“Now they just say it will get better on its own.”: a qualitative exploration of discontinuation of facility-based tele-mental health services in Bangladesh

BACKGROUND: Discontinuation of mental health care is a persistent global challenge, with up to one-third of patients dropping out before treatment completion. Evidence on discontinuation from facility-based tele-mental health services in low- and middle-income countries remains limited. This study explores why patients disengage from facility-based tele-mental health services delivered through Wellbeing Centres in Bangladesh. METHOD: A qualitative study was conducted between October 2024 and February 2025 using mobile phone interviews. Participants were service recipients who had discontinued follow-up services provided by the Wellbeing Centres. A total of 26 interviews were conducted, and the data were analyzed thematically. RESULTS: Discontinuation was shaped by dynamic and sometimes contradictory patient experiences. First, perceptions of treatment outcomes influenced disengagement in complex ways: both perceived improvement and perceived lack of benefit led to discontinuation, reflecting shifting expectations of care. Second, everyday constraints-including fluctuations in mental wellbeing, competing life demands, distance from facilities, and communication gaps with providers-disrupted continuity of care. Third, family dynamics played a critical role, with limited support and motivation reducing sustained engagement with services. CONCLUSION: Discontinuation from facility-based tele-mental health services is not solely driven by access barriers but emerges from the interaction between perceived recovery, unmet expectations, and socio-cultural influences, particularly family involvement. Interventions should move beyond access-focused models to incorporate continuous patient engagement, clearer communication of treatment pathways, and active involvement of family members. These findings have implications for the design and scale-up of facility-based tele-mental health services in low- and middle- income countries (LMICs).