When Help Is Far Away: Barriers to Accessing Mental Health Care for Secondary School Students in Abuja, Nigeria, and Implications for Social Work Practice

When Help Is Far Away: Barriers to Accessing Mental Health Care for Secondary School Students in Abuja, Nigeria, and Implications for Social Work Practice | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article When Help Is Far Away: Barriers to Accessing Mental Health Care for Secondary School Students in Abuja, Nigeria, and Implications for Social Work Practice Gerald Chigozie Nweke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8623395/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose : The mental health of students determines their social, psychological and emotional well-being. It also facilitates good academic performance. The absence of mental health services results in mental health challenges as students are vulnerable to issues such as academic pressure, stress, burnout and depression. Therefore, the study looked at barriers to accessing mental health care for government secondary school students in Abuja, Nigeria. Materials and methods : In-depth Interview was used to collect data from 12 secondary school students (6 males and 6 females) across the six area councils in Abuja. Three key themes stood out from the data collection guides. These are “the prevalence of mental health challenges,” “barriers to accessing mental health services”, and “strategies to improve access and utilisation of mental health care.” Results : Findings from the study revealed a high prevalence of mental health challenges among government secondary students resulting from stress and burnout arising from course overload, unhealthy competition among students, lack of awareness and knowledge on how to manage their mental wellbeing and high expectations from parents, friends and classmates. Further findings also identified barriers to accessing mental health services, including (a) absence of professional care providers, (b) required cost , (c) religious beliefs and (e) lack of effective mental health care facility. The study also revealed strategies to improve access and utilisation of mental health care, such as (a) providing experts in mental health care, (b) establishing mental health care facilities , (c) public education and enlightenment and (d) adopting culturally-based psycho-education. Discussion and conclusion : These findings have implications for social workers who have a critical role in bridging the gaps in mental health services, providing essential support that helps students thrive academically, socially, and emotionally. Social workers serve as advocates, counsellors, and facilitators within the educational system; integral to the school mental health workforce and the leading mental health care service providers in educational settings. Mental Health Care Services Barriers Care facilities Secondary School Students Social Work Introduction Mental health is a crucial aspect of overall well-being, encompassing the social, psychological, and emotional aspects of our lives (Kumar, 2024 ). Mental health is a state of mental well-being that enables people to cope with the stresses of life, to realise their abilities, learn effectively, function well, and contribute to their communities (World Health Organisation [WHO], 2022b). It influences how we think, feel, and act (Zhang, 2024 ). Children and adolescents are always at risk of developing mental health problems, especially vulnerable children facing poverty, discrimination and violence (WHO, 2021). Adolescence is a critical period of transition during which young people face significant physical, emotional, and social changes and are exposed to a range of difficult experiences, such as stigma, bullying, and other life stressors (Collins et al., 2024 ). An estimated 1 in 7 children and adolescents aged 10 to 19 are affected by mental health conditions, with anxiety, depression, and behavioural disorders among the most common. With one-third of mental health conditions emerging before the age of 14 and half before the age of 18, early action is essential to enable children and young people to thrive and realise their full potential (WHO & UNICEF, 2024). The lack of access to basic social, health and education services, combined with wide-reaching structural inequalities, is known to aggravate risks for mental ill-health (WHO, 2021). Undiagnosed and untreated mental health conditions can create negative outcomes with long-term impacts that can span a lifetime and affect the health, education, and livelihood outcomes of future generations (WHO, 2022a). Globally, the mental health scenario is characterised by the prevalence of mental disorders and the limited existence of formal care services (Coronel-Santos & Rodríguez-Macías, 2022 ). Globally, it is estimated that one in seven (14.3%) of 10–19-year-olds experience mental health conditions, yet these remain largely unrecognised and untreated (WHO, 2025). There are concerning trends about the mental health of U.S. high school students, with 4 in 10 (40%) students having persistent feelings of sadness or hopelessness; 2 in 10 (20%) students seriously considered attempting suicide, and nearly 1 in 10 (9%) attempted suicide (Centres for Disease Control and Prevention, 2024 ). Findings from Li et al. ( 2025 ) revealed that mental health problems among secondary school students in Guangdong, China, are alarming: A total of 8,013 secondary school students were studied. The prevalence of abnormal mental health was 22.4% by the Mental Health Inventory of Middle School Students (MMHI-60), 19.7% by the School Refusal Behaviour Evaluation Scale (SRBES), 5.4% by the Revised Chinese Internet Addiction Scale (CIAS-R), and 20.3% by the Adolescent Suicide Tendency Scale (ASTS), respectively. Among 102,072 students (48.3% boys and 51.7% girls), aged between 11 and 19 years in Brazil, Escobar et al. ( 2020 ) reported risk behaviours including substance use, sedentary lifestyle, sexual behaviour, and suffering violence and bullying. Also, across 50 countries (including Europe, America, and Oceania), in a study involving school-aged children, focusing on the role of education, socioeconomic status, and school-based health programs, findings from Alshahrani et al. ( 2025 ) highlight that those nations with comprehensive public health policies report better mental wellbeing, whereas regions with limited resources, experience greater health inequalities. Given these findings, in-school programs focused on improving mental health outcomes should be developed. It is necessary to promote a healthy environment for students, with easy access to counselling from mental health care professionals. On average, African governments allocate less than 50 US cents per capita to mental health, well below the recommended US $ 2 per capita for low-income countries (WHO, 2022a). Public funding and human resources for mental services in general are low. Mental health services aimed at children and young people are practically non-existent, especially in low- and middle-income countries in Africa (WHO & UNICEF, 2024). Among secondary students in Tigray Region, Ethiopia, Gebremedhin et al. ( 2020 ) reported a prevalence of psychological distress at 34.9%, current alcohol use [AOR = 3.08; 95% CI: (1.64, 5.77)], physical fight [AOR = 2.99; 95% CI: (1.69–5.28)], contact sexual abuse [AOR = 2.37; 95% CI: (1.23, 4.55)], non-contact sexual abuse [AOR = 1.91; 95% CI: (1.04, 3.49)], and being bullied [AOR = 1.81; 95% CI: (1.03, 3.29)] were significantly associated with psychological distress. Among adolescents in Kenya, Johnson et al. ( 2023 ) reported depression and anxiety symptoms and the need for mental health services. Furthermore, using data from the Global School-based Health Survey (GSHS) from 2010 to 2017 of eleven sub-Saharan African countries, with a sample of 25,454 in-school adolescents, Aboagye et al. ( 2021 ) reported bullying victimisation affected 38.8% of adolescents overall—ranging from 22.2% in Mauritius to 54.6% in Sierra Leone—and was more likely among younger adolescents experiencing loneliness, anxiety, suicidal behaviours, marijuana use, and truancy. Despite this high burden, the availability and quality of mental health services for children and adolescents in Africa are greatly lacking (WHO, 2021). Adolescents in Nigerian secondary schools are confronted with high expectations and societal demands, which may place serious burdens on them (Oke et al., 2025 ). In Rivers state, Onyechi and Adeniji ( 2025 ) found that 26.5% of adolescents reported experiencing suicidal thoughts, with a slightly higher prevalence in rural areas (26.9%) compared to urban areas (26.0%). In Lagos state, loss of interest (29.6%), symptoms were "having no close friend in school" (OR 2.66, 95% CI 2.08–3.41), "diagnosis of depression" (OR 1.33, 95% CI 1.09–1.63) (Adewuya et al., 2021 ). In Oyo state, the pervasive influence of insecurity on secondary school students’ daily lives and mental health is reported: heightened levels of fear, anxiety, and stress due to various security challenges such as communal conflict, raping, maiming and killings through violent clashes; compounded by a sense of vulnerability and uncertainty about personal safety, which significantly affected their ability to concentrate on academic tasks and engage effectively in school activities (Oluokun & Okediji, 2024 ). Also, in Bauchi, North-East Nigeria, among in-school adolescents, 0.7% were moderately severely depressed. Most respondents (88.7%) had minimal anxiety, while 1.5% and 0.3% had moderate and severe anxiety, respectively. Almost one-quarter of the respondents (23.2%) had thought of ending their life in the past month before the survey, with up to 4.2% attempting suicide (Mohammed et al., 2024 ). Most in-school adolescents lack knowledge, have a poor attitude towards mental health and are more likely to display conduct problems impacting their mental health status (Olowe et al., 2025 ). These findings highlight the need for targeted interventions to address the unique challenges faced by adolescents, aiming to reduce the prevalence of mental health challenges and promote healthier coping strategies. Several factors are responsible for the rise in poor mental health and mental illness among secondary school students. Some factors include verbal, physical and social bullying (Liu et al., 2025 ; Han et al., 2025 ), academic pressure (Steare et al., 2023 ), low socioeconomic status of parents and low parental education (Stea et al., 2024 ), frequent social media use, persistent feelings of sadness or hopelessness, and some suicide risk (considering attempting suicide and having made a suicide plan) (Young, 2024 ), father’s education, mother's education and grade rank (Li, et al., 2025 ), family status and practices, peer relationships and school climate (Lin & Guo, 2024 ), social inclusion and parental expectations (Fassl et al., 2025 ), sexual abuse, physical neglect and physical abuse (Edet et al., 2022 ), stressful situation and disappointed by boy/girl-friend (Nwankwo et al., 2021 ), family size and parental occupations (Bede, 2015 ). Despite the high prevalence of mental illnesses, mental health remains underprioritized in many African countries (WHO, 2022a). The rise in adolescent mental health conditions highlights the need for interventions, particularly in schools, for timely access to young people, building on inherent strengths and competencies (Olowe et al., 2025 ). Some factors serve as barriers to mental health care services in Nigeria. Despite the clear need for action, access to mental health care services for children and young people remains inadequate (WHO & UNICEF, 2024). Mental health care services in Nigeria consist mainly of large government psychiatric hospitals (Chijioke et al., 2024 ). Poor access to mental health care due to low government investment is one of the major hurdles to prevention and care services (WHO, 2022a). Healthcare workers have insufficient knowledge of child and adolescent mental health, hold negative attitudes toward children and adolescents with mental health problems, and exhibit poor practices related to child and adolescent mental health (Mkubwa et al., 2024 ). Limited mental health education and awareness, shame and stigma, name-calling, ridicule, and chastisement are also barriers that people with mental illnesses face in communities (WHO, 2022a; Adeosun et al., 2015 ). The majority of young people experiencing mental health symptoms do not access care due to systemic barriers such as low service availability and unaffordable costs (WHO & UNICEF, 2024). Other factors include poor education, ignorance, absence of services in rural communities, waiting time at the facilities, bureaucracy in treatment and poor information management, high cost of service, travel distance, feelings of shame and loss of productive income (Chijioke et al., 2024 ). Consequences associated with untreated mental illness have several implications. Untreated mental illness could lead to problems with family and friends as well as to suicidal thoughts (Ibrahim et al., 2020 ); the presence of chronic illnesses, depression, anxiety, behavioural disorders, and psychotic-like experiences was associated with adolescent suicidal behaviour (Nwankwo et al., 2021 ; Adewuya & Oladipo, 2020 ). The consequences of failing to address adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults (WHO, 2025). All mental health challenges resulting from abuse types predicted various deliberate self-harming behaviours (Edet et al., 2022 ). Poor knowledge (62.2%), poor attitude (54.7%) and being substantially at risk of conduct problems (Olowe et al., 2025 ). Adolescents with mental health conditions are particularly vulnerable to social exclusion, discrimination, educational difficulties, risk-taking behaviours, physical ill-health and human rights violations (WHO, 2025). Mental health interventions to prevent trauma and screen for mental disorders among secondary school students should be instituted in Nigeria. Social work is a helping profession that has the power to improve people’s lives on an individual, family, group, and community level (Wahab & Manjunathswamy, 2024 ). Social workers are integral to the school mental health workforce and the leading social service providers in educational settings (Ding et al., 2023 ). Social workers in school settings are known for their functions to evaluate students’ needs and provide interventions across the ecological systems to remove students’ learning barriers and promote healthy sociopsychological outcomes (Huxtable, 2022 ). School social workers are professionally-responsible for services, including trauma-informed care, social–emotional learning, and restorative justice programs in school mental health services (Gherardi, 2017 ; Crutchfield et al., 2020 ; Elswick et al., 2019 ). Social workers in school settings provide counselling to students with mental health issues and serve as facilitators in providing mental health care services, including collaboration with school and community-based partners (Childs & Iachini, 2024 ). While psychologists, teachers, school nurses, and school administrators are key determinants of service use to develop strategies for adolescent mental health assessment (Grunin et al., 2025 ), school social workers offer direct and indirect assistance to students, families, and school personnel (Wahab & Manjunathswamy, 2024 ). Social workers in schools play a vital role in promoting mental health among students by addressing social, emotional, and behavioural challenges; bridging the gap between academic demands and students' emotional needs by offering tailored interventions that promote mental health care (Sankpal, 2016 ). Adolescents in schools are the least likely to seek help for their mental health problems. School may be an important route to improve early recognition of adolescents with mental health problems in need of support (Beukema et al., 2024 ). Thus, most school social work interventions and services target high-needs students to improve their social, mental/behavioural health, and academic outcomes, followed by primary and secondary prevention activities to promote school climate, school culture, teacher, student, and parent interactions, and parents' wellbeing (Ding et al., 2023 ). Literature reviews in Nigeria related to mental health are few. Most studies focused on knowledge and attitude to mental health (Olowe et al., 2025 ), predictor factors such as suicide ideation, depression, insecurity (Nwankwo et al., 2021 ; Edet et al., 2022 ; Adewuya & Oladipo, 2020 ; Oke et al., 2025 ; Mohammed et al., 2024 ; Oluokun & Okediji, 2024 ), psychotic experiences and health-seeking behaviours (Adewuya et al., 2021 ; Onyechi & Adeniji, 2025 ), among others. While these studies are commendable, none of them focused on barriers to accessing mental health care for secondary school students. Thus, this current study will be different. The present study investigates barriers to accessing mental health care services for government secondary school students in Abuja, Nigeria and practice considerations for social work. We analysed (a) the prevalence of mental health challenges; (b) barriers to accessing mental health care services; and (c) strategies to improve access and utilisation of mental health care services. It is believed that findings from this study will provide information on the roles of social workers in advocating for student mental well-being and how they collaborate with other important key stakeholders to achieve this. This study also hopes to identify and highlight the importance of social workers as service providers to the multidisciplinary team in ensuring and providing relevant mental health care services to secondary school students. Materials and Method Study Area The study was carried out in Abuja, the Federal Capital Territory (FCT) of Nigeria, located in the central region of the country and regarded as the seat of the federal government and a rapidly growing urban centre within the West African region. The FCT covers an area of approximately 8,000 square kilometres and is administratively divided into six Area Councils: Abaji, Abuja Municipal (AMAC), Bwari, Gwagwalada, Kuje, and Kwali, each with both urban and peri-urban communities (ACReSAL, 2024 ; FCDA, 2025). Abuja hosts a large and diverse population because of its status as the nation’s capital, resulting in growing demand for education and social services; the FCT Education Secretariat coordinates policy formulation and implementation of educational services across all levels, including secondary education in public schools (FCT Education Secretariat, n.d.). Within the FCT, government secondary schools form a significant component of the formal education system, catering to thousands of adolescents aged roughly 13–18 years. According to the FCT Secondary Education Board (n.d.), there are about 90 public secondary schools with nearly 89,000 enrolled students and over 4,000 academic staff, serving diverse communities across the six Area Councils (FCT Secondary Education Board, n.d.