Barriers to Seeking Mental Health Support Among Nurses and Midwives in Sub-Saharan Africa: A Scoping Review

In hospitals and clinics across the globe, the people who care for the sick often carry a heavy, invisible burden of their own. Nurses and midwives face high levels of stress, exhaustion, and emotional strain, a condition often called burnout. When these caregivers feel overwhelmed, the natural human response is to seek help. Yet, in many parts of the world, a gap exists between feeling unwell and actually finding support. This gap is not just about the availability of doctors or counselors; it is about the complex web of personal fears, workplace rules, and cultural beliefs that can stop a person from asking for the help they need. Understanding why these barriers exist is crucial, because when the healers cannot heal themselves, the entire system of care suffers.

A team of researchers set out to map these obstacles specifically for nurses and midwives in sub-Saharan Africa. They conducted a wide search of scientific literature, looking for studies published between 2020 and 2026 that discussed the challenges these professionals face when trying to access mental health support. The researchers gathered twenty relevant studies from countries like South Africa, Ghana, Kenya, and Uganda, and then carefully organized the findings into three main categories: things happening inside the individual, things happening within the workplace, and things happening in the wider society. Their goal was not just to count how many people were stressed, but to understand why those who were stressed often did not reach out for professional help.

The investigation revealed that the reasons for not seeking help are deeply rooted in how these professionals view themselves and their jobs. On a personal level, many nurses and midwives do not recognize their own distress as a medical issue that requires treatment. Even when they feel high levels of anxiety or fear, they often dismiss these feelings as a normal part of the job or a sign of personal weakness. Instead of seeing a counselor, they rely on informal methods to cope, such as talking to friends, praying, or simply trying to ignore the problem. While these methods might offer temporary relief, the researchers found that without professional support, these individual efforts are often not enough to sustain a caregiver through long-term hardship.

The workplace itself presents significant hurdles. In many of the hospitals and clinics studied, there was little to no formal support system for staff mental health. Nurses reported that they were left to manage their own emotional burdens, often while carrying crushing workloads and facing a constant stream of patient deaths. In some cases, the very act of seeking help was seen as a risk to one's career. There was a pervasive fear that admitting to mental health struggles could lead to being labeled as unreliable or could jeopardize their professional licenses. Even when support services existed, awareness of them was low, and few staff members actually used them. The environment often felt unsupportive, leaving workers to feel isolated in their struggles.

Beyond the hospital walls, cultural attitudes played a powerful role in silencing those in need. In many communities, mental illness carries a heavy stigma, a social shame that can lead to isolation and neglect. This stigma was particularly sharp for those working in psychiatric care or for those who contracted infectious diseases like COVID-19. Nurses who fell ill were sometimes shunned by their own families and colleagues, who feared they might be contagious or simply did not want to be associated with the illness. This social rejection created a climate where admitting to any form of emotional or psychological struggle felt dangerous. The researchers noted that much of the stigma discussed in the studies was tied to these specific crises or professions, rather than a general discussion about mental health among nurses, but the effect was the same: it discouraged people from speaking up.

Despite the clear identification of these barriers, the review found a striking absence of solutions that have been tested in this region. While many studies recommended that hospitals should offer counseling, create better support programs, or run awareness campaigns, no study in the group actually tested whether these interventions worked to encourage nurses to seek help. The evidence suggests that simply having a service available is not enough; the culture of the workplace and the beliefs of the community must also change. The researchers concluded that to truly support the mental well-being of nurses and midwives in sub-Saharan Africa, future efforts must focus on directly asking these professionals about their barriers, creating safe and confidential pathways to care, and addressing the deep-seated cultural fears that keep them silent. Until these steps are taken, the gap between needing help and getting it will likely remain wide.