Spatial distribution and factors associated with availability of mental health services in Ethiopia: data from national health-facility survey

Despite the substantial burden of mental health disorders in Ethiopia, access to mental health services remains limited and unevenly distributed. This study aimed to examine the spatial distribution of mental health services in Ethiopian health facilities and identify factors contributing to their availability. Data were drawn from the 2021–2022 Ethiopian Service Provision Assessment-Plus (ESPA+) survey, which included a census of hospitals and a representative sample of health centres, posts, and clinics. Spatial patterns were assessed using the Global Moran’s Index (Moran’s I) to evaluate spatial autocorrelation, while hotspot analysis employing Getis-Ord Gi* statistics identified areas with high and low service availability. A Poisson regression was conducted to assess factors associated with mental health service availability. Analysis of 1,158 health facilities revealed a significant clustering of mental health services in Ethiopia, with a Global Moran’s I value of 0.09 ( P < 0.01). Hotspot analysis identified areas of high mental health service availability in Addis Ababa, central and south-western Oromia, and north-western Amhara, while areas with low availability were found in Afar, Benishangul-Gumuz, Gambella, Harari, Dire Dawa, northern Somali, and northern SNNPR. Factors negatively associated with mental health service availability included rural location, primary facility status, a small catchment population (< 10,000), and facilities charging service fees. This study highlights significant disparities in the availability of mental health services in Ethiopia, particularly in rural and underserved regions. Expanding mental health services within primary healthcare units, and revisiting task-shifting strategies to mitigate shortages in the mental health workforce may help to improve access to mental health care. Integrating innovative delivery models,such as telemedicine and community-based initiatives,will be helpful in fostering equitable mental healthcare nationwide.