-b). These schools represent assorted settings—ranging from rural-fringe schools in councils like Abaji and Kwali to densely populated urban schools in Abuja Municipal Area Council—making the FCT an ideal study area to explore barriers to accessing mental health care in the context of government secondary school environments where support services, resources, and education quality and may vary significantly (The Guardian, 2023). Sampling Procedure A multi-stage stratified purposive sampling technique was adopted to ensure analytical depth, geographical, and contextual diversity and representation across the six Area Councils of the FCT: Abaji, AMAC, Bwari, Gwagwalada, Kuje, and Kwali. In the first stage, one government secondary school was purposively selected from each Area Council, resulting in six schools. The selected schools were: Government Secondary School (GSS) Yaba Abaji, GSS Nyanya (AMAC), GSS Kubwa (Bwari), GSS Gwagwalada, GSS Kuje, and GSS Kwali. These schools were selected based on three scientific criteria: (i) location within distinct urban, peri-urban, and semi-rural settings to capture structural differences in access to mental health services, (ii) official ownership by the FCT Secondary Education Board, and (iii) enrolment of mixed-gender adolescent students. Purposive school selection is appropriate in qualitative health research where contextual variation is essential for understanding service access barriers rather than statistical generalisation (Palinkas et al., 2015 ). The administrative structure and distribution of public secondary schools across the six Area Councils are officially documented by the FCT Secondary Education Board (n.d.-b), validating the sampling frame used. In the second stage, two students were selected from each school, yielding a total of 12 participants for the in-depth interviews (IDI). Selection within schools was based on a gender-stratified purposive sampling method, with one male and one female student selected from each school to ensure gender balance and reduce systematic gender bias in perceptions of mental health care access. Eligible participants were adolescents aged from 13 to 18 years, enrolled in senior secondary classes (SS1 to SS3), who demonstrated awareness of mental health service barriers, as identified through referrals from senior teachers or school counsellors. Additional criteria included willingness to participate and ability to articulate experiences during interviews. Gender stratification is widely recommended in adolescent mental health research since gender-specific mental health care can be a promising approach to meet gender-specific mental health needs (Herrmann et al., 2024 ; Fine et al., 2025 ). Selecting an equal number of participants from each school enhances comparability across settings, while the total sample size of 12 is methodologically appropriate for achieving thematic saturation in qualitative interview studies (Guest et al., 2020 ; Hennink et al., 2017 ). This sampling approach is therefore context-sensitive, well-suited and robust for exploring in-depth insights into barriers to accessing mental health care among government secondary school students in Abuja. Data Collection A semi-structured in-depth interview (IDI) schedule was used for data collection. This enabled the researcher to explore barriers to accessing mental health care among government secondary school students in Abuja. Semi-structured interview is widely recognised in qualitative research for providing flexibility, depth and participant-guided narratives while still maintaining a systematic structure guided by pre-designed prompts (Creswell & Poth, 2016 ; Tisdell et al., 2025 ). An interview guide was developed based on the research questions on barriers to accessing mental health care. Participants were provided with consent forms where clear explanations regarding the study and participation were made, and were assured that their responses would be used for academic purposes only. Interviews were conducted face-to-face within the school settings of participants during break hours. Each interview lasted between 35 and 40 minutes, depending on the participant’s availability and willingness to elaborate. All interviews were conducted in English, the dominant language of the residents of Abuja and the dominant language used in teaching secondary school students within Abuja. To ensure trustworthiness, the researcher established rapport with participants before data collection, emphasised confidentiality, and allowed them to narrate experiences freely. With participants’ informed consent, all interviews were audio-recorded using a digital recorder and later transcribed verbatim for analysis. Field notes documenting non-verbal cues and contextual observations were also taken to support the interpretation of the interview data (Nowell et al., 2017 ). The researcher contacted and interviewed participants using questions like (a) what is the prevalence of mental health challenges? (b) What are the barriers to accessing mental health care services? and (c) what are the strategies to improve access and utilisation of mental health care? The combination of rich verbal accounts, contextual reflections, and systematic transcription enhanced the credibility and depth of the dataset. The study was conducted between August and November 2025. Data Analysis The data gathered from the semi-structured in-depth interviews (IDI) were analysed using thematic analysis, following the six-phase framework proposed by Braun and Clarke ( 2006 ). All interviews were audio-recorded with participants’ consent and subsequently transcribed to ensure accuracy and retention of the participants’ original perspectives. The transcribed interviews were imported into Nvivo12 software; it was read while being coded, and as the themes emerged, the researcher reviewed them to enhance familiarisation, consistency and frequency. After familiarisation, the transcripts were manually coded using an inductive approach. Codes were developed to represent meaningful units of data relating to the prevalence of mental health challenges, barriers to accessing mental health care services and strategies to improve access and utilisation of mental health care. Similar codes were then collated into broader themes that captured patterned meanings across participants. These themes were reviewed, refined, and defined to ensure that they adequately reflected the data and addressed the study objectives. The final results were presented in a narrative form supported by direct quotes, presented in various themes, thereby ensuring an authentic representation of barriers to accessing mental health care among secondary school students in Abuja. These themes emerged from the analysis but were guided by the research objective of this study. The occurring and recurring themes included the prevalence of mental health challenges, barriers to accessing mental health care services and strategies to improve access and utilisation of mental health care. Ethical Considerations Ethical approval for this study was obtained from the Research Ethics Committee of [blinded for review]. All participants were informed about the aim of the study, assured of anonymity, and provided informed consent prior to participation. Participation was voluntary, and respondents were free to withdraw from the study at any point without any consequences. Results Demographic characteristics of participants S/N Gender Age Class Area Council School type Religion Living Arrangement Household economic perception 1 Male 15 SS2 Abaji Boarding School Christianity Both Parents Manageable 2 Female 16 SS3 Abaji Boarding School Islam Single Parent Difficult 3 Male 17 SS2 AMAC Day School Christianity Both Parents Comfortable 4 Female 14 SS2 AMAC Day School Islam Guardian Difficult 5 Male 15 SS3 Bwari Boarding School Christianity Guardian Manageable 6 Female 17 SS3 Bwari Boarding School Christianity Both Parents Manageable 7 Male 16 SS3 Gwagwalada Day School Islam Single Parents Manageable 8 Female 18 SS3 Gwagwalada Day School Christianity Both Parents Manageable 9 Male 16 SS2 Kwali Day School Christianity Both Parents Difficult 10 Female 16 SS2 Kwali Day School Christianity Both Parents Difficult 11 Male 15 SS1 Kuje Day School Islam Both Parents Manageable 12 Female 18 SS3 Kuje Day School Christianity Both Parents Manageable The socio-demographic profile of the 12 respondents revealed that gender was equally represented, with 6 females (50.0%) and 6 males (50.0%), ensuring balanced gender perspectives in understanding barriers to accessing mental health care among government secondary school students in Abuja. Data from the age distribution showed that most respondents were aged 16 years, 4 respondents (33.3%), followed by 15 years, 3 respondents (25.0%), and 17 years. 2 respondents (16.7%), 18 years, 2 respondents (16.7%), 14 years, and 1 respondent (8.3%), align with typical senior secondary school age ranges. The area council distribution was evenly spread, with two respondents (16.7%) each from Abaji, AMAC, Bwari, Gwagwalada, Kwali, and Kuje, ensuring geographic balance across the FCT. With respect to class level, SS3 students constituted the largest group, 6 respondents (50.0%), followed by SS2 students, 5 respondents (41.7%), and SS1 students, 1 respondent (8.3%), indicating greater representation of senior students who may experience heightened academic and transition-related stress. Regarding school type, the majority attended day schools, 8 respondents (66.7%), while four respondents (33.3%) were enrolled in boarding schools, a factor that may influence access to family-based support and external mental health services. Concerning religion, Christianity was predominant: 8 respondents (66.7%), while Islam constituted 4 respondents (33.3%), reflecting the religious diversity of the FCT and its relevance to mental health perceptions and help-seeking pathways. About living arrangements, most respondents lived with both parents, 8 respondents (66.7%), which may imply greater potential access to emotional and financial support, whereas two respondents (16.7%) lived with a single parent and another two (16.7%) lived with guardians, arrangements often associated with increased psychosocial stress among adolescents. Finally, for the household economic perception, the majority of students described their household situation as manageable, 7 respondents (58.3%), indicating moderate financial stability, while four respondents (33.3%) reported difficult economic conditions, and only one respondent (8.3%) suggested a comfortable household situation, indicating the presence of economic vulnerability among a substantial proportion of participants. The prevalence of mental health challenges among students All participants affirmed the prevalence of mental health challenges among students, as academic activities come with lots of challenges that might put the mental well-being of students at risk. Some respondents were of the view that mental health challenges are prevalent as a result of stress and burnout arising from course overload. Comments from participants include: A 15-year-old male student from Abaji said: Mental health issues are everywhere, and students feel stressed out from course overload, reading and assignments. Students are often tired, and this further results in sleeping, burnout and mental exhaustion even when lectures are ongoing. When the course load is too demanding, we experience too much stress that leaves us emotionally exhausted. A 14-year-old female student from AMAC added: Stress is a common challenge we experience because we are mandated to come to class, do our assignments and practicals on time. Most time it is so exhausting, but we are expected to do it. Most teachers do not even care how we feel about these academic demands; they only mandate us to do it, even when we have shown signs of being overwhelmed. An 18-year-old female student from Gwagwalada further commented: Mental health challenges are prevalent here because of truancy. Many students skip attendance because of psychological problems like mental exhaustion. They think they can't cope with academic activities because of how demanding they are. This is an issue which the school management has yet to address. Some of the participants were of the view that the prevalence of mental health challenges among students arises as a result of unhealthy competition among students. Students often compare their academic grades (low or high), financial status and relationship status (especially rejection) with that of their classmates. This often results in an uneven advantage that leaves many students depressed, affecting their self-esteem. Some responses include: A 17-year-old female student from Bwari revealed: Students these days overthink. They are always comparing themselves and competing with one another. This has resulted in an inferiority complex and low self-esteem. This has constituted a serious mental health challenge among students as it often leaves the student at the low end depressed, and subsequently results in low self-esteem. An 18-year-old female student from Gwagwalada added: Mental health issue arises also from rejection of advances in friendships and relationships among students. A student once attempted suicide because a female student rejected his advances for a relationship. There are also other reasons for its prevalence. Low grade is another factor, as students with low grades often have a low assessment of themselves and their ability. Evidence from data from participants further associated the increase in mental health challenges among students with a lack of awareness and knowledge on how to manage their mental well-being. These include not knowing when to rest and take a break from academic activities, and resorting to relaxation for some time. Views from participants include: An 18-year-old female student from Kuje commented: Mental health challenges are on the rise because of a lack of knowledge and understanding of one's Mental health. Many students do not know how to maintain and manage their mental well-being. They don't know when to rest, how to avoid depression, pressure and other risk factors associated with the rise in mental health challenges. A 15-year-old male student from Kuje also added: Most times, students lack the knowledge of how to set realistic expectations for their academics and social relationships. Most often, students are encouraged to set goals, but are not taught how to set reasonable and attainable academic and relationship goals. Lack of this knowledge results in students setting unrealistic goals, which leads to failure. Failure to realise these goals results in mental health challenges like depression. Some views from participants also associated the prevalence of mental health challenges among students with expectations. These include expectations from parents, friends and classmates. Many parents/guardians place huge expectations on their children to attain good grades. Failure to attain such academic grades results in parents being disappointed. Some participants revealed: A 15-year-old male student from Abaji said: A serious factor responsible for the rise in mental health issues is expectations from parents and friends. This puts undue pressure on students to attain high grades. Most students experience pressure to perform well, resulting from expectations from parents, family members and friends. This has resulted in students’ breakdown, especially when they realise they have failed to attain such heights. A 16-year-old male student from Kwali further added: Mental health challenges among many students can be directly linked to failure to realise the high expectations placed on students by their parents. While this expectation can boost our motivation to aspire for good grades, it can affect our concentration because we also need recreation and rest to cool off our brains. This has resulted in students overworking themselves, making them vulnerable to mental exhaustion and overlabour. Barriers to accessing mental health care services Participants shared several risk factors serving as barriers inhibiting access to mental health care among students. These factors prevent students from seeking mental health care services. Some of these barriers include: (a) absence of professional care providers, (b) required cost, (c) religious beliefs, (d) fear of mockery, (e) lack of effective mental health care facility, and (f) preferences of non-formal healing rituals. We present data explaining these factors below. Absence of professional care providers Data from participants revealed that the lack of professional care providers is a serious barrier associated with accessing mental health care services. This indicates a lack of experts in the area of mental health care. Some participants had this to say: A 15-year-old male student from Abaji revealed: Most mental health care services are provided by teachers playing the role of counsellors or mental healthcare practitioners. Most teachers resort to beating students in need of mental care. This results in students’ hesitancy to approach mental care services. They withdraw because they are afraid of experiencing ill-treatment from teachers acting as mental health care practitioners. A 15-year-old male student from Bwari added: There are no mental health practitioners available to provide mental health care to students. Even when students have increasingly shown signs of mental health challenges like depression and burnout, mental health care professionals are lacking. Students are mostly referred to other settings that seem exhausting. This discourages students from considering mental health care. Required cost Some participants also revealed that accessing mental health care costs some money, an extra fee aside from tuition fees that parents/guardians mostly cannot afford to pay. Many students are already faced with economic difficulty. Incurring an extra fee as a mental health care cost appears difficult to incur. Some participants revealed: A 17-year-old female student from AMAC commented: We do not have extra money to pay for mental health care services. They cost a lot. Our parents still struggle to pay our tuition fees. Most times, it takes several weeks after resumption for parents to pay the