Abstract
BACKGROUND: Refugees face a high burden of mental health problems, with global estimates suggesting that up to one in three may suffer from depression, anxiety, or post-traumatic stress disorder. These issues are often linked to exposure to conflict, forced displacement, and vulnerable living conditions. Despite the availability of mental health and psychosocial support (MHPSS) services in Nakivale Refugee Settlement in Uganda, utilization remains low. This study explored the barriers and facilitators influencing access to mental health services among refugees in this setting. METHODS: We conducted an exploratory qualitative study. Data collection included four focus group discussions (FGDs) with refugees who had previously used mental health services and ten key informant interviews (KIIs) with mental health service providers and community leaders representing refugee communities. Each FGD included 8-12 participants and was stratified by nationality, focusing on the four largest refugee groups in Nakivale: Congolese, Burundian, Rwandan, and Somali. Participants were purposively selected. Thematic analysis was conducted using a combined inductive and deductive approach, guided by the Health Belief Model and socio-ecological framework. RESULTS: Barriers to mental health service utilization included individual-level factors such as stigma, cultural beliefs, low perceived need, economic hardship, and low health literacy. System-level barriers comprised inadequate human resources, poor infrastructure, medication-related constraints, transport and referral challenges, and limited community awareness. Facilitators included culturally adapted therapy models, strong refugee identity and entitlements, community-based service delivery, trusted community leadership, structured psychoeducation, effective interagency coordination, ongoing staff development, and the strategic use of trained lay mental health agents. CONCLUSION: Improving mental health service utilization in refugee settlements requires addressing stigma and poverty, increasing medication availability, and decentralizing services. Interventions should integrate psychoeducation, community mobilization, and coordinated policy and workforce support. These findings provide a contextual roadmap for strengthening MHPSS delivery in low-resource humanitarian settings.