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Table 2 Summary of barriers experienced by people with SMD

From: Engaging and staying engaged: a phenomenological study of barriers to equitable access to mental healthcare for people with severe mental disorders in a rural African setting

  Engaged Disengaged Non-Engaged
Poverty Difficulty to maintain ongoing access to treatment (not being able to cover cost of treatment) Difficulty to maintain ongoing access to treatment Inability to initiate treatment due to lack of money for direct and indirect costs of treatment
Difficulty to obtain poverty certificate Difficulty to obtain poverty certificate Lack of social support (inability to reciprocate)
The pressure to maintain dignity
Concealing poverty
Medication-related barriers Unreliable medication supplies The belief that holy water and modern medication should be mutually exclusive  
Medication side-effects Intolerable medication side-effects
Lack of some medications
Ineffective medications
Long-term care Medication-side-effects from prolonged use Stigma of long-term engagement with care Presence of other co-morbid illnesses
Declining social support over years Looking for cure Having physical disability
Presence of other co-morbid illnesses Low personal autonomy Having severe functional impairment
Presence of other co-morbid illnesses
The nature of SMD The challenge from co-morbid alcohol use The challenge from co-morbid alcohol use The challenge from co-morbid alcohol use
Wish to discontinue treatment to use alcohol (although engaged) Lack of help for families when service users are uncooperative Severity of the illness
Spontaneous improvement Premature discontinuation of medication to use alcohol Not wanting treatment
Violence towards others