tuition of their children. Incurring an extra fee for mental health care services is really challenging. A 16-year-old female student from Abaji added: Everything requires money in this school. Students are only allowed access to care if they have paid their school fees. Access to care, whether medical, psychological or otherwise, is prohibited for students who haven't paid their fees. In addition, there is an extra service fee for accessing mental of medical care. Not every parent can afford these extra fees. Religious belief Some participants also revealed that there is a need for mental healthcare, as they strongly resort to their belief that God will care for any mental challenge or illness through prayer and faith in Him. These participants do not see the need for mental health care as they solely rely on their faith. Views include: A 15-year-old male student from Bwari commented: The religious belief factor constitutes a serious barrier to accessing mental health care. This results from the belief that mental health can't be cured by professional services but through prayer and fasting, believing and waiting on God. This has prevented many students from considering mental health care services. It appears they do not see the need for it. A 16-year-old female student from Kwali added: I am a Christian; I believe in God’s healing power. There is nothing God can’t do. He is always here to heal me from any mental challenges resulting from my academic stress. I do not see the need for mental health care. Unless for other students who do not believe in God. Fear of mockery Some participants revealed that their fellow students will make fun of them once they admit to having mental health challenges. This view stems from the perception that males are expected to portray courage and bravery in handling life’s situations, compared to females presumed to show emotions. Responses from participants include: A 17-year-old female student from Bwari revealed: Many male students do not want to open up when they have mental health issues. They believe they will be mocked or belittled among their classmates (fellow males and females, too). They fear being labelled weaklings, not manly or brave enough. They associate the presence of mental health challenges with weakness. Thus, they desist from showing any sign of needing mental health care. A 16-year-old male student from Gwagwalada further added: Most times, we male students do not like showing any sign of stress, tiredness or being depressed. It mostly means we are showing weakness, and female students see it as a sign of losing our bravery and masculinity. So, it may not be well for male students to show a sign of needing mental health care or psychological support. We are rather expected to give it. A 16-year-old male student from Kwali also commented: One barrier could be cultural pressure to conform to gender roles. Boys are expected to be strong, brave and courageous. They always try to conform to this cultural expectation even when doing so is to their detriment. Desiring to opt for mental care is regarded as a sign of weakness. Lack of an effective mental health care facility Evidence from participants also revealed that students do experience a need for mental health care because of the absence of an effective mental health care facility. There are no established building of unit designated specifically to render services related to mental care within the school premises. Responses from participants revealed: A 16-year-old male student from Gwagwalada commented: Lack of an effective mental health care facility within the school setting is a serious barrier. There are no designated buildings or facilities saddled with the responsibility of ensuring the mental well-being of students. Once a student shows signs requiring effective mental health care, they are often moved out of the school to some other place or hospital. This mostly adds to the exhaustion already experienced by the student. Thus, many students remain hesitant to communicate their mental health care needs. An 18-year-old female student from Kuje added: If students are to show willingness to receive or need mental health care, there ought to be an established facility to provide such service. But in our situation, there are none. No effective structure is equipped with the tools and manpower to provide mental health care. So, it has resulted in students’ reluctance to consider the need for mental health care. Preferences for non-formal healing rituals Evidence from data also revealed that students withdraw from mental health care because they believe in the potency of non-formal healing rituals. They prefer this method to clinical support. This results from the upbringing that the native pattern of healing has more potent power than clinical support. Some participants revealed: A 15-year-old male student from Kuje said: I think a non-formal approach to addressing mental health challenges is more effective than a clinical method or support. My parents also taught me, and we use different native patterns to address many health-related problems we have experienced in the past. I have preferences for non-formal healing rituals over formal clinical support. To me, seeking formal mental care services is a waste of time. A 17-year-old male student from AMAC also added: I do not think clinical support is more effective in addressing mental health challenges than non-formal ritual methods. Mental health challenges are complex most times; they are beyond clinical support. The non-formal ritual method is carried out by a traditionalist or herbalist who first uses a metaphysical source to enquire the cause of any challenge, and thereafter proffers immediate solutions to them. Strategies for improving access and utilisation of mental health care Participants also shared some ideas on ways to improve access and utilisation of mental health care among students. These strategies can help students understand the need and role of mental health care in the social, emotional and psychological well-being. These strategies include: (a) providing experts in mental health care, (b) establishing mental health care facilities, (c) public education and enlightenment, and (d) adopting culturally-based psycho-education. We present data explaining these factors below. Providing experts in mental health care Some participants were of the view that the presence of an expert in mental health care would improve the access and willingness of students to receive mental health care. Experts understand their role and the effective way to render quality services. Some participants had this to say: A 15-year-old male student from Abaji said: Concern and care from experts can help foster the willingness of students towards mental care services. Mental care practitioners should show empathy and concern for students with mental health challenges; they are already going through a lot. They should not adopt beating or scolding. They should provide support to students in need of mental care. A 14-year-old female student from AMAC added: Once experts and mental health care professionals are available, I will certainly go to them and communicate my mental health challenges if I observe any. It shows me that they will understand my situation. Many teachers who are prompted to play the role of mental health care practitioners do not understand the mental needs of students. Establishing mental health care facilities Responses from participants also revealed the need to establish mental health care facilities within the school setting to ensure easy access and utilisation of mental health care. These facilities must be equipped with tools and manpower. Views from participants include: A 16-year-old female student from Abaji revealed: The government should effectively establish and equip mental health care facilities for quality services and make them accessible to all students, irrespective of their family or economic status. All students should have equal rights and access to mental health care services. This will effectively encourage students to utilise them. A 16-year-old male student from Gwagwalada added: The government must endeavour to provide adequate funds and appoint an effective committee to supervise the establishment of mental health care facilities and provide professionals and practitioners skilled in the area of mental health. These practitioners can collectively work with school authorities to ensure students’ mental well-being is guaranteed. Public education and enlightenment Some participants also revealed the need for enlightenment and reorientation. Most students do not understand the need for mental health care. Public enlightenment is key in promoting awareness of the effects and challenges posed by ignoring one’s mental well-being. Some participants commented: A 17-year-old male student from AMAC revealed: Students need to be enlightened on how mental well-being is achieved. This enlightenment can also be extended to parents and society at large. Public education and community enlightenment can be important to promote awareness of the need for mental care. Many students give excuses because they do not understand it is for their personal well-being. A 15-year-old male student from Bwari added: Teachers, parents and religious authorities must collaborate to educate students on the need for mental health care and the dangers of substituting it with prayer and fasting. Students should be enlightened that clinical support has its role in promoting general mental well-being. Adopting Culturally-based psycho-education Views from participants also highlight the need for adopting culturally-based psycho-education targeted at improving the general perception of mental health care. This will improve one’s disposition to mental health challenges and facilitate access and utilisation. Some participants had this to say: A 16-year-old male student from Kwali said: Some culturally-held assumptions that encourage students to believe that males are brave and should not show the need for mental health care must be addressed. Adopting a culturally-based psycho education targeted at students to change some of the cultural beliefs that are detrimental to mental wellbeing. This helps the students and the general public become aware of the threats associated with culturally-based beliefs in the area of mental well-being. An 18-year-old female student from Kuje added: Many students don't know that mental health challenges are treatable to an extent, especially through clinical methods. Some believe in non-formal rituals for treating mental health challenges, while many believe mental health challenges have no cure; they perceive it as an untreatable illness. This has prevented them from seeking out mental health care services. This must be addressed with cultural reorientation. Students, especially parents, need to understand that clinical procedures have improved over the past years. They should be enlightened to embrace this improvement for their mental well-being. Discussion The study investigated barriers to accessing mental health care for secondary school students in Abuja, Nigeria and implications for social work practice. The study reveals a high prevalence of mental health challenges among secondary school students in Abuja. Findings from the study identified that one of the reasons for the prevalence of mental health challenges among students is stress and burnout arising from course overload and academic pressure. This aligns with the findings of Gao ( 2023 ), who reported academic stress resulting in academic burnout. Concerning the impact of academic burnout on adolescents, Wang et al. (2019) further confirmed that academic weariness can lead to problematic behaviours such as absenteeism and school dropout. Haritay et al. ( 2025 ) also argued that academic stress is a significant risk factor for mental health development during adolescence, while Anand et al. ( 2025 ) found that academic stress results in moderate-to-severe anxiety. It is not a coincidence that views from respondents further confirm that stress and academic pressure significantly impact mental health and overall development. Findings also revealed unhealthy competition among students as a risk factor for the prevalence of mental challenges among students. This resonates with the findings of Fülöp et al. ( 2025 ), who reported mental challenges such as anxiety and school burnout were significantly higher in the competitive schools. Lu (2025) also found that grade had a certain impact on the emotional health of students. This leaves us with emphasis on the importance of improving the educational environment and strengthening family support to promote students' mental health development. Also, results from the study associated a lack of awareness and knowledge with the prevalence of mental health challenges. This further corroborates the findings of Olowe et al. ( 2025 ), who reported that the level of knowledge is a significant predictor of mental health status. Most in-school adolescents who lack knowledge and have a poor attitude towards mental health are more likely to display conduct problems impacting their mental health status. Lee et al. ( 2023 ) also reported that mental health awareness was influenced by knowledge of mental health and attitude towards mental health. This creates a need for baseline evidence for designing in-school programmes with a mental wellness focus to promote the mental health of adolescents, leveraging professional and parental networks. Results from the study highlight several barriers to accessing mental health care. Findings identified the absence of professional care providers as one of these barriers. This aligns with the findings of Gadgil et al. ( 2025 ), who found factors such as knowledge and expertise to be predominant factors that influence willingness to seek care and treatment of mental health challenges. Anyebe et al. ( 2021 ) reported lack of skilled mental health human resources and inadequate training of available personnel were identified as the major barriers to the provision of mental health services. Thus, a lack of expertise can result in a barrier to accessing health care. Appropriately trained professionals are key for early identification and treatment of mental challenges and disorders, establishing multilevel coordination and collaboration between schools, community services, policy makers and other health care providers (Cubillos et al., 2021 ; Brady et al., 2021 ). This highlights the urgent need for action in ways to recruit mental health practitioners in schools, and the lack of expertise that often prevents students from seeking help. Furthermore, findings from the study highlighted the cost as a barrier to accessing mental health care among students. Jack-Ide and Uys ( 2013 ) reported barriers in accessing mental health services, including physical, financial and cultural. Kuhlman et al. ( 2025 ) reported high Cost as a barrier shaping access to care. Also, Findings from Olugbile et al. ( 2013 ) showed that the average monthly cost of treatment of patients receiving mental care was lower than that of patients from the medical outpatients’ clinic. However, the cost for psychiatric patients far exceeded the cost for medical patients. Mental health services need to be provided throughout the schools and health care system to enable people to access them affordably (Jack-Ide & Uys, 2013 ). This finding, therefore, highlights a need for policymakers to change policy regarding the coverage of Nigerians with mental challenges and treatment. In doing so, the major barrier related to high cost in accessing care and treatment gap can be reduced. Findings from the study also highlighted religious belief as a barrier to accessing mental care among students. Sandu et al. ( 2025 ) found that religion may provide psychological support, offering effective coping tools and emotional help. Adhering to religious beliefs provides believers with a sense of purpose; those who follow them often report higher levels of satisfaction with their life and overall well-being (Mancuso & Lorona, 2023; Garssen et al.,2020; VanderWeele, 2017 ). Since religious belief often improves mental health (Garssen et al.,2020; Mancuso & Lorona, 2023), it is no coincidence that participants with such a belief do not see the need for mental care, as revealed above that mental health challenges can be cured through prayer and fasting, believing and waiting on God. This result aligns with findings from Shipurut ( 2024 ), who found that religious beliefs in supernatural causes and remedies of mental illnesses influence people’s knowledge and attitudes towards mental illness and help-seeking behaviour. Kanu and Nosike ( 2025 ) also reported that religious beliefs often provide comfort, social support, and a sense of purpose, contributing to reduced stress and improved emotional well-being. This confirms why those with religious beliefs are reluctant to access mental care. The findings underscore the need for an inclusive approach that integrates mental health awareness into religious practices while encouraging faith-based institutions to promote psychological well-being. The findings have practical implications for mental health professionals, religious leaders, and policymakers seeking to address mental health concerns within religious communities. Evidence from the findings also highlighted the lack of effective mental health care facilities as a barrier to accessing mental care services. Due to a dearth of hospitals and mental health professionals to lack of basic amenities, and poor funding, it is glaring that psychiatric care in Nigeria is in dire straits, as the number of mental cases has spiked by over 200 per cent in the last few months (Guardian Nigeria, 2024). This result resonates with the findings of Anyebe et al. ( 2021 ), who reported poor funding as the major barrier to the provision of mental health services at the community level. Mental health services in Nigeria consist mainly of large government psychiatric hospitals. There are eight Neuropsychiatric hospitals and a similar number of teaching hospital psychiatric departments for a population of 200 million people. These Neuropsychiatric hospitals cannot accommodate the mental services needed for the Nigerian population (Chijioke et al., 2024 ). Therefore, addressing community mental health care needs by establishing care facilities is essential (Benoni et al., 2025 ). This result highlights the need for efforts through policies and legislation towards improving the provision of mental care services by focusing more on establishing mental health care facilities within schools and communities. Results from the