Barriers and facilitators to mental health service access among male students in higher learning institutions in Ndola Zambia

Abstract Background Despite growing recognition of mental health challenges among university students globally, male students in Sub-Saharan Africa disproportionately remain outside the reach of formal mental health services. This study explored the factors that shape individual-level access to mental health services among male students in higher learning institutions in Ndola, Zambia. Methods A qualitative descriptive design was employed. Sixteen participants were recruited through purposive, convenience, and snowball sampling: male students who had accessed mental health services (n = 4), those who had never accessed services (n = 8), and institutional mental health coordinators (n = 4). Data were collected via in-depth unstructured interviews and analyzed using inductive thematic analysis supported by NVivo 12. Results Male students who had never accessed services demonstrated adequate knowledge of mental health conditions and recognized the benefits of help-seeking. Key facilitators included personal experience of distress, provider competence, confidentiality assurance, therapeutic rapport, and structured appointment systems. Barriers comprised multi-dimensional stigma, cultural masculinity norms, intergenerational family beliefs, financial constraints, limited-service promotion, facility scarcity, and provider-related inadequacies. Available services encompassed counselling, psychiatric care, medication, emotional support, coaching, mentorship, and HIV-integrated care. Findings novel to the Ndola context revealed that the desire to be understood motivated help-seeking, while facility scarcity and appointment systems emerged as critical structural factors. Conclusions Multi-layered interventions addressing stigma, service decentralization, mental health literacy, alongside strengthened provider rapport and streamlined appointment systems, are needed to reduce barriers and build on facilitators of access for male students.