Multi-Stakeholder Perspectives on Barriers to Mental Health Support for Informal Caregivers

Highlights: Public health relevance—How does this work relate to a public health issue? Informal caregiver psychological distress is a widespread public health concern driven in part by inequitable access to mental health services. Caregiver experiences reveal how multilevel structural and policy conditions constrain access to mental health support and contribute to inequities. Public health significance—Why is this work of significance to public health? The study demonstrates how barriers and limited supports for caregiver mental health operate and reinforce one another across socioecological contexts. Findings identify system- and policy-level conditions that shape caregivers’ ability to recognize need, navigate services, and sustain engagement with care. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Practitioners should implement culturally and linguistically responsive, caregiver-focused mental health screening and navigation, including community health workers. Policies and research should support stable, caregiver-inclusive mental health services that address structural barriers and strengthen system-level supports. Background: Informal caregivers experience elevated psychological distress but face substantial challenges in accessing mental health support. Prior research has focused primarily on individual or interpersonal determinants, with less attention to how organizational, community, and policy contexts shape access and contribute to inequities in service availability. Methods: Fifty-one stakeholders, including 17 informal caregivers, 23 community health workers (CHWs), and 11 mental health professionals, completed a demographic survey and 60–90-min semi-structured interviews in English or Spanish. Data were analyzed using thematic analysis, combining deductive coding guided by the Socioecological Model with inductive identification of emergent themes. Results: Participants identified both barriers and supports influencing access to caregiver mental health support across socioecological levels. Individual-level barriers included limited mental health literacy, stigma, competing responsibilities, and language or technology challenges. Interpersonal barriers reflected family minimization of distress and limited encouragement for help-seeking. Organizational barriers involved program instability, restrictive eligibility criteria, long wait times, limited cultural responsiveness, and workplace constraints, while community-level influences included stigma and scarce affordable services. Policy-level barriers reflected immigration-related exclusions and the absence of caregiver-specific mental health coverage. Identified supports, such as CHW navigation and culturally responsive services, were often constrained by structural and organizational limitations. Conclusions: Caregivers face intersecting, multilevel barriers that constrain access to mental health support, while available supports are frequently insufficient to overcome structural constraints. Findings highlight the need for coordinated public health and systems-level strategies that address organizational and policy conditions shaping equitable access to caregiver mental health care.