study also identified preferences for non-formal healing rituals over clinical support as one of the barriers to accessing mental care among students. Burns and Tomita ( 2015 ) reported that approximately half of individuals seeking formal health care for mental challenges in Africa choose traditional healers as their first care provider. This choice is associated with delays in accessing formal mental health services. Low- and middle-income countries (LMICs) experience low mental care due to a lack of adequate infrastructure, human resources and treatment options (Kohn et al., 2004 ). People seeking help for mental disorders in LMICs rely heavily on alternative or informal sources of care. Understanding pathways to care for those with mental health challenges requires clarification of the extent to which informal practitioners feature early in the care pathway, as it is likely that the choice of initial provider contributes to potential delays in accessing mental health care. Implication for social work practice Findings from the study indicate that schools are faced with increasing responsibility not only to ensure students’ academic success but also to address the growing mental health concerns. Social workers in schools play a critical role in bridging these gaps, providing essential support that helps students thrive academically, socially, and emotionally (The University of Texas at Arlington, 2024 ). Findings from the study highlighted stress and burnout arising from course overload as a factor associated with the prevalence of mental health challenges among students. This has implications for social work practice as social workers are saddled with the professional responsibility of creating conducive teaching and learning environments, advocating for social justice and child protection, conducting psychosocial assessments, and providing counselling and trauma debriefing for students (Khumalo et al., 2025 ). The ability to conduct thorough assessments distinguishes effective school social workers. They perform biopsychosocial evaluations that examine students’ physical, emotional, and mental conditions within the context of their environment (Social Work Institute, 2025 ). This assessment can help social workers to critically examine the challenges of stress and burnout resulting from academic pressure and course overload. Thus, inform individualised intervention plans tailored to each student’s unique circumstances. Findings from the study also revealed unhealthy competition among students as a factor responsible for the prevalence of mental health challenges among students. This underscores the need for schools to prioritise mental health and wellbeing, recognising that students’ academic success is closely linked to their mental health (Yesufu & Egbabor-Fred, 2021 ). This also has implications for social work practice since school social workers serve as advocates, counsellors, and facilitators within the educational system. Their dedication and expertise contribute significantly to creating a positive and supportive school environment, empowering students to achieve their full potential and lead fulfilling lives (Parallel Learning, 2023 ). Findings also identified the absence of professional mental care providers as a barrier to accessing mental care services. This has implications for social work practitioners whose primary mental health service in schools includes counselling and collaboration with school and community-based partners (Childs & Iachini, 2024 ). School social workers are integral to the school mental health workforce and the leading social service providers in educational settings (Ding et al., 2023 ). Since social workers are experienced in handling issues such as trauma and perceptions of student engagement and professional collaboration (Watson et al., 2022 ; Capp et al., 2021 ), they are best suited to assume the role of providing mental care services to students within secondary schools. They also maintain collaboration with mental health care professionals inside the school to share resources, holding student triage meetings, and regularly communicating about student and family needs (Polizotto & Zinn, 2021 ). Social workers have a role in addressing the issue of religious belief, since findings from the study identified it as a barrier to accessing mental care among students. School social work interventions and services targeted high-needs students to improve their social, mental/behavioural health, followed by primary and secondary prevention activities to promote school climate, school culture, belief system, teacher, student, and parent interactions, and parents’ wellbeing (Ding et at., 2023). School social workers have a critical role in decreasing barriers to accessing school-based mental health services, particularly religious belief (Murphy et al., 2025). This is relevant to spiritual/religious clients faced with mental health challenges. In working with these clients, social workers are informed by holistic practice principles, and both the research and lived experiences of clients on the impacts of spirituality/religion on mental well-being (Smith & Read, 2025 ). People draw strength and comfort from their religion to support mental health. Religious/spiritual practices and beliefs are identified as effective mental health strategies (Malviya, 2023 ). Social workers must foster collaboration with religious leaders in mental health care and integration of religious/spiritual practices into mainstream mental health interventions. This may improve mental health care for people with religious beliefs (Smith & Read, 2025 ; Malviya, 2023 ). Finally, findings from the study revealed a lack of effective mental health care facilities as a barrier to accessing mental care services among students. This implies social workers who can carry out school-based mental health programs, such as crisis intervention and counselling, directly in schools, reducing the need for students to travel to clinics outside the school and advocating for the incorporation of mental health services into school structures so quality support is available and accessible to students at the point of need (Ding et al., 2023 ). Social workers can coordinate and mobilise community and external agency partnerships to link students and families with specialised treatment providers, bring in additional support services and help navigate barriers such as scheduling, transportation, and cost, which are mostly compounded by facility shortages (The University of Texas at Arlington, 2024 ). Limitations of the study The researcher acknowledges a couple of limitations of this study. First, the limited sample size (12 participants). This restricts the generalizability of the findings, coupled with the fact that the study was restricted to just six government secondary schools within Abuja, as these schools were purposively selected by the researcher to capture diverse view contexts regarding barriers to accessing mental health services among students. Therefore, the researcher encouraged similar studies in private secondary schools within Abuja. Secondly, the fact that the views of school administrators, teachers, mental health practitioners, and family members were not captured in this study accounts for just one-sided perspectives. Hence, subsequent studies should capture the views of school administrators, teachers, mental health practitioners, and family members to provide a robust understanding of barriers to mental care services. Further studies should consider institutional barriers to accessing mental health services. Such findings will provide more insights into the concerns that will amplify calls for workshops and seminars by social workers to enlighten people on the risk factors associated with accessing mental health services. Notwithstanding, findings from this study remain relevant to students, school administrators, teachers, social workers, policymakers and stakeholders in Nigeria. All should make efforts to ensure mental health services are available and accessible for secondary school students. Conclusion In conclusion, the study explored barriers to accessing mental health care for secondary school students in Abuja, Nigeria and practice considerations for social work, contributing to an in-depth understanding of the prevalence of mental health challenges among secondary school students and barriers to accessing quality mental health services. Findings from the study revealed a high prevalence of mental health challenges among government secondary students resulting from stress and burnout arising from course overload, unhealthy competition among students, lack of awareness and knowledge on how to manage their mental wellbeing and high expectations from parents, friends and classmates. Further findings also identified barriers to accessing mental health services, including (a) absence of professional care providers, (b) required cost, (c) religious beliefs and (e) lack of effective mental health care facility. The study also revealed strategies to improve access and utilisation of mental health care, such as (a) providing experts in mental health care, (b) establishing mental health care facilities, (c) public education and enlightenment and (d) adopting culturally-based psycho-education. These findings have implications for social workers who play a critical role in bridging the gaps in mental health services, providing essential support that helps students thrive academically, socially, and emotionally. Social workers serve as advocates, counsellors, and facilitators within the educational system; integral to the school mental health workforce and the leading social service providers in educational settings. Declarations Disclosure statement No potential conflict of interest was reported by the author(s). Funding The author(s) reported there is no funding associated with the work featured in this article. Author Contribution G.C.N. conceived and designed the study, conducted the literature review, collected and analyzed the data, and wrote the original draft of the manuscript. G.C.N. reviewed and approved the final version of the manuscript and takes full responsibility for its content. Acknowledgement I wish to thank Dr. Onalu Chinyere and Dr. Ajibo Henry, all lecturers in the Social Work Department, University of Nigeria, Nsukka, for their guidance and encouragement. References Aboagye, R. G., Seidu, A. A., Hagan Jr, J. E., Frimpong, J. B., Budu, E., Adu, C., & Ahinkorah, B. O. (2021). A multi-country analysis of the prevalence and factors associated with bullying victimisation among in-school adolescents in sub-Saharan Africa: evidence from the global school-based health survey. BMC psychiatry , 21 (1), 325. ACReSAL (2024). About the Federal Capital Territory (FCT). ACReSAL. https://acresal.gov.ng/states/fct/ Adeosun, I., Adegbohun, A., Peters, T., Jeje, O., Bello, A., & Manuwa, O. 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Social support and adolescent mental health in Kenya: a parallel mediation analysis of perceived control and gratitude. Frontiers in Paediatrics , 13 , 1626249. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8623395","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588467831,"identity":"fca1ce37-7911-455b-aeda-e8e0a00c6b95","order_by":0,"name":"Gerald Chigozie Nweke","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYLCCB2xAgoeB8QGI4iNKSwJEC7MBiGIjRQubBIhDUIu8e+/DDwlldxL7eQ4fq/yaYyfDxsD88NENPFoMzxw3lkg49yxxZm9b2m3ZbclAh7EZG+fg0zIjjUEise1w7obzPGa3JbcxA7XwsEnj1TL/GfMPkJb95/m/FUtuqyesRV6CjQ1iC28PG+PHbYcJazHgSWOzSDh3uH7GmWPG0ozbjvOwMRPwi3z7MeYbH8oOG/P3JD/8+HNbtT0/e/PDx3htOYDEYeYBk3iUg21pQOIw/iCgehSMglEwCkYmAACAEkgm1qhNAQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Nigeria","correspondingAuthor":true,"prefix":"","firstName":"Gerald","middleName":"Chigozie","lastName":"Nweke","suffix":""}],"badges":[],"createdAt":"2026-01-17 04:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8623395/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8623395/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102748097,"identity":"3dca046a-c181-488b-b559-55102403bbdb","added_by":"auto","created_at":"2026-02-16 09:05:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1106223,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8623395/v1/dfd765d9-444a-49c3-8be0-349c833a46d4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"When Help Is Far Away: Barriers to Accessing Mental Health Care for Secondary School Students in Abuja, Nigeria, and Implications for Social Work Practice","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health is a crucial aspect of overall well-being, encompassing the social, psychological, and emotional aspects of our lives (Kumar, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Mental health is a state of mental well-being that enables people to cope with the stresses of life, to realise their abilities, learn effectively, function well, and contribute to their communities (World Health Organisation [WHO], 2022b). It influences how we think, feel, and act (Zhang, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Children and adolescents are always at risk of developing mental health problems, especially vulnerable children facing poverty, discrimination and violence (WHO, 2021). Adolescence is a critical period of transition during which young people face significant physical, emotional, and social changes and are exposed to a range of difficult experiences, such as stigma, bullying, and other life stressors (Collins et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). An estimated 1 in 7 children and adolescents aged 10 to 19 are affected by mental health conditions, with anxiety, depression, and behavioural disorders among the most common. With one-third of mental health conditions emerging before the age of 14 and half before the age of 18, early action is essential to enable children and young people to thrive and realise their full potential (WHO \u0026amp; UNICEF, 2024). The lack of access to basic social, health and education services, combined with wide-reaching structural inequalities, is known to aggravate risks for mental ill-health (WHO, 2021). Undiagnosed and untreated mental health conditions can create negative outcomes with long-term impacts that can span a lifetime and affect the health, education, and livelihood outcomes of future generations (WHO, 2022a).\u003c/p\u003e \u003cp\u003eGlobally, the mental health scenario is characterised by the prevalence of mental disorders and the limited existence of formal care services (Coronel-Santos \u0026amp; Rodr\u0026iacute;guez-Mac\u0026iacute;as, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Globally, it is estimated that one in seven (14.3%) of 10\u0026ndash;19-year-olds experience mental health conditions, yet these remain largely unrecognised and untreated (WHO, 2025). There are concerning trends about the mental health of U.S. high school students, with 4 in 10 (40%) students having persistent feelings of sadness or hopelessness; 2 in 10 (20%) students seriously considered attempting suicide, and nearly 1 in 10 (9%) attempted suicide (Centres for Disease Control and Prevention, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Findings from Li et al. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) revealed that mental health problems among secondary school students in Guangdong, China, are alarming: A total of 8,013 secondary school students were studied. The prevalence of abnormal mental health was 22.4% by the Mental Health Inventory of Middle School Students (MMHI-60), 19.7% by the School Refusal Behaviour Evaluation Scale (SRBES), 5.4% by the Revised Chinese Internet Addiction Scale (CIAS-R), and 20.3% by the Adolescent Suicide Tendency Scale (ASTS), respectively. Among 102,072 students (48.3% boys and 51.7% girls), aged between 11 and 19 years in Brazil, Escobar et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) reported risk behaviours including substance use, sedentary lifestyle, sexual behaviour, and suffering violence and bullying. Also, across 50 countries (including Europe, America, and Oceania), in a study involving school-aged children, focusing on the role of education, socioeconomic status, and school-based health programs, findings from Alshahrani et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) highlight that those nations with comprehensive public health policies report better mental wellbeing, whereas regions with limited resources, experience greater health inequalities. Given these findings, in-school programs focused on improving mental health outcomes should be developed. It is necessary to promote a healthy environment for students, with easy access to counselling from mental health care professionals.\u003c/p\u003e \u003cp\u003eOn average, African governments allocate less than 50 US cents per capita to mental health, well below the recommended US\u003cspan\u003e$\u003c/span\u003e 2 per capita for low-income countries (WHO, 2022a). Public funding and human resources for mental services in general are low. Mental health services aimed at children and young people are practically non-existent, especially in low- and middle-income countries in Africa (WHO \u0026amp; UNICEF, 2024). Among secondary students in Tigray Region, Ethiopia, Gebremedhin et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) reported a prevalence of psychological distress at 34.9%, current alcohol use [AOR\u0026thinsp;=\u0026thinsp;3.08; 95% CI: (1.64, 5.77)], physical fight [AOR\u0026thinsp;=\u0026thinsp;2.99; 95% CI: (1.69\u0026ndash;5.28)], contact sexual abuse [AOR\u0026thinsp;=\u0026thinsp;2.37; 95% CI: (1.23, 4.55)], non-contact sexual abuse [AOR\u0026thinsp;=\u0026thinsp;1.91; 95% CI: (1.04, 3.49)], and being bullied [AOR\u0026thinsp;=\u0026thinsp;1.81; 95% CI: (1.03, 3.29)] were significantly associated with psychological distress. Among adolescents in Kenya, Johnson et al. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) reported depression and anxiety symptoms and the need for mental health services. Furthermore, using data from the Global School-based Health Survey (GSHS) from 2010 to 2017 of eleven sub-Saharan African countries, with a sample of 25,454 in-school adolescents, Aboagye et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) reported bullying victimisation affected 38.8% of adolescents overall\u0026mdash;ranging from 22.2% in Mauritius to 54.6% in Sierra Leone\u0026mdash;and was more likely among younger adolescents experiencing loneliness, anxiety, suicidal behaviours, marijuana use, and truancy. Despite this high burden, the availability and quality of mental health services for children and adolescents in Africa are greatly lacking (WHO, 2021).