"I try not to go in order to hide my shame": A qualitative study exploring barriers and facilitators to mental health help-seeking among adolescents in Moshi Urban, Tanzania

Background: Adolescent mental health disorders represent a growing public health concern globally, with a substantial proportion of young people experiencing unmet mental health needs. Despite this burden, help-seeking behavior among adolescents remains low, particularly in low- and middle-income countries (LMICs), where structural, social, and cultural barriers persist. In Tanzania, limited context-specific evidence exists on factors influencing mental health help-seeking among adolescents, particularly within school settings. Methods: A cross-sectional qualitative study was conducted among adolescents aged 15-19 years attending secondary schools in Moshi Urban, Kilimanjaro region, Tanzania, between April and May 2025. A total of 11 participants, including students, teachers, a school administrator, and a school healthcare provider, were recruited using convenience sampling. Data were collected using semi-structured questionnaires and focus group discussions, and audio-recorded for accuracy. Transcripts were analyzed using thematic analysis, following a systematic six-step approach. Codes were organized into subthemes and overarching themes. Results: Three major themes emerged: facilitators, barriers, and suggested strategies for improving mental health help-seeking behavior. Key facilitators included the presence of school-based support systems, encouragement from trusted individuals (peers, parents, and teachers), perceived severity of mental health problems, and positive experiences from others. Major barriers included lack of trust and concerns about confidentiality, fear of information disclosure, stigma and fear of judgment, rigid school schedules, and poor teacher-student relationships. Participants highlighted the need for confidential, professionally led counselling services, increased mental health education, strengthened school-based programs, and improved access to mental health information as critical strategies to enhance help-seeking behavior. Conclusion: Mental health help-seeking behavior among adolescents in Moshi Urban is influenced by a complex interplay of interpersonal, institutional, and individual factors. While supportive environments and social networks facilitate help-seeking, persistent barriers particularly related to trust, confidentiality, and stigma limit access to care. Strengthening school-based mental health services, improving mental health literacy, and ensuring confidential, youth-friendly support systems are essential to enhance help-seeking behavior and improve adolescent mental health outcomes in Tanzania and similar settings. Keywords: Adolescents; mental health; help-seeking behavior; qualitative study; Tanzania; barriers; facilitators; school-based interventions