BACKGROUND:
Despite increased focus on mental health as a sustainable development goal and human right, treatment gaps between service need and access remain high globally. Treatment gaps are impacted by the availability and desirability of the services being provided with mental health systems and can be assessed through the health systems building blocks framework, which identifies six factors for providing mental health services that are responsive to the needs of the individuals and communities served.

METHODS:
This study explored service user and provider experiences of treatment gaps within Lesotho’s mental health system, across socioecological levels of care and the building blocks framework, as well as recommendations for improvement. Qualitative data were collected with 218 participants across 25 five groups and four interviews, including health workers, mental health workers, and community members. Participants and data collection sites were selected for diversity, ensuring that all districts, ecological regions, and geographic areas were represented.

RESULTS:
Two themes and seven sub-themes were identified. Participants felt that communication across governmental and nongovernmental sectors and between levels of care was limited and suggested developing policies to better guide service delivery. Service delivery could also be improved by diversifying care options and providers. Participants identified shortages in the mental health workforce and recommended better support for employees, training more providers, and better capacitating specialists and generals to provide care. Access could be enhanced through infrastructure development.

CONCLUSIONS:
These findings provide direction for strengthening mental health services in resource-constrained settings, through collaboration to improve service availability and responsiveness to improve desirability.