Table 3 Key concepts across the included studies

Barriers

Barriers affecting healthcare providers and service users

Limited resources

• Lack of available general and specialist services

• Limited service capacity

• Workforce shortages

• Difficulty attracting and retaining staff

• High turnover of staff

• Time constraints

• Limited funding

• Financial disadvantage

• Costs for service users

• Lack of transport

• High workloads

Beks et al. [65], Cosgrave et al. [18], Cosgrave et al. [33], De Silva et al. [34], Dunstan et al. [35], Evans et al. [36], Hussain et al. [38], Johnson et al. [39], Clough et al. [45], Muir-Cochrane et al. [50], Bowman et al. [51], Butterfly Foundation [52], Mental Health Council of Tasmania [53], National Rural Health Alliance [54], Crotty et al. [56], Henderson et al. [58], Henderson et al. [59], Newman et al. [60], Orlowski et al. [61], Orlowski et al. [62], Orlowski et al. [63], Procter et al. [64], Isaacs et al. [66], Byrne et al. [71], Onnis et al. [74], Taylor et al. [75], Consumers of Mental Health WA [78], Bridgman et al. [79], Reynish et al. [80], Ellem et al. [82], Black et al. [55], Weber and Davis [42]

System complexity and navigation

• Long waiting times

• Inefficient referral pathways

• Lack of care-coordination

• Delays in assessment and diagnosis

• Difficulty navigating services

• Limited training

• Professional culture or organisational functions

Evans et al. [36], Clough et al. [45], Butterfly Foundation [52], Beks et al. [65], Cosgrave et al. [33] Cosgrave et al. [18], Henderson et al. [59], Kidd et al. [69], Malatzky et al. [73], Orlowski et al. [63], Wand et al. [41], Bowman et al. [51], Dawson et al. [57], Orlowski et al. [61], Reynish et al. [80], Consumers of Mental Health WA [78], Henderson et al. [58], Isaacs et al. [66], Mental Health Council of Tasmania [53], Wand et al. [40], Weber and Davis [42], Duggan et al. [46], Onnis et al. [74]

Attitudinal and social matters

• Stereotypical views of patients

• Stigma

• Fear of judgement

• Lack of trust or confidence in services

• Privacy and confidentiality concerns

• Consumer vulnerability

• Preference for keeping to oneself

• Stoicism

• Reluctance to seek help

• Lack of awareness about mental health issues

• Dual-relationships

Butterfly Foundation [52], Hinton et al. [81], Muir-Cochrane et al. [50], Procter et al. [64], Trail et al. [70], Dunstan et al. [35], Evans et al. [36], Hussain et al. [38], Johnson et al. [39], Orlowski et al. [61], Reynish et al. (72), Wilson et al. [43], Bowman et al. (31), Consumers of Mental Health WA [78], Isaacs et al. [66], Isaacs et al. [67], Isaacs et al. [68], De Silva et al. [34], [36], Newman et al. [60]

Technological limitations

• Poor connectivity

• High cost

• Lack of suitability for use among specific client groups

Bowman et al. (31), Orlowski et al. [62], Orlowski et al. [61], Procter et al. (56), Consumers of Mental Health WA [78], Mental Health Council of Tasmania [53], Newman et al. [60]

Lack of awareness

• Lack of awareness about mental health issues

• Lack of awareness of needs

• Lack of awareness about services available

Wilson et al. [43], Muir-Cochrane et al. [50], Butterfly Foundation [52], Isaacs et al. [67], Consumers of Mental Health WA [78]

Barriers affecting service users

Distance to services

• Lengthy travel time due to distance to services

Butterfly Foundation [52], Orlowski et al. [62], Orlowski et al. [63], Byrne et al. [71], Consumers of Mental Health WA [78], Mental Health Council of Tasmania [53], Procter et al. [64]

Insufficient culturally-sensitive practices

• Lack of culturally-suited staff, processes, and services

• Cultural assumptions about experience and medical treatment

Malatzky et al. [73], Mirza [48], Mollah et al. [49], Consumers of Mental Health WA [78], Henderson et al. [58]

Facilitators

Facilitators affecting healthcare providers and service users

Person-centred and collaborative care

• Interservice collaborations

• Shared knowledge

• Informal working relationships

• A non-judgemental and positive approach to service delivery

• Involving clients and their families in care

• Regular contact

• Continuity of care

• Appropriate and skilled communication

• Flexibility in meeting places

Barraclough et al. [31], Beks et al. [65], Crotty et al. [56], De Silva et al. [34], Evans et al. [36], Henderson et al. [59], Orlowski et al. [63], Hinton et al. [81], Procter et al. [64], Wand et al. [41], Dawson et al. [57], Dunstan et al. [35], Orlowski et al. [61], Henderson et al. [58], Weber and Davis [42], Knight et al. [72], Onnis et al. [74]

Technological facilitation

• Technology used in conjunction to face-to-face service delivery

• SMS appointment reminders

Newman et al. [60], Orlowski et al. [62], Orlowski et al. [63], Taylor et al. [75], Orlowski et al. [61], Richardson et al. [76], Bowman et al. [51], Consumers of Mental Health WA [78], Henderson et al. [58], Mental Health Council of Tasmania [53]

Environment and ease of service access

• Non-clinical and comfortable environment

• Easy access to after-hours services

• Services delivered by dedicated staff with local knowledge

• Screening for specific disorders if supported by organisational tools

• Outreach options

• Co-location of services

• Organisational culture, priorities, systems, and structures

• Low/no cost services

Barraclough et al. [31], Beks et al. [65], Hinton et al. [81], Malatzky et al. [73], Mollah et al. [49], Reynish et al. [80]

Community supports

• Sense of community

• Clinicians being involved in the community and knowing local issues

• Clinician visibility outside of health-provider role

Crotty et al. [56], Henderson et al. [59], Johnson et al. [39], Beks et al. [65], Isaacs et al. [66]

Facilitators affecting service users

Mental health literacy

• Familiarity and confidence in using services

• Knowledge of mental health services

Butterfly Foundation [52], Henderson et al. [59], Trail et al. [70], Dawson et al. [57], Isaacs et al. [66]

Culturally-sensitive practice

• Cultural competency

• Use of Aboriginal mental health workers, spiritual healers, and involvement of the community elders

Mirza [48], Mollah et al. [49], Isaacs et al. [66]