Factors influencing referral pathways and collaboration between traditional and mental health practitioners in Sub-Saharan Africa: a scoping review

PURPOSE: In Sub-Saharan Africa, traditional and biomedical mental health systems coexist, yet referral pathways and collaboration between Traditional Health Practitioners and Mental Health Care Practitioners remain inconsistent. Understanding factors shaping these pathways is essential for improving continuity, cultural responsiveness, and access to mental health care. This scoping review aimed to map and synthesize evidence on factors influencing referral pathways and collaboration between Traditional Health Practitioners and Mental Health Care Practitioners in Sub-Saharan Africa. METHODS: A scoping review was conducted following the Arksey and O'Malley framework, enhanced by Levac et al., and reported using PRISMA-ScR guidelines. Electronic databases, including EBSCOhost, PubMed, Scopus, and Google Scholar, were searched for English-language, peer-reviewed studies published between 2012 and 2025. Studies examining referral pathways, collaboration, barriers, or enablers between Traditional Health Practitioners and Mental Health Care Practitioners within Sub-Saharan Africa were included. Data were charted and synthesized using thematic analysis. RESULTS: Nineteen studies met the inclusion criteria. The findings revealed barriers to collaboration and referral, including a lack of trust between practitioners, weak policy implementation, stigma, differing conceptualizations of mental illness, communication and educational gaps, resource constraints, and patient cultural preferences. Enablers included informal referral practices and practitioners' willingness to collaborate. CONCLUSION: Referral pathways and collaboration between Traditional Health Practitioners and Mental Health Care Practitioners were influenced by systemic, relational, and cultural factors. While formal referral structures remain limited, informal collaboration and practitioner willingness present opportunities to strengthen continuity of care. Strategies to enhance culturally responsive, policy-supported collaboration are needed to improve mental health outcomes and reduce treatment gaps in Sub-Saharan Africa.