\u003c/p\u003e \u003cp\u003eAdolescents in Nigerian secondary schools are confronted with high expectations and societal demands, which may place serious burdens on them (Oke et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In Rivers state, Onyechi and Adeniji (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) found that 26.5% of adolescents reported experiencing suicidal thoughts, with a slightly higher prevalence in rural areas (26.9%) compared to urban areas (26.0%). In Lagos state, loss of interest (29.6%), symptoms were \"having no close friend in school\" (OR 2.66, 95% CI 2.08\u0026ndash;3.41), \"diagnosis of depression\" (OR 1.33, 95% CI 1.09\u0026ndash;1.63) (Adewuya et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In Oyo state, the pervasive influence of insecurity on secondary school students\u0026rsquo; daily lives and mental health is reported: heightened levels of fear, anxiety, and stress due to various security challenges such as communal conflict, raping, maiming and killings through violent clashes; compounded by a sense of vulnerability and uncertainty about personal safety, which significantly affected their ability to concentrate on academic tasks and engage effectively in school activities (Oluokun \u0026amp; Okediji, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Also, in Bauchi, North-East Nigeria, among in-school adolescents, 0.7% were moderately severely depressed. Most respondents (88.7%) had minimal anxiety, while 1.5% and 0.3% had moderate and severe anxiety, respectively. Almost one-quarter of the respondents (23.2%) had thought of ending their life in the past month before the survey, with up to 4.2% attempting suicide (Mohammed et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Most in-school adolescents lack knowledge, have a poor attitude towards mental health and are more likely to display conduct problems impacting their mental health status (Olowe et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). These findings highlight the need for targeted interventions to address the unique challenges faced by adolescents, aiming to reduce the prevalence of mental health challenges and promote healthier coping strategies.\u003c/p\u003e \u003cp\u003eSeveral factors are responsible for the rise in poor mental health and mental illness among secondary school students. Some factors include verbal, physical and social bullying (Liu et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Han et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), academic pressure (Steare et al., \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), low socioeconomic status of parents and low parental education (Stea et al., \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), frequent social media use, persistent feelings of sadness or hopelessness, and some suicide risk (considering attempting suicide and having made a suicide plan) (Young, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), father\u0026rsquo;s education, mother's education and grade rank (Li, et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), family status and practices, peer relationships and school climate (Lin \u0026amp; Guo, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), social inclusion and parental expectations (Fassl et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), sexual abuse, physical neglect and physical abuse (Edet et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), stressful situation and disappointed by boy/girl-friend (Nwankwo et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), family size and parental occupations (Bede, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Despite the high prevalence of mental illnesses, mental health remains underprioritized in many African countries (WHO, 2022a). The rise in adolescent mental health conditions highlights the need for interventions, particularly in schools, for timely access to young people, building on inherent strengths and competencies (Olowe et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome factors serve as barriers to mental health care services in Nigeria. Despite the clear need for action, access to mental health care services for children and young people remains inadequate (WHO \u0026amp; UNICEF, 2024). Mental health care services in Nigeria consist mainly of large government psychiatric hospitals (Chijioke et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Poor access to mental health care due to low government investment is one of the major hurdles to prevention and care services (WHO, 2022a). Healthcare workers have insufficient knowledge of child and adolescent mental health, hold negative attitudes toward children and adolescents with mental health problems, and exhibit poor practices related to child and adolescent mental health (Mkubwa et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Limited mental health education and awareness, shame and stigma, name-calling, ridicule, and chastisement are also barriers that people with mental illnesses face in communities (WHO, 2022a; Adeosun et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The majority of young people experiencing mental health symptoms do not access care due to systemic barriers such as low service availability and unaffordable costs (WHO \u0026amp; UNICEF, 2024). Other factors include poor education, ignorance, absence of services in rural communities, waiting time at the facilities, bureaucracy in treatment and poor information management, high cost of service, travel distance, feelings of shame and loss of productive income (Chijioke et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsequences associated with untreated mental illness have several implications. Untreated mental illness could lead to problems with family and friends as well as to suicidal thoughts (Ibrahim et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); the presence of chronic illnesses, depression, anxiety, behavioural disorders, and psychotic-like experiences was associated with adolescent suicidal behaviour (Nwankwo et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Adewuya \u0026amp; Oladipo, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The consequences of failing to address adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults (WHO, 2025). All mental health challenges resulting from abuse types predicted various deliberate self-harming behaviours (Edet et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Poor knowledge (62.2%), poor attitude (54.7%) and being substantially at risk of conduct problems (Olowe et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Adolescents with mental health conditions are particularly vulnerable to social exclusion, discrimination, educational difficulties, risk-taking behaviours, physical ill-health and human rights violations (WHO, 2025). Mental health interventions to prevent trauma and screen for mental disorders among secondary school students should be instituted in Nigeria.\u003c/p\u003e \u003cp\u003eSocial work is a helping profession that has the power to improve people\u0026rsquo;s lives on an individual, family, group, and community level (Wahab \u0026amp; Manjunathswamy, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Social workers are integral to the school mental health workforce and the leading social service providers in educational settings (Ding et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Social workers in school settings are known for their functions to evaluate students\u0026rsquo; needs and provide interventions across the ecological systems to remove students\u0026rsquo; learning barriers and promote healthy sociopsychological outcomes (Huxtable, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). School social workers are professionally-responsible for services, including trauma-informed care, social\u0026ndash;emotional learning, and restorative justice programs in school mental health services (Gherardi, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Crutchfield et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Elswick et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Social workers in school settings provide counselling to students with mental health issues and serve as facilitators in providing mental health care services, including collaboration with school and community-based partners (Childs \u0026amp; Iachini, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). While psychologists, teachers, school nurses, and school administrators are key determinants of service use to develop strategies for adolescent mental health assessment (Grunin et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), school social workers offer direct and indirect assistance to students, families, and school personnel (Wahab \u0026amp; Manjunathswamy, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Social workers in schools play a vital role in promoting mental health among students by addressing social, emotional, and behavioural challenges; bridging the gap between academic demands and students' emotional needs by offering tailored interventions that promote mental health care (Sankpal, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Adolescents in schools are the least likely to seek help for their mental health problems. School may be an important route to improve early recognition of adolescents with mental health problems in need of support (Beukema et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Thus, most school social work interventions and services target high-needs students to improve their social, mental/behavioural health, and academic outcomes, followed by primary and secondary prevention activities to promote school climate, school culture, teacher, student, and parent interactions, and parents' wellbeing (Ding et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLiterature reviews in Nigeria related to mental health are few. Most studies focused on knowledge and attitude to mental health (Olowe et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), predictor factors such as suicide ideation, depression, insecurity (Nwankwo et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Edet et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Adewuya \u0026amp; Oladipo, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Oke et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Mohammed et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Oluokun \u0026amp; Okediji, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), psychotic experiences and health-seeking behaviours (Adewuya et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Onyechi \u0026amp; Adeniji, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), among others. While these studies are commendable, none of them focused on barriers to accessing mental health care for secondary school students. Thus, this current study will be different. The present study investigates barriers to accessing mental health care services for government secondary school students in Abuja, Nigeria and practice considerations for social work. We analysed (a) the prevalence of mental health challenges; (b) barriers to accessing mental health care services; and (c) strategies to improve access and utilisation of mental health care services. It is believed that findings from this study will provide information on the roles of social workers in advocating for student mental well-being and how they collaborate with other important key stakeholders to achieve this. This study also hopes to identify and highlight the importance of social workers as service providers to the multidisciplinary team in ensuring and providing relevant mental health care services to secondary school students.\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area\u003c/h2\u003e \u003cp\u003eThe study was carried out in Abuja, the Federal Capital Territory (FCT) of Nigeria, located in the central region of the country and regarded as the seat of the federal government and a rapidly growing urban centre within the West African region. The FCT covers an area of approximately 8,000 square kilometres and is administratively divided into six Area Councils: Abaji, Abuja Municipal (AMAC), Bwari, Gwagwalada, Kuje, and Kwali, each with both urban and peri-urban communities (ACReSAL, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; FCDA, 2025). Abuja hosts a large and diverse population because of its status as the nation\u0026rsquo;s capital, resulting in growing demand for education and social services; the FCT Education Secretariat coordinates policy formulation and implementation of educational services across all levels, including secondary education in public schools (FCT Education Secretariat, n.d.).\u003c/p\u003e \u003cp\u003eWithin the FCT, government secondary schools form a significant component of the formal education system, catering to thousands of adolescents aged roughly 13\u0026ndash;18 years. According to the FCT Secondary Education Board (n.d.), there are about 90 public secondary schools with nearly 89,000 enrolled students and over 4,000 academic staff, serving diverse communities across the six Area Councils (FCT Secondary Education Board, n.d.-b). These schools represent assorted settings\u0026mdash;ranging from rural-fringe schools in councils like Abaji and Kwali to densely populated urban schools in Abuja Municipal Area Council\u0026mdash;making the FCT an ideal study area to explore barriers to accessing mental health care in the context of government secondary school environments where support services, resources, and education quality and may vary significantly (The Guardian, 2023).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling Procedure\u003c/h3\u003e\n\u003cp\u003eA multi-stage stratified purposive sampling technique was adopted to ensure analytical depth, geographical, and contextual diversity and representation across the six Area Councils of the FCT: Abaji, AMAC, Bwari, Gwagwalada, Kuje, and Kwali. In the first stage, one government secondary school was purposively selected from each Area Council, resulting in six schools. The selected schools were: Government Secondary School (GSS) Yaba Abaji, GSS Nyanya (AMAC), GSS Kubwa (Bwari), GSS Gwagwalada, GSS Kuje, and GSS Kwali. These schools were selected based on three scientific criteria: (i) location within distinct urban, peri-urban, and semi-rural settings to capture structural differences in access to mental health services, (ii) official ownership by the FCT Secondary Education Board, and (iii) enrolment of mixed-gender adolescent students. Purposive school selection is appropriate in qualitative health research where contextual variation is essential for understanding service access barriers rather than statistical generalisation (Palinkas et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The administrative structure and distribution of public secondary schools across the six Area Councils are officially documented by the FCT Secondary Education Board (n.d.-b), validating the sampling frame used.\u003c/p\u003e \u003cp\u003eIn the second stage, two students were selected from each school, yielding a total of 12 participants for the in-depth interviews (IDI). Selection within schools was based on a gender-stratified purposive sampling method, with one male and one female student selected from each school to ensure gender balance and reduce systematic gender bias in perceptions of mental health care access. Eligible participants were adolescents aged from 13 to 18 years, enrolled in senior secondary classes (SS1 to SS3), who demonstrated awareness of mental health service barriers, as identified through referrals from senior teachers or school counsellors. Additional criteria included willingness to participate and ability to articulate experiences during interviews. Gender stratification is widely recommended in adolescent mental health research since gender-specific mental health care can be a promising approach to meet gender-specific mental health needs (Herrmann et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Fine et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Selecting an equal number of participants from each school enhances comparability across settings, while the total sample size of 12 is methodologically appropriate for achieving thematic saturation in qualitative interview studies (Guest et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Hennink et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This sampling approach is therefore context-sensitive, well-suited and robust for exploring in-depth insights into barriers to accessing mental health care among government secondary school students in Abuja.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eA semi-structured in-depth interview (IDI) schedule was used for data collection. This enabled the researcher to explore barriers to accessing mental health care among government secondary school students in Abuja. Semi-structured interview is widely recognised in qualitative research for providing flexibility, depth and participant-guided narratives while still maintaining a systematic structure guided by pre-designed prompts (Creswell \u0026amp; Poth, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Tisdell et al., \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). An interview guide was developed based on the research questions on barriers to accessing mental health care. Participants were provided with consent forms where clear explanations regarding the study and participation were made, and were assured that their responses would be used for academic purposes only. Interviews were conducted face-to-face within the school settings of participants during break hours. Each interview lasted between 35 and 40 minutes, depending on the participant\u0026rsquo;s availability and willingness to elaborate. All interviews were conducted in English, the dominant language of the residents of Abuja and the dominant language used in teaching secondary school students within Abuja. To ensure trustworthiness, the researcher established rapport with participants before data collection, emphasised confidentiality, and allowed them to narrate experiences freely. With participants\u0026rsquo; informed consent, all interviews were audio-recorded using a digital recorder and later transcribed verbatim for analysis. Field notes documenting non-verbal cues and contextual observations were also taken to support the interpretation of the interview data (Nowell et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The researcher contacted and interviewed participants using questions like (a) what is the prevalence of mental health challenges? (b) What are the barriers to accessing mental health care services? and (c) what are the strategies to improve access and utilisation of mental health care? The combination of rich verbal accounts, contextual reflections, and systematic transcription enhanced the credibility and depth of the dataset. The study was conducted between August and November 2025.