Calls for collaboration between mental health workers and traditional or faith healers have been longstanding in many low- and middle-income countries. In recent years, several examples of these attempts at collaboration have been reported with varying levels of success and sustainability. While there have been some initial success stories, there have also been reported challenges, primarily focused on cultural beliefs and the continued use of mechanical restraints. With this focus on the ethics of care, less attention has been paid to the pragmatics of care in contexts where there are few, if any, alternatives. In this paper, we discuss findings and observations from the Together for Mental Health and other projects which explored collaborations between healers and health workers in Ghana. Although collaboration has been acknowledged as beneficial for improving mental health care and reducing harmful practices, efforts have been driven by the formal health system with expectations of acceptance by healers. However, most of these efforts have not acknowledged the livelihood needs of healers nor their reputations and authority, sometimes resulting in a competitive healing economy. We use examples from our research to show that building sustainable collaborative pathways must move beyond cultural and ethical discourse to include a recognition of the pragmatics of healing.
