Introduction:Mental disorders are common and are associated with severe disability, cost andmortality. The burden of mental disorders in low income countries like Ethiopia is compoundedby thehuge treatment gap, which is over 90% for Severe Mental Disorders (SMD) such as schizophrenia,bipolar disorder and major depressive disorder.rnThe current strategy of the Federal Ministry of Health to narrow the treatment gap focuses onintegration of mental health care into primary care. This agenda of integration has been advocated bythe World Health Organization(WHO), and relies on training primary care staff to provideevidence-based interventions for selected (priority) disorders. However, neither the WHO nor the Ministry ofHealth provided explicit suggestions on how the integration would occur. Although Faith andTraditional Healers (FTHs) are key for the success of such integration, there is no direction on howthey may be engaged or support care provision.rnUnderstanding treatment practices, attitudes, cultural factors and explanatory models that influencecommunity utilization of FTHs and the link of these factors with utilization ofbio-medical servicesmay allow development of strategies to support collaboration between the FTHsand the biomedicalsector. It may also improve access to timelybio-medicalcare. Thisproposed study will explore the roleof FTHs in thecare of patients with SMDand the impact on bio-medical service utilization and patientlevel outcomes. Thestudyhypothesizes that most patients with SMDs will use FTHs before accessingbiomedicalcare andthese patientsare likely to have longer duration of untreated psychosis resulting inpoorer clinical, social and economic outcomes.rnObjectives: the mainobjectiveof the study is to explore the pattern and determinants of the use ofFTHs practices for the care of SMDs, andimpacton patient level outcomes.rnMethods: four complementary studies will be conducted using a mixedquantitative and qualitativeresearchdesign.o Study Iwill havetwocomponentsrno The first component will be a cross-sectional communitybased study on 1,500 randomlyselected sample ofcommunity members in Sodo district todetermine community attitudetowards FTHs and describe the prevalence and pattern of use of FTHs by the community.rno The second part of the initial cross-sectional survey will describe the profile of FTHs, theirEMs about SMDsas well as define types of use of available service (predominant use)rno Study IIwill havetwocomponentso The first component will be toexplore the prevalence, pattern and determinants of use ofrnFTHs among community(Key informant) identifiedpersons with SMD, completed usingall available information(Butajira Case Detection MethodBCDM);rno The second component to determine baseline clinical, social and economic profiles in thethree groups ofpatients with SMDbasedontheir level