Abstract
Background Mental illness constitutes a significant and growing public health concern in India, with limited access to care and pervasive stigma contributing to low treatment rates. There is limited qualitative research examining community-level perspectives on mental health in rural Indian settings. The objective of the study was to study community perspectives on mental illness and mental health services in the district of Faridabad. Methods A qualitative study was conducted using five focus group discussions (FGDs) involving community members and Accredited Social Health Activists (ASHAs) across four primary health centers (PHCs) in Faridabad. Data were collected through semi-structured discussions, transcribed, and analyzed using grounded theory with open, axial, and theoretical coding. Rigor was ensured through triangulation, field notes, and iterative analysis until data saturation was achieved. Results Grounded theory analysis identified six themes contributing to community perceptions and help-seeking for mental illness: (1) mental illness perceived as abnormal behavior; (2) strong stigma and fear of social contagion; (3) attribution to psychosocial stressors such as tension and family conflict; (4) preference for traditional healers over medical professionals; (5) structural barriers to accessing formal mental health care; and (6) stigma-related avoidance of professional help. These categories formed a cyclical explanatory model in which cultural beliefs, structural limitations, and social stigma perpetuate reliance on informal care and delay engagement with formal mental health services. Conclusion Community perceptions in Faridabad reflect a complex interplay of cultural, social, and structural factors that delay engagement with formal mental health care. Interventions must address stigma, improve service accessibility, and incorporate culturally sensitive public education to improve mental health outcomes in similar Indian contexts.