Many trauma survivors seem to be reluctant to seek professional help for mental health issues. The present study aimed to enhance the understanding of perceived barriers and facilitators to mental health service use in adult survivors of institutional abuse (IA) in foster care. It further aimed to explore survivors’ suggestions on how to increase mental health service use. Semi-structured interviews were conducted with 46 adult IA survivors. The interview guideline comprised questions regarding (1) self-perceived barriers and (2) facilitators to mental health services, as well as (3) suggestions on how to facilitate mental health service use. A thematic analysis was conducted to identify themes from the interview transcripts. Barriers and facilitators were compared with previous findings of a systematic review on trauma survivors. The most prominent barrier themes were Lack of knowledge and treatment-related doubts, Concerns related to stigma, shame & rejection, and Trauma-specific barriers. A barrier that seemed to be characteristic for IA survivors was Previous negative experiences with child care workers or other professionals in foster care institutions. Key themes that were identified from the survivors’ suggestions were also found in the perceived facilitators, namely Specific psychotherapist recommended by significant others, professionals, or institutions, as well as Treatment costs covered. Receiving Social support from significant others or professionals was a further prominent facilitator to mental health service use. These findings reinforce the importance of multi-professional strategies and evidence-based interventions to increase CM survivors’ mental health service use.