Strategies for collaborative mental health care in post-conflict Tigray: A qualitative study

There is a significant mental health service gap in Sub-Saharan Africa, with many people relying on traditional healers due to factors such as limited resources and conflict. While mental health collaborative care provision between traditional and biomedical providers is recommended, this recommendation lacks context-specific strategies for post-conflict Tigray. This study explores and identifies strategies for collaborative care provision for mental health services in the post-conflict setting of Tigray, Ethiopia. In-depth interviews were conducted with 50 participants, including traditional healers, senior psychiatry clinicians, and their service users, in Tigray, Ethiopia. Participants were recruited through stakeholder contacts and the snowball method. Data were analysed using a thematic framework approach, with NVivo software assistance. The study adhered to the Consolidated Criteria for Reporting Qualitative Research(COREQ). Five themes emerged as strategies for collaborative mental health care between traditional and biomedical services in the post-conflict setting: (i) government and institutional support, (ii) joint training and knowledge exchange, (iii) patient-centred support, (iv) shared referral pathway, and (v) integrated intervention approach. The study highlights new insights for collaboration, such as reaching consensus on care provision despite differences in the causes of illness, involving traditional practitioners in humanitarian meetings, and implementing integration at holy water sites through trained volunteer counsellors. These context-specific strategies for collaborative care may enhance mental health services in post-conflict. We recommend developing guidelines, formalising partnerships, encouraging dialogue, and prioritising the suggested strategies for effective implementation. • Collaborative care between traditional and biomedical systems is recommended. • Context-specific collaboration strategies lack evidence as social factors shape care • Novel approaches involved humanitarian meetings engagement, care consensus and holy water volunteer counsellors. • This study provides insights for low-resource, post-conflict settings. • Further research is needed on prioritising and the effectiveness of strategies.