Navigating resilience and barriers in mental health care: retrospective accounts of ethnic minority older adults during the COVID-19 pandemic in remote Northern Thailand

Abstract Background Ethnic minority older adults living in remote mountainous areas may face substantial barriers to accessing mental health care, particularly during the COVID-19 pandemic. However, limited evidence exists regarding their experiences of mental health care and the factors influencing service utilization in these underserved communities. This study explored the retrospectively recalled experiences of ethnic minority older adults and their caregivers in navigating mental health care during the COVID-19 pandemic and the continuing consequences of these experiences in remote Northern Thailand. Methods A qualitative study design was used. Face-to-face, in-depth interviews were conducted with 22 participants, including 11 ethnic minority older adults with mental health problems and 11 family caregivers. Although interviews were conducted between January and March 2024, participants were asked to retrospectively describe their experiences with mental health care during the COVID-19 pandemic and any continuing consequences in the post-pandemic period. Data were analyzed using inductive thematic analysis. Results Two overarching themes and eleven sub-themes were identified. The first theme, Challenges in providing mental health care for ethnic minority older adults with mental health problems , described barriers related to limited mental health literacy, restricted access to mental health services and technology, geographic isolation, perceived disparities in service provision, inadequate caregiver preparedness, and the psychological consequences of the COVID-19 pandemic. The second theme, Perceptions and expectations of mental health care , reflected the importance of culturally responsive care, cultural and spiritual practices, family support, alternative approaches to care, and strategies for improving mental health service delivery. Participants also described resilience through family relationships, community engagement, and cultural resources that supported coping during the pandemic. Conclusions Ethnic minority older adults in remote communities retrospectively described multiple barriers to accessing and utilizing mental health services during the COVID-19 pandemic. At the same time, family support, community participation, and cultural and spiritual practices were perceived as important resources for coping with mental health challenges. These findings suggest the importance of culturally responsive and accessible mental health services that are aligned with the needs and contexts of ethnic minority communities.