Barriers and facilitators to collaboration between traditional and biomedical mental health services in a post-conflict healthcare system: A qualitative study in Tigray, Ethiopia

Background: The World Health Organisation advocates a biopsychosocial model combining traditional and biomedical care to address mental health gaps, especially in low-resource, conflict-affected health systems. This study explores the factors influencing collaboration between traditional and biomedical mental health services in Tigray, where research on such collaborative care remains limited. Methods: In-depth interviews were conducted with 50 participants, including biomedical practitioners, traditional healers, and service users from both modalities of care in Tigray, Ethiopia. Interviews focused on perspectives of the need for more collaboration and the barriers and enablers to achieving a collaborative mental health system. A thematic framework analysis approach was employed for data analysis, utilising NVivo qualitative data analysis software. Results: Traditional practitioners, biomedical practitioners, and their service users recognised the value of collaboration in mental health care in a post-conflict Tigray context, despite acknowledging the presence of challenges. Safety concerns, unclear roles, coordination gaps, and fear of combined treatment effects were barriers to collaboration. Facilitators include opportunities arising from experience sharing by international organisations, as well as existing psychosocial and spiritual rituals. Conclusion: The study revealed opportunities for collaboration between traditional and biomedical mental health services within post-conflict healthcare systems. Despite existing challenges, both practitioners and service users demonstrated a strong willingness to collaborate and utilise these services. These findings showed the need for contextual collaborative care strategies to enhance mental health care and foster community healing in post-conflict settings.