Objective: The Ethiopian Ministry of health integrated mental health services into the community health service. However, the service has not been implemented yet. Therefore, this study aimed to explore the barriers and facilitators of mental health service implementation into the Ethiopian community health program.

Methods: A qualitative case study was conducted in the Ethiopian primary health care system in 2019. We have conducted about eight key informant interviews with policymakers, service managers, and service providers. The interviews were tape-recorded, transcribed, translated, and analyzed manually using the World Health Organization building blocks framework.

Results: The recently designed integration of mental health services into the health extension program was not implemented so far. The identified barriers were low political commitment, shortage of resources, non-functional referral system, lack of interest from private health service organizations, attitudinal problems from both the society and service providers, the lack of reporting system for mental health problems. There are also facilitators like; well-designed primary health care system, trained health extension workers, changing political commitment and attitude of the community.

Conclusion: A series of activities are expected especially from the health system leaders to implement, follow, and evaluate mental health services at the health extension programs.