Pathways to mental healthcare access: lived experiences of help-seeking among mental health service users in a rural South African hospital

Abstract Background Access to mental health services remains a significant public health challenge in rural South Africa despite ongoing policy efforts to strengthen mental healthcare delivery. Understanding the pathways individuals follow before accessing professional mental health services is important for improving early intervention, reducing treatment delays, and strengthening service utilisation. This study aimed to explore the help-seeking pathways followed by mental health service users before accessing professional psychological services at a rural public hospital in Limpopo Province, South Africa. Methods This study used a qualitative approach with a hermeneutic phenomenological design to explore participants’ lived experiences of help seeking for mental health concerns. Thirteen mental health service users receiving psychological services at a rural public hospital in Limpopo Province were purposively selected. Data were collected through semi-structured individual interviews and analyzed using Interpretative Phenomenological Analysis (IPA), as described by Smith et al., [15]. Results The findings revealed that help-seeking pathways often began with informal support from family members and friends, followed by engagement with religious, traditional, and professional sources of care. Delays in accessing professional mental healthcare were influenced by limited mental health literacy, stigma, misinterpretation of symptoms, and culturally embedded explanations of psychological distress. Although professional services were generally accessed when distress persisted or became difficult to manage, participants’ pathways were not uniformly linear. Some continued to use religious or traditional practices alongside professional mental healthcare, demonstrating the overlapping and dynamic nature of help-seeking. Conclusions The findings highlight the need to strengthen mental health literacy, improve community awareness of available services, and enhance collaboration between formal mental health services and community support systems. Strengthening referral pathways and culturally responsive mental healthcare approaches may improve access to psychological services and facilitate earlier engagement with mental healthcare in rural South African settings.