Gilbert M. MunyokiMeshack Onyambu OndoraChelelgo, Victor Kibichii2024-02-012024-02-012023-08https://ir-library.ku.ac.ke/handle/123456789/27413A Research Thesis Submitted In Partial Fulfillment of the Requirements for the Award of Degree of Master of Public Health (Epidemiology and Disease Control) in the School of Health Sciences of Kenyatta University, August 2023.World Health Organization (WHO) defines mental health as a state of well-being where people realize and recognize their capacities, cope with life stressors, and contribute positively to society. Cases of mental illness in Kenya have been on the rise with an estimated prevalence of 10.7%. There is a gap between the need or demand for mental health services (MHS) and their utilization despite the government’s effort to devolve mental health care services to level 4 hospitals. There are about 284 level 4 hospitals in the country and only 29 of them offer mental health services. Psychiatric services are available in 26 out of 47 counties in Kenya. This leaves people in the remaining 21 counties to seek mental health services from other counties or MNTRH located in Nairobi. Therefore, there is need to address the barriers that limit the provision and use of mental health services if there is hope to lower the burden resulting from mental illnesses in Kenya. The main objective of the study was to investigate barriers to the utilization of mental health services at the MNTRH outpatient clinic. The study was a cross-sectional descriptive study that employed mixed (qualitative and quantitative) methods. Questionnaires were used to collect data coupled with structured interviews of key informants. 216 caregivers completed the questionnaires, and 5 key informants (healthcare workers) were interviewed. The study findings revealed that the cost of seeking mental health services is a critical barrier to accessing these services at the MNTRH outpatient clinic. More than half of the participants missed their clinics due to the cost of medication, 56% (n=120), consultation costs 55% (n=118), and transport= 54% (n=116). Pearson’s Chi-square showed statistically significant associations between the cost of transport, consultation, and medication and missing appointments among mentally ill patients at MNTRH (p < 0.01). Similarly, stigma from the community was associated with patients’ intentions to cease their attendance at clinics at MNTRH (p < 0.01). Caregivers sought other types of mental health services such as spiritual healing before taking their mentally ill relative for formal care. People with mental illness experienced social stigma 59.3% (n=128). It was concluded that the cost of mental health services was a barrier to access and utilization of mental health services. The study also concluded that stigmatizing mentally ill patients, families, and healthcare workers discourages them from seeking or offering mental health services. The study also found that there are healthcare workers’ and facility-related barriers to utilization of mental health services. The study recommended the Ministry of Health and MNTRH develop a strategic or sponsored payment plan besides NHIF for people with mental health tailored to patients' or caregivers’ level of income to reduce barriers to mental health services due to cost, particularly of medication. Future studies should use comprehensive theoretical models such as Social Ecological Model to conceptualize multiple factors that may influence the utilization of mental health services not only at MNTRH but also in Kenya.enMental Health ServicesCaregivers of Mental Health OutpatientsMathari National Teaching and Referral HospitalNairobi CityKenyaThesis