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data gathered from the semi-structured in-depth interviews (IDI) were analysed using thematic analysis, following the six-phase framework proposed by Braun and Clarke (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). All interviews were audio-recorded with participants\u0026rsquo; consent and subsequently transcribed to ensure accuracy and retention of the participants\u0026rsquo; original perspectives. The transcribed interviews were imported into Nvivo12 software; it was read while being coded, and as the themes emerged, the researcher reviewed them to enhance familiarisation, consistency and frequency. After familiarisation, the transcripts were manually coded using an inductive approach. Codes were developed to represent meaningful units of data relating to the prevalence of mental health challenges, barriers to accessing mental health care services and strategies to improve access and utilisation of mental health care. Similar codes were then collated into broader themes that captured patterned meanings across participants. These themes were reviewed, refined, and defined to ensure that they adequately reflected the data and addressed the study objectives. The final results were presented in a narrative form supported by direct quotes, presented in various themes, thereby ensuring an authentic representation of barriers to accessing mental health care among secondary school students in Abuja. These themes emerged from the analysis but were guided by the research objective of this study. The occurring and recurring themes included the prevalence of mental health challenges, barriers to accessing mental health care services and strategies to improve access and utilisation of mental health care.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for this study was obtained from the Research Ethics Committee of [blinded for review]. All participants were informed about the aim of the study, assured of anonymity, and provided informed consent prior to participation. Participation was voluntary, and respondents were free to withdraw from the study at any point without any consequences.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of participants\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClass\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eArea Council\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSchool type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLiving Arrangement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHousehold economic perception\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAbaji\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eBoarding School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBoth Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eManageable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAbaji\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eBoarding School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSingle Parent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDifficult\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAMAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDay School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBoth Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eComfortable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAMAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDay School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGuardian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDifficult\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBwari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eBoarding School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGuardian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eManageable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBwari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eBoarding School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBoth Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eManageable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eGwagwalada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDay School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSingle Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eManageable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eGwagwalada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDay School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBoth Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eManageable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eKwali\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDay School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBoth Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDifficult\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eKwali\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDay School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBoth Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDifficult\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eKuje\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDay School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBoth Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eManageable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eKuje\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDay School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBoth Parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eManageable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe socio-demographic profile of the 12 respondents revealed that gender was equally represented, with 6 females (50.0%) and 6 males (50.0%), ensuring balanced gender perspectives in understanding barriers to accessing mental health care among government secondary school students in Abuja. Data from the age distribution showed that most respondents were aged 16 years, 4 respondents (33.3%), followed by 15 years, 3 respondents (25.0%), and 17 years. 2 respondents (16.7%), 18 years, 2 respondents (16.7%), 14 years, and 1 respondent (8.3%), align with typical senior secondary school age ranges. The area council distribution was evenly spread, with two respondents (16.7%) each from Abaji, AMAC, Bwari, Gwagwalada, Kwali, and Kuje, ensuring geographic balance across the FCT. With respect to class level, SS3 students constituted the largest group, 6 respondents (50.0%), followed by SS2 students, 5 respondents (41.7%), and SS1 students, 1 respondent (8.3%), indicating greater representation of senior students who may experience heightened academic and transition-related stress. Regarding school type, the majority attended day schools, 8 respondents (66.7%), while four respondents (33.3%) were enrolled in boarding schools, a factor that may influence access to family-based support and external mental health services. Concerning religion, Christianity was predominant: 8 respondents (66.7%), while Islam constituted 4 respondents (33.3%), reflecting the religious diversity of the FCT and its relevance to mental health perceptions and help-seeking pathways. About living arrangements, most respondents lived with both parents, 8 respondents (66.7%), which may imply greater potential access to emotional and financial support, whereas two respondents (16.7%) lived with a single parent and another two (16.7%) lived with guardians, arrangements often associated with increased psychosocial stress among adolescents. Finally, for the household economic perception, the majority of students described their household situation as manageable, 7 respondents (58.3%), indicating moderate financial stability, while four respondents (33.3%) reported difficult economic conditions, and only one respondent (8.3%) suggested a comfortable household situation, indicating the presence of economic vulnerability among a substantial proportion of participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe prevalence of mental health challenges among students\u003c/h3\u003e\n\u003cp\u003eAll participants affirmed the prevalence of mental health challenges among students, as academic activities come with lots of challenges that might put the mental well-being of students at risk. Some respondents were of the view that mental health challenges are prevalent as a result of stress and burnout arising from course overload. Comments from participants include:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 15-year-old male student from Abaji said:\u003c/p\u003e\u003cp\u003eMental health issues are everywhere, and students feel stressed out from course overload, reading and assignments. Students are often tired, and this further results in sleeping, burnout and mental exhaustion even when lectures are ongoing. When the course load is too demanding, we experience too much stress that leaves us emotionally exhausted.\u003c/p\u003e\u003cp\u003eA 14-year-old female student from AMAC added:\u003c/p\u003e\u003cp\u003eStress is a common challenge we experience because we are mandated to come to class, do our assignments and practicals on time. Most time it is so exhausting, but we are expected to do it. Most teachers do not even care how we feel about these academic demands; they only mandate us to do it, even when we have shown signs of being overwhelmed.\u003c/p\u003e\u003cp\u003eAn 18-year-old female student from Gwagwalada further commented:\u003c/p\u003e\u003cp\u003eMental health challenges are prevalent here because of truancy. Many students skip attendance because of psychological problems like mental exhaustion. They think they can't cope with academic activities because of how demanding they are. This is an issue which the school management has yet to address.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome of the participants were of the view that the prevalence of mental health challenges among students arises as a result of unhealthy competition among students. Students often compare their academic grades (low or high), financial status and relationship status (especially rejection) with that of their classmates. This often results in an uneven advantage that leaves many students depressed, affecting their self-esteem. Some responses include:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 17-year-old female student from Bwari revealed:\u003c/p\u003e\u003cp\u003eStudents these days overthink. They are always comparing themselves and competing with one another. This has resulted in an inferiority complex and low self-esteem. This has constituted a serious mental health challenge among students as it often leaves the student at the low end depressed, and subsequently results in low self-esteem.\u003c/p\u003e\u003cp\u003eAn 18-year-old female student from Gwagwalada added:\u003c/p\u003e\u003cp\u003eMental health issue arises also from rejection of advances in friendships and relationships among students. A student once attempted suicide because a female student rejected his advances for a relationship. There are also other reasons for its prevalence. Low grade is another factor, as students with low grades often have a low assessment of themselves and their ability.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eEvidence from data from participants further associated the increase in mental health challenges among students with a lack of awareness and knowledge on how to manage their mental well-being. These include not knowing when to rest and take a break from academic activities, and resorting to relaxation for some time. Views from participants include:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAn 18-year-old female student from Kuje commented:\u003c/p\u003e\u003cp\u003eMental health challenges are on the rise because of a lack of knowledge and understanding of one's Mental health. Many students do not know how to maintain and manage their mental well-being. They don't know when to rest, how to avoid depression, pressure and other risk factors associated with the rise in mental health challenges.\u003c/p\u003e\u003cp\u003eA 15-year-old male student from Kuje also added:\u003c/p\u003e\u003cp\u003eMost times, students lack the knowledge of how to set realistic expectations for their academics and social relationships. Most often, students are encouraged to set goals, but are not taught how to set reasonable and attainable academic and relationship goals. Lack of this knowledge results in students setting unrealistic goals, which leads to failure. Failure to realise these goals results in mental health challenges like depression.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome views from participants also associated the prevalence of mental health challenges among students with expectations. These include expectations from parents, friends and classmates. Many parents/guardians place huge expectations on their children to attain good grades. Failure to attain such academic grades results in parents being disappointed. Some participants revealed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 15-year-old male student from Abaji said:\u003c/p\u003e\u003cp\u003eA serious factor responsible for the rise in mental health issues is expectations from parents and friends. This puts undue pressure on students to attain high grades. Most students experience pressure to perform well, resulting from expectations from parents, family members and friends. This has resulted in students\u0026rsquo; breakdown, especially when they realise they have failed to attain such heights.\u003c/p\u003e\u003cp\u003eA 16-year-old male student from Kwali further added:\u003c/p\u003e\u003cp\u003eMental health challenges among many students can be directly linked to failure to realise the high expectations placed on students by their parents. While this expectation can boost our motivation to aspire for good grades, it can affect our concentration because we also need recreation and rest to cool off our brains. This has resulted in students overworking themselves, making them vulnerable to mental exhaustion and overlabour.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eBarriers to accessing mental health care services\u003c/h2\u003e \u003cp\u003eParticipants shared several risk factors serving as barriers inhibiting access to mental health care among students. These factors prevent students from seeking mental health care services. Some of these barriers include: (a) absence of professional care providers, (b) required cost, (c) religious beliefs, (d) fear of mockery, (e) lack of effective mental health care facility, and (f) preferences of non-formal healing rituals. We present data explaining these factors below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAbsence of professional care providers\u003c/h2\u003e \u003cp\u003eData from participants revealed that the lack of professional care providers is a serious barrier associated with accessing mental health care services. This indicates a lack of experts in the area of mental health care. Some participants had this to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 15-year-old male student from Abaji revealed:\u003c/p\u003e\u003cp\u003eMost mental health care services are provided by teachers playing the role of counsellors or mental healthcare practitioners. Most teachers resort to beating students in need of mental care. This results in students\u0026rsquo; hesitancy to approach mental care services. They withdraw because they are afraid of experiencing ill-treatment from teachers acting as mental health care practitioners.\u003c/p\u003e\u003cp\u003eA 15-year-old male student from Bwari added:\u003c/p\u003e\u003cp\u003eThere are no mental health practitioners available to provide mental health care to students. Even when students have increasingly shown signs of mental health challenges like depression and burnout, mental health care professionals are lacking. Students are mostly referred to other settings that seem exhausting. This discourages students from considering mental health care.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRequired cost\u003c/h2\u003e \u003cp\u003eSome participants also revealed that accessing mental health care costs some money, an extra fee aside from tuition fees that parents/guardians mostly cannot afford to pay. Many students are already faced with economic difficulty. Incurring an extra fee as a mental health care cost appears difficult to incur. Some participants revealed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 17-year-old female student from AMAC commented:\u003c/p\u003e\u003cp\u003eWe do not have extra money to pay for mental health care services. They cost a lot. Our parents still struggle to pay our tuition fees. Most times, it takes several weeks after resumption for parents to pay the tuition of their children. Incurring an extra fee for mental health care services is really challenging.\u003c/p\u003e\u003cp\u003eA 16-year-old female student from Abaji added:\u003c/p\u003e\u003cp\u003eEverything requires money in this school. Students are only allowed access to care if they have paid their school fees. Access to care, whether medical, psychological or otherwise, is prohibited for students who haven't paid their fees. In addition, there is an extra service fee for accessing mental of medical care. Not every parent can afford these extra fees.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eReligious belief\u003c/h2\u003e \u003cp\u003eSome participants also revealed that there is a need for mental healthcare, as they strongly resort to their belief that God will care for any mental challenge or illness through prayer and faith in Him. These participants do not see the need for mental health care as they solely rely on their faith. Views include:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 15-year-old male student from Bwari commented:\u003c/p\u003e\u003cp\u003eThe religious belief factor constitutes a serious barrier to accessing mental health care. This results from the belief that mental health can't be cured by professional services but through prayer and fasting, believing and waiting on God. This has prevented many students from considering mental health care services. It appears they do not see the need for it.