BARRIERS AND FACILITATORS TO ACCESSING PSYCHOTHERAPY AMONG ADOLESCENTS IN PUBLIC HEALTH SYSTEMS: A SYSTEMATICALLY INFORMED NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6265Keywords:
Adolescent Mental Health; Psychotherapy Access; Barriers to Care; Facilitators of Care; Public Health Systems; Mental Health ServicesAbstract
Background: Access to psychotherapy among adolescents in public health systems remains a significant challenge despite the growing burden of youth mental health disorders. Individual, family, service, and system-level factors influence whether adolescents initiate and sustain engagement with treatment.
Objectives: To synthesize evidence on barriers and facilitators to accessing psychotherapy among adolescents within publicly funded or subsidized health systems and to identify multilevel determinants relevant to equitable service delivery.
Methods: A systematically informed narrative review was conducted following PRISMA 2020 conventions. PubMed, Scopus, and the Cochrane Library were searched for studies published between 2015 and December 2025 on psychotherapy access among children and adolescents within public health systems. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to access or engagement were included and synthesized narratively using a four-level individual, family, service, and system framework.
Results: Twenty studies met the inclusion criteria. Structural barriers, including long waiting times, limited specialist availability, geographic distance, and fragmented service coordination, were the most consistently reported obstacles. Stigma and cultural or linguistic mismatch further hindered engagement, particularly among migrant and minority populations, while limited mental health literacy and parental non-acceptance were key family-related barriers. Key facilitators included strong therapeutic relationships, active family support, school-based delivery, telehealth, and culturally adapted care models.
Conclusions: Access to adolescent psychotherapy is shaped by interacting multilevel determinants. Reducing inequities requires coordinated strategies addressing structural barriers and psychosocial factors. Future research should adopt standardized definitions of access and prioritize underserved populations and low-resource settings.
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