Exploring implementation barriers of mental health programs in primary health care: a qualitative study from Iran

Integrating mental health services into primary health care (PHC) has been globally recognized as a key strategy to improve access, reduce treatment costs, and enhance the continuity of care-especially in low- and middle-income countries (LMICs). Despite substantial policy efforts in Iran, the effective implementation of these programs remains suboptimal, with limited understanding of the underlying barriers from the perspective of healthcare professionals. This study aimed to explore and analyze the barriers to implementing mental health programs within Iran's PHC system, drawing on the experiences and insights of frontline health professionals.

This qualitative study was conducted in 2024 in Hormozgan Province, southern Iran, using a conventional content analysis approach. Data were collected through 16 in-depth, semi-structured interviews with psychologists, community health workers, and mental health officers. Interviews were transcribed verbatim and analyzed using MAXQDA software, following the principles of inductive coding and thematic categorization.

Four main categories of implementation barriers were identified: (1) human and organizational capacity limitations (ineffective inter-professional collaboration, lack of training, and excessive workload) (2), infrastructural and environmental deficiencies (insufficient counseling spaces, poor accessibility, and inadequate technical resources) (3), cultural and social barriers (stigma, low public awareness, and resistance from patients or families), and (4) institutional and systemic challenges (program overload, weak data systems, unrealistic performance indicators, and limited inter-sectoral coordination).

This study highlights critical human, infrastructural, cultural, and institutional barriers that hinder the effective integration of mental health services into PHC in Iran. Strengthening workforce capacity, improving physical and digital infrastructure, promoting community awareness, and reforming performance and governance systems are essential steps toward sustainable implementation.

Not applicable.