\u003c/p\u003e\u003cp\u003eA 16-year-old female student from Kwali added:\u003c/p\u003e\u003cp\u003eI am a Christian; I believe in God\u0026rsquo;s healing power. There is nothing God can\u0026rsquo;t do. He is always here to heal me from any mental challenges resulting from my academic stress. I do not see the need for mental health care. Unless for other students who do not believe in God.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFear of mockery\u003c/h2\u003e \u003cp\u003eSome participants revealed that their fellow students will make fun of them once they admit to having mental health challenges. This view stems from the perception that males are expected to portray courage and bravery in handling life\u0026rsquo;s situations, compared to females presumed to show emotions. Responses from participants include:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 17-year-old female student from Bwari revealed:\u003c/p\u003e\u003cp\u003eMany male students do not want to open up when they have mental health issues. They believe they will be mocked or belittled among their classmates (fellow males and females, too). They fear being labelled weaklings, not manly or brave enough. They associate the presence of mental health challenges with weakness. Thus, they desist from showing any sign of needing mental health care.\u003c/p\u003e\u003cp\u003eA 16-year-old male student from Gwagwalada further added:\u003c/p\u003e\u003cp\u003eMost times, we male students do not like showing any sign of stress, tiredness or being depressed. It mostly means we are showing weakness, and female students see it as a sign of losing our bravery and masculinity. So, it may not be well for male students to show a sign of needing mental health care or psychological support. We are rather expected to give it.\u003c/p\u003e\u003cp\u003eA 16-year-old male student from Kwali also commented:\u003c/p\u003e\u003cp\u003eOne barrier could be cultural pressure to conform to gender roles. Boys are expected to be strong, brave and courageous. They always try to conform to this cultural expectation even when doing so is to their detriment. Desiring to opt for mental care is regarded as a sign of weakness.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLack of an effective mental health care facility\u003c/h2\u003e \u003cp\u003eEvidence from participants also revealed that students do experience a need for mental health care because of the absence of an effective mental health care facility. There are no established building of unit designated specifically to render services related to mental care within the school premises. Responses from participants revealed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 16-year-old male student from Gwagwalada commented:\u003c/p\u003e\u003cp\u003eLack of an effective mental health care facility within the school setting is a serious barrier. There are no designated buildings or facilities saddled with the responsibility of ensuring the mental well-being of students. Once a student shows signs requiring effective mental health care, they are often moved out of the school to some other place or hospital. This mostly adds to the exhaustion already experienced by the student. Thus, many students remain hesitant to communicate their mental health care needs.\u003c/p\u003e\u003cp\u003eAn 18-year-old female student from Kuje added:\u003c/p\u003e\u003cp\u003eIf students are to show willingness to receive or need mental health care, there ought to be an established facility to provide such service. But in our situation, there are none. No effective structure is equipped with the tools and manpower to provide mental health care. So, it has resulted in students\u0026rsquo; reluctance to consider the need for mental health care.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePreferences for non-formal healing rituals\u003c/h2\u003e \u003cp\u003eEvidence from data also revealed that students withdraw from mental health care because they believe in the potency of non-formal healing rituals. They prefer this method to clinical support. This results from the upbringing that the native pattern of healing has more potent power than clinical support. Some participants revealed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 15-year-old male student from Kuje said:\u003c/p\u003e\u003cp\u003eI think a non-formal approach to addressing mental health challenges is more effective than a clinical method or support. My parents also taught me, and we use different native patterns to address many health-related problems we have experienced in the past. I have preferences for non-formal healing rituals over formal clinical support. To me, seeking formal mental care services is a waste of time.\u003c/p\u003e\u003cp\u003eA 17-year-old male student from AMAC also added:\u003c/p\u003e\u003cp\u003eI do not think clinical support is more effective in addressing mental health challenges than non-formal ritual methods. Mental health challenges are complex most times; they are beyond clinical support. The non-formal ritual method is carried out by a traditionalist or herbalist who first uses a metaphysical source to enquire the cause of any challenge, and thereafter proffers immediate solutions to them.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStrategies for improving access and utilisation of mental health care\u003c/h2\u003e \u003cp\u003eParticipants also shared some ideas on ways to improve access and utilisation of mental health care among students. These strategies can help students understand the need and role of mental health care in the social, emotional and psychological well-being. These strategies include: (a) providing experts in mental health care, (b) establishing mental health care facilities, (c) public education and enlightenment, and (d) adopting culturally-based psycho-education. We present data explaining these factors below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eProviding experts in mental health care\u003c/h2\u003e \u003cp\u003eSome participants were of the view that the presence of an expert in mental health care would improve the access and willingness of students to receive mental health care. Experts understand their role and the effective way to render quality services. Some participants had this to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 15-year-old male student from Abaji said:\u003c/p\u003e\u003cp\u003eConcern and care from experts can help foster the willingness of students towards mental care services. Mental care practitioners should show empathy and concern for students with mental health challenges; they are already going through a lot. They should not adopt beating or scolding. They should provide support to students in need of mental care.\u003c/p\u003e\u003cp\u003eA 14-year-old female student from AMAC added:\u003c/p\u003e\u003cp\u003eOnce experts and mental health care professionals are available, I will certainly go to them and communicate my mental health challenges if I observe any. It shows me that they will understand my situation. Many teachers who are prompted to play the role of mental health care practitioners do not understand the mental needs of students.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eEstablishing mental health care facilities\u003c/h2\u003e \u003cp\u003eResponses from participants also revealed the need to establish mental health care facilities within the school setting to ensure easy access and utilisation of mental health care. These facilities must be equipped with tools and manpower. Views from participants include:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 16-year-old female student from Abaji revealed:\u003c/p\u003e\u003cp\u003eThe government should effectively establish and equip mental health care facilities for quality services and make them accessible to all students, irrespective of their family or economic status. All students should have equal rights and access to mental health care services. This will effectively encourage students to utilise them.\u003c/p\u003e\u003cp\u003eA 16-year-old male student from Gwagwalada added:\u003c/p\u003e\u003cp\u003eThe government must endeavour to provide adequate funds and appoint an effective committee to supervise the establishment of mental health care facilities and provide professionals and practitioners skilled in the area of mental health. These practitioners can collectively work with school authorities to ensure students\u0026rsquo; mental well-being is guaranteed.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ePublic education and enlightenment\u003c/h2\u003e \u003cp\u003eSome participants also revealed the need for enlightenment and reorientation. Most students do not understand the need for mental health care. Public enlightenment is key in promoting awareness of the effects and challenges posed by ignoring one\u0026rsquo;s mental well-being. Some participants commented:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 17-year-old male student from AMAC revealed:\u003c/p\u003e\u003cp\u003eStudents need to be enlightened on how mental well-being is achieved. This enlightenment can also be extended to parents and society at large. Public education and community enlightenment can be important to promote awareness of the need for mental care. Many students give excuses because they do not understand it is for their personal well-being.\u003c/p\u003e\u003cp\u003eA 15-year-old male student from Bwari added:\u003c/p\u003e\u003cp\u003eTeachers, parents and religious authorities must collaborate to educate students on the need for mental health care and the dangers of substituting it with prayer and fasting. Students should be enlightened that clinical support has its role in promoting general mental well-being.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eAdopting Culturally-based psycho-education\u003c/h2\u003e \u003cp\u003eViews from participants also highlight the need for adopting culturally-based psycho-education targeted at improving the general perception of mental health care. This will improve one\u0026rsquo;s disposition to mental health challenges and facilitate access and utilisation. Some participants had this to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA 16-year-old male student from Kwali said:\u003c/p\u003e\u003cp\u003eSome culturally-held assumptions that encourage students to believe that males are brave and should not show the need for mental health care must be addressed. Adopting a culturally-based psycho education targeted at students to change some of the cultural beliefs that are detrimental to mental wellbeing. This helps the students and the general public become aware of the threats associated with culturally-based beliefs in the area of mental well-being.\u003c/p\u003e\u003cp\u003eAn 18-year-old female student from Kuje added:\u003c/p\u003e\u003cp\u003eMany students don't know that mental health challenges are treatable to an extent, especially through clinical methods. Some believe in non-formal rituals for treating mental health challenges, while many believe mental health challenges have no cure; they perceive it as an untreatable illness. This has prevented them from seeking out mental health care services. This must be addressed with cultural reorientation. Students, especially parents, need to understand that clinical procedures have improved over the past years. They should be enlightened to embrace this improvement for their mental well-being.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study investigated barriers to accessing mental health care for secondary school students in Abuja, Nigeria and implications for social work practice. The study reveals a high prevalence of mental health challenges among secondary school students in Abuja. Findings from the study identified that one of the reasons for the prevalence of mental health challenges among students is stress and burnout arising from course overload and academic pressure. This aligns with the findings of Gao (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), who reported academic stress resulting in academic burnout. Concerning the impact of academic burnout on adolescents, Wang et al. (2019) further confirmed that academic weariness can lead to problematic behaviours such as absenteeism and school dropout. Haritay et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) also argued that academic stress is a significant risk factor for mental health development during adolescence, while Anand et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) found that academic stress results in moderate-to-severe anxiety. It is not a coincidence that views from respondents further confirm that stress and academic pressure significantly impact mental health and overall development. Findings also revealed unhealthy competition among students as a risk factor for the prevalence of mental challenges among students. This resonates with the findings of F\u0026uuml;l\u0026ouml;p et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), who reported mental challenges such as anxiety and school burnout were significantly higher in the competitive schools. Lu (2025) also found that grade had a certain impact on the emotional health of students. This leaves us with emphasis on the importance of improving the educational environment and strengthening family support to promote students' mental health development. Also, results from the study associated a lack of awareness and knowledge with the prevalence of mental health challenges. This further corroborates the findings of Olowe et al. (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), who reported that the level of knowledge is a significant predictor of mental health status. Most in-school adolescents who lack knowledge and have a poor attitude towards mental health are more likely to display conduct problems impacting their mental health status. Lee et al. (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) also reported that mental health awareness was influenced by knowledge of mental health and attitude towards mental health. This creates a need for baseline evidence for designing in-school programmes with a mental wellness focus to promote the mental health of adolescents, leveraging professional and parental networks.\u003c/p\u003e \u003cp\u003eResults from the study highlight several barriers to accessing mental health care. Findings identified the absence of professional care providers as one of these barriers. This aligns with the findings of Gadgil et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), who found factors such as knowledge and expertise to be predominant factors that influence willingness to seek care and treatment of mental health challenges. Anyebe et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) reported lack of skilled mental health human resources and inadequate training of available personnel were identified as the major barriers to the provision of mental health services. Thus, a lack of expertise can result in a barrier to accessing health care. Appropriately trained professionals are key for early identification and treatment of mental challenges and disorders, establishing multilevel coordination and collaboration between schools, community services, policy makers and other health care providers (Cubillos et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Brady et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This highlights the urgent need for action in ways to recruit mental health practitioners in schools, and the lack of expertise that often prevents students from seeking help.\u003c/p\u003e \u003cp\u003eFurthermore, findings from the study highlighted the cost as a barrier to accessing mental health care among students. Jack-Ide and Uys (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) reported barriers in accessing mental health services, including physical, financial and cultural. Kuhlman et al. (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) reported high Cost as a barrier shaping access to care. Also, Findings from Olugbile et al. (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) showed that the average monthly cost of treatment of patients receiving mental care was lower than that of patients from the medical outpatients\u0026rsquo; clinic. However, the cost for psychiatric patients far exceeded the cost for medical patients. Mental health services need to be provided throughout the schools and health care system to enable people to access them affordably (Jack-Ide \u0026amp; Uys, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). This finding, therefore, highlights a need for policymakers to change policy regarding the coverage of Nigerians with mental challenges and treatment. In doing so, the major barrier related to high cost in accessing care and treatment gap can be reduced.\u003c/p\u003e \u003cp\u003eFindings from the study also highlighted religious belief as a barrier to accessing mental care among students. Sandu et al. (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) found that religion may provide psychological support, offering effective coping tools and emotional help. Adhering to religious beliefs provides believers with a sense of purpose; those who follow them often report higher levels of satisfaction with their life and overall well-being (Mancuso \u0026amp; Lorona, 2023; Garssen et al.,2020; VanderWeele, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Since religious belief often improves mental health (Garssen et al.,2020; Mancuso \u0026amp; Lorona, 2023), it is no coincidence that participants with such a belief do not see the need for mental care, as revealed above that mental health challenges can be cured through prayer and fasting, believing and waiting on God. This result aligns with findings from Shipurut (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), who found that religious beliefs in supernatural causes and remedies of mental illnesses influence people\u0026rsquo;s knowledge and attitudes towards mental illness and help-seeking behaviour. Kanu and Nosike (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) also reported that religious beliefs often provide comfort, social support, and a sense of purpose, contributing to reduced stress and improved emotional well-being. This confirms why those with religious beliefs are reluctant to access mental care. The findings underscore the need for an inclusive approach that integrates mental health awareness into religious practices while encouraging faith-based institutions to promote psychological well-being. The findings have practical implications for mental health professionals, religious leaders, and policymakers seeking to address mental health concerns within religious communities.