Integrative MHPSS in Public Health Care in Tigray, Ethiopia

Our project explored: How can countries with low resources, such as Ethiopia, develop integrative mental health and psychosocial frameworks that are culturally grounded, community-informed, and centered on the needs of vulnerable populations?
In Tigray, Ethiopia, communities have faced decades of compounded adversity, genocide, war, sexual violence, displacement, and famine. These overlapping crises have exacerbated mental health and psychosocial needs and impeded safety and well-being. While public health interventions are often mobilized in emergencies, mental health remains underprioritized, with existing global frameworks rarely integrating the lived experiences and priorities of affected communities.

To address this gap, our project engaged: humanitarian and healthcare workers, journalists, human rights advocates, survivors of sexual and gender-based violence (SGBV), MHPSS regional coordinator, clinical psychologist, social worker, and SGBV one-stop center coordinator. Through interviews, we identified the demanding mental health challenges faced by displaced and vulnerable groups, noting the variation in their needs, and strategies that could inform more inclusive frameworks for disaster preparedness and response.

Key Lessons Learned
- Mental Health Stigma remains one of the most significant barriers, resulting in symptoms of anxiety, depression, PTSD, and behavioral changes. Community members stressed the importance of engaging religious leaders and initiating open dialogue on mental health.
- Social Fabric Rupture as a result of physical displacement which has torn communities apart. Community members recommend revitalizing cultural practices, such as coffee ceremonies and community gatherings, as pathways for reconnection. Along with building mental health networks that address all levels of the IASC Pyramid- from basic needs to specialized services.
- Accessibility Barriers persist due to limited resources, integration, and training of MHPSS into existing systems. Community members emphasized the importance of holistic approaches that combine social, emotional, and psychosocial care, the expansion of mobile services, and the decentralization of mental health care.
Community-Driven Approach
One concrete recommendation emerged: identify individuals already trained in Psychological First Aid, trauma- informed care, SGBV response, or Group Problem Management Plus, and leverage their skills to provide psychoeducation, informal counseling, and emergency MHPSS support. These community members could also volunteer in hospitals, schools, and one-stop centers, or participate in “train-the-trainer” initiatives to expand reach.
By grounding this research in the lived realities of those most affected, we built knowledge that not only strengthens mental health support in Tigray but also offers a model for other low-resource and crisis-affected settings. The lessons shared by survivors, practitioners, and community leaders reiterate a global mental health shift that healing can only happen when those impacted are at the center of designing and implementation.