Indonesia has faced increasing mental health problems, and integrating psychological services into primary healthcare was intended to make care more accessible, with these services commencing in Sleman Regency. Although the services initially faced challenges, the number of people using them has increased significantly in recent years, prompting researchers to ask how people actually reach them. Previous research had documented barriers and facilitators to accessing psychological services in Indonesia, but the mechanisms and processes of help-seeking had never been thoroughly examined in the Indonesian context, and the integrated services had never been evaluated from the perspective of the people who use them.

The researchers addressed this gap through interviews with 15 adult service users, analysed with a six-step reflexive thematic analysis using an inductive approach, meaning themes were built from the participants' accounts rather than tested against a predefined framework. The analysis produced four themes, each with three subthemes classified as barriers or facilitators to help-seeking. The themes were: developing recognition of the need for psychological help; the yearning to improve amidst stigmatisation; dealing with difficult services; and making sense of the treatment journey.

Crucially, the researchers mapped these themes onto four stages of the help-seeking process: before seeking help, in the early phase, during treatment, and after treatment. This staging shows that difficulties are not confined to a single moment, such as the decision to seek care, but recur throughout the entire journey. Across these phases, participants encountered personal, sociocultural and systemic barriers.

Stigma emerged as a persistent sociocultural challenge, coexisting with a strong personal desire to improve. Systemic and service-level difficulties, described in the theme of dealing with difficult services, added further friction even after people had decided to seek care. Despite these obstacles, the study's conclusion is not simply one of hardship.

Service users demonstrated adaptive coping strategies to overcome challenges and access the services, and once engaged, they received psychological treatments they found helpful. The theme of making sense of the treatment journey suggests that participants actively worked to interpret and integrate their experiences of care. The findings underscore the complexity of help-seeking in the Indonesian context and offer a user-perspective evaluation of a service model that has not previously been assessed in this way.

Because the study is qualitative and based on 15 adult service users in one regency, the findings describe the experiences of this group rather than statistical estimates for the wider population, and the published version is an early-release, peer-reviewed accepted manuscript subject to further edits before the final version of record.

Subject of Research: Help-seeking pathways to integrated primary care psychological services for common mental disorders in Sleman, Indonesia

Article Title: A struggle throughout: the help-seeking journey to psychological services for common mental disorders in Sleman, Indonesia

Article References: Syafitri, D., Samuels, F., Rismarini, N. A., Lau, J. Y. F., & Brown, J. S. L. (2026). A struggle throughout: the help-seeking journey to psychological services for common mental disorders in Sleman, Indonesia. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15855-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15855-7

Keywords: mental health, Indonesia, primary healthcare, psychological services, help-seeking, qualitative research, thematic analysis, stigma, health services research, Sleman, struggle, throughout