\u003c/p\u003e \u003cp\u003eEvidence from the findings also highlighted the lack of effective mental health care facilities as a barrier to accessing mental care services. Due to a dearth of hospitals and mental health professionals to lack of basic amenities, and poor funding, it is glaring that psychiatric care in Nigeria is in dire straits, as the number of mental cases has spiked by over 200 per cent in the last few months (Guardian Nigeria, 2024). This result resonates with the findings of Anyebe et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), who reported poor funding as the major barrier to the provision of mental health services at the community level. Mental health services in Nigeria consist mainly of large government psychiatric hospitals. There are eight Neuropsychiatric hospitals and a similar number of teaching hospital psychiatric departments for a population of 200\u0026nbsp;million people. These Neuropsychiatric hospitals cannot accommodate the mental services needed for the Nigerian population (Chijioke et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Therefore, addressing community mental health care needs by establishing care facilities is essential (Benoni et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This result highlights the need for efforts through policies and legislation towards improving the provision of mental care services by focusing more on establishing mental health care facilities within schools and communities.\u003c/p\u003e \u003cp\u003eResults from the study also identified preferences for non-formal healing rituals over clinical support as one of the barriers to accessing mental care among students. Burns and Tomita (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) reported that approximately half of individuals seeking formal health care for mental challenges in Africa choose traditional healers as their first care provider. This choice is associated with delays in accessing formal mental health services. Low- and middle-income countries (LMICs) experience low mental care due to a lack of adequate infrastructure, human resources and treatment options (Kohn et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). People seeking help for mental disorders in LMICs rely heavily on alternative or informal sources of care. Understanding pathways to care for those with mental health challenges requires clarification of the extent to which informal practitioners feature early in the care pathway, as it is likely that the choice of initial provider contributes to potential delays in accessing mental health care.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eImplication for social work practice\u003c/h2\u003e \u003cp\u003eFindings from the study indicate that schools are faced with increasing responsibility not only to ensure students\u0026rsquo; academic success but also to address the growing mental health concerns. Social workers in schools play a critical role in bridging these gaps, providing essential support that helps students thrive academically, socially, and emotionally (The University of Texas at Arlington, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Findings from the study highlighted stress and burnout arising from course overload as a factor associated with the prevalence of mental health challenges among students. This has implications for social work practice as social workers are saddled with the professional responsibility of creating conducive teaching and learning environments, advocating for social justice and child protection, conducting psychosocial assessments, and providing counselling and trauma debriefing for students (Khumalo et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The ability to conduct thorough assessments distinguishes effective school social workers. They perform biopsychosocial evaluations that examine students\u0026rsquo; physical, emotional, and mental conditions within the context of their environment (Social Work Institute, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This assessment can help social workers to critically examine the challenges of stress and burnout resulting from academic pressure and course overload. Thus, inform individualised intervention plans tailored to each student\u0026rsquo;s unique circumstances.\u003c/p\u003e \u003cp\u003eFindings from the study also revealed unhealthy competition among students as a factor responsible for the prevalence of mental health challenges among students. This underscores the need for schools to prioritise mental health and wellbeing, recognising that students\u0026rsquo; academic success is closely linked to their mental health (Yesufu \u0026amp; Egbabor-Fred, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This also has implications for social work practice since school social workers serve as advocates, counsellors, and facilitators within the educational system. Their dedication and expertise contribute significantly to creating a positive and supportive school environment, empowering students to achieve their full potential and lead fulfilling lives (Parallel Learning, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFindings also identified the absence of professional mental care providers as a barrier to accessing mental care services. This has implications for social work practitioners whose primary mental health service in schools includes counselling and collaboration with school and community-based partners (Childs \u0026amp; Iachini, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). School social workers are integral to the school mental health workforce and the leading social service providers in educational settings (Ding et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Since social workers are experienced in handling issues such as trauma and perceptions of student engagement and professional collaboration (Watson et al., \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Capp et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), they are best suited to assume the role of providing mental care services to students within secondary schools. They also maintain collaboration with mental health care professionals inside the school to share resources, holding student triage meetings, and regularly communicating about student and family needs (Polizotto \u0026amp; Zinn, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSocial workers have a role in addressing the issue of religious belief, since findings from the study identified it as a barrier to accessing mental care among students. School social work interventions and services targeted high-needs students to improve their social, mental/behavioural health, followed by primary and secondary prevention activities to promote school climate, school culture, belief system, teacher, student, and parent interactions, and parents\u0026rsquo; wellbeing (Ding et at., 2023). School social workers have a critical role in decreasing barriers to accessing school-based mental health services, particularly religious belief (Murphy et al., 2025). This is relevant to spiritual/religious clients faced with mental health challenges. In working with these clients, social workers are informed by holistic practice principles, and both the research and lived experiences of clients on the impacts of spirituality/religion on mental well-being (Smith \u0026amp; Read, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). People draw strength and comfort from their religion to support mental health. Religious/spiritual practices and beliefs are identified as effective mental health strategies (Malviya, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Social workers must foster collaboration with religious leaders in mental health care and integration of religious/spiritual practices into mainstream mental health interventions. This may improve mental health care for people with religious beliefs (Smith \u0026amp; Read, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Malviya, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, findings from the study revealed a lack of effective mental health care facilities as a barrier to accessing mental care services among students. This implies social workers who can carry out school-based mental health programs, such as crisis intervention and counselling, directly in schools, reducing the need for students to travel to clinics outside the school and advocating for the incorporation of mental health services into school structures so quality support is available and accessible to students at the point of need (Ding et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Social workers can coordinate and mobilise community and external agency partnerships to link students and families with specialised treatment providers, bring in additional support services and help navigate barriers such as scheduling, transportation, and cost, which are mostly compounded by facility shortages (The University of Texas at Arlington, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThe researcher acknowledges a couple of limitations of this study. First, the limited sample size (12 participants). This restricts the generalizability of the findings, coupled with the fact that the study was restricted to just six government secondary schools within Abuja, as these schools were purposively selected by the researcher to capture diverse view contexts regarding barriers to accessing mental health services among students. Therefore, the researcher encouraged similar studies in private secondary schools within Abuja. Secondly, the fact that the views of school administrators, teachers, mental health practitioners, and family members were not captured in this study accounts for just one-sided perspectives. Hence, subsequent studies should capture the views of school administrators, teachers, mental health practitioners, and family members to provide a robust understanding of barriers to mental care services. Further studies should consider institutional barriers to accessing mental health services. Such findings will provide more insights into the concerns that will amplify calls for workshops and seminars by social workers to enlighten people on the risk factors associated with accessing mental health services. Notwithstanding, findings from this study remain relevant to students, school administrators, teachers, social workers, policymakers and stakeholders in Nigeria. All should make efforts to ensure mental health services are available and accessible for secondary school students.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the study explored barriers to accessing mental health care for secondary school students in Abuja, Nigeria and practice considerations for social work, contributing to an in-depth understanding of the prevalence of mental health challenges among secondary school students and barriers to accessing quality mental health services. Findings from the study revealed a high prevalence of mental health challenges among government secondary students resulting from stress and burnout arising from course overload, unhealthy competition among students, lack of awareness and knowledge on how to manage their mental wellbeing and high expectations from parents, friends and classmates. Further findings also identified barriers to accessing mental health services, including (a) absence of professional care providers, (b) required cost, (c) religious beliefs and (e) lack of effective mental health care facility. The study also revealed strategies to improve access and utilisation of mental health care, such as (a) providing experts in mental health care, (b) establishing mental health care facilities, (c) public education and enlightenment and (d) adopting culturally-based psycho-education. These findings have implications for social workers who play a critical role in bridging the gaps in mental health services, providing essential support that helps students thrive academically, socially, and emotionally. Social workers serve as advocates, counsellors, and facilitators within the educational system; integral to the school mental health workforce and the leading social service providers in educational settings.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the author(s).\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe author(s) reported there is no funding associated with the work featured in this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eG.C.N. conceived and designed the study, conducted the literature review, collected and analyzed the data, and wrote the original draft of the manuscript. G.C.N. reviewed and approved the final version of the manuscript and takes full responsibility for its content.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eI wish to thank Dr. Onalu Chinyere and Dr. Ajibo Henry, all lecturers in the Social Work Department, University of Nigeria, Nsukka, for their guidance and encouragement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAboagye, R. G., Seidu, A. A., Hagan Jr, J. E., Frimpong, J. B., Budu, E., Adu, C., \u0026amp; Ahinkorah, B. O. (2021). A multi-country analysis of the prevalence and factors associated with bullying victimisation among in-school adolescents in sub-Saharan Africa: evidence from the global school-based health survey. \u003cem\u003eBMC psychiatry\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(1), 325.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eACReSAL (2024). About the Federal Capital Territory (FCT). 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Impact of school social work on the mental health of students in Uselu Secondary School, Egor Local Government Area of Edo State. \u003cem\u003eUniversity of Benin Journal of the Humanities\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(1), 15\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYet school social workers also converted traditional mental health supports, such as individual counselling and group check-ins, to a virtual format.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoung, E. (2024). Frequent social media use and experiences with bullying victimisation, persistent feelings of sadness or hopelessness, and suicide risk among high school students\u0026mdash;Youth Risk Behaviour Survey, United States, 2023. \u003cem\u003eMMWR supplements\u003c/em\u003e, \u003cem\u003e73\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, B. (2024). Unlocking mental health: New insights and treatments. \u003cem\u003eAllied Journal of Medical Research\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(6), 266. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.35841/aaajmr-8.6.266\u003c/span\u003e\u003cspan address=\"10.35841/aaajmr-8.6.266\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.alliedacademies.org/articles/unlocking-mental-health-new-insights-and-treatments-30952.html?\u003c/span\u003e\u003cspan address=\"https://www.alliedacademies.org/articles/unlocking-mental-health-new-insights-and-treatments-30952.html?\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao, M., Miao, H., Zhu, L. L., Zhang, X. H., \u0026amp; Zang, L. W. (2025). Social support and adolescent mental health in Kenya: a parallel mediation analysis of perceived control and gratitude. \u003cem\u003eFrontiers in Paediatrics\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 1626249.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mental Health, Care Services, Barriers, Care facilities, Secondary School Students, Social Work","lastPublishedDoi":"10.21203/rs.3.rs-8623395/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8623395/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: The mental health of students determines their social, psychological and emotional well-being. It also facilitates good academic performance. The absence of mental health services results in mental health challenges as students are vulnerable to issues such as academic pressure, stress, burnout and depression. Therefore, the study looked at barriers to accessing mental health care for government secondary school students in Abuja, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e: In-depth Interview was used to collect data from 12 secondary school students (6 males and 6 females) across the six area councils in Abuja. Three key themes stood out from the data collection guides. These are “the prevalence of mental health challenges,” “barriers to accessing mental health services”, and “strategies to improve access and utilisation of mental health care.”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Findings from the study revealed a high prevalence of mental health challenges among government secondary students resulting from stress and burnout arising from course overload, unhealthy competition among students, lack of awareness and knowledge on how to manage their mental wellbeing and high expectations from parents, friends and classmates. Further findings also identified barriers to accessing mental health services, including (a) absence of professional care providers, (b) required cost\u003cem\u003e,\u003c/em\u003e (c) religious beliefs and (e) lack of effective mental health care facility. The study also revealed strategies to improve access and utilisation of mental health care, such as (a) providing experts in mental health care, (b) establishing mental health care facilities\u003cem\u003e,\u003c/em\u003e (c) public education and enlightenment and (d) adopting culturally-based psycho-education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion and conclusion\u003c/strong\u003e: These findings have implications for social workers who have a critical role in bridging the gaps in mental health services, providing essential support that helps students thrive academically, socially, and emotionally. Social workers serve as advocates, counsellors, and facilitators within the educational system; integral to the school mental health workforce and the leading mental health care service providers in educational settings.\u003c/p\u003e","manuscriptTitle":"When Help Is Far Away: Barriers to Accessing Mental Health Care for Secondary School Students in Abuja, Nigeria, and Implications for Social Work Practice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 15:52:45","doi":"10.21203/rs.3.rs-8623395/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"98c10727-d8a4-4697-a8db-dde338a33304","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-13T15:52:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 15:52:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8623395","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8623395","identity":"rs-8623395","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}