From Distress to Care
Background: Large gaps between psychological distress and use of professional mental-health care persist in Nigeria, but conventional explanations often isolate stigma, literacy, beliefs, or service scarcity as separate barriers. Such accounts under-specify how distress is interpreted, negotiated within relationships, routed through plural care systems, and converted or not converted into actual service use. This conceptual paper develops the Contextual-Ecological Distress-to-Care (CEDC) Framework for South-East Nigeria. Approach: The framework was developed through a purposive, iterative conceptual synthesis of recent help-seeking theory, Nigerian and sub-Saharan African empirical evidence, and Nigerian mental-health policy and service literature, with foundational South-East Nigerian studies retained where uniquely informative. Framework: CEDC conceptualises help-seeking as a recursive six-stage pathway: distress emergence and recognition; explanatory appraisal and meaning-making; disclosure and relational negotiation; pathway selection and sequencing; conversion of intention into access; and engagement, continuation, switching, and re-entry. These stages are shaped simultaneously by individual, relational, religious-cultural, service, socioeconomic, digital-information, and policy environments. Professional psychological care is treated as one pathway within a plural ecology rather than an inevitable endpoint. Contribution: The framework integrates sociocultural meaning with material access, distinguishes intentions from realised service use, and models switching between professional, primary-care, faith-based, traditional, family/community, digital, and no-care pathways. It generates testable propositions and stage-specific intervention targets for counselling psychology, primary care, community partnerships, and mental-health policy. The framework requires prospective empirical validation across South-East Nigerian states and other pluralistic, resource-constrained settings.