless communications systems.
In high-income and upper-middle-income countries, telehealth has significantly transformed the landscape of mental health service delivery particularly for individuals in remote or underserved areas. This innovation enables clients to receive therapy, counselling, and psychosocial support without the constraints of physical location. Through virtual consultations, mental health professionals can now reach populations that were historically excluded from continuous care due to geographical, logistical, or infrastructural limitations.
The flexibility of telehealth allows patients to schedule sessions at convenient times, mitigating work or family conflicts and eliminating the costs or difficulties associated with travel. Importantly, patients may also feel more at ease discussing personal or sensitive issues in the comfort of their own homes. For mental health providers, telehealth extends their reach, creating new possibilities for engagement in rural and underserved communities.
The effectiveness of telehealth for mental health care has been particularly evident during the COVID-19 pandemic. Studies reveal a significant increase in telehealth utilization for mental health services during this period, reinforcing its practicality, acceptance, and potential for scaling up in different population settings.
Future Outlook for Mental Health Care Accessibility
The future of mental health care in low- and middle-income countries (LMICs) is gradually shifting towards more equitable models of service delivery. As innovations such as community-based mental health programs and telehealth services become increasingly integrated into primary healthcare (PHC) systems, the accessibility of mental health support in remote and underserved communities is expected to improve.
This integrative approach holds promise for bridging the treatment gap and reducing disparities in mental health care. By combining the strengths of local community resources with the technological reach of telehealth, a more inclusive and responsive mental health system can be cultivated one that is sensitive to cultural contexts, logistical challenges, and socio-economic realities.
With continued awareness, stakeholder engagement, and strategic policy evolution, the trajectory points toward an inclusive mental health future where care is not a privilege for the few but a fundamental right for all individuals, irrespective of geographic or social status.
Conclusion and Recommendations
Innovative approaches such as telehealth and community-based service delivery models present a unique opportunity to address long-standing gaps in mental health care access, particularly for underserved and underprivileged populations. These strategies not only enhance availability but also ensure that services are culturally relevant, contextually appropriate, and logistically feasible.
To maximize these gains, targeted health education must be prioritized to improve mental health literacy among disadvantaged communities. Equally critical is the introduction and scaling up of sustainable financing mechanisms, such as community health insurance schemes or subsidized mental health programs, to ensure affordability and continuity of care.
Ultimately, expanding access to equitable, high-quality mental health care will depend on a multi-pronged strategy combining technology, policy reform, public health advocacy, and community engagement to reshape the mental health landscape for vulnerable populations. Such a strategy is essential not just for alleviating mental health burdens, but for enhancing overall societal resilience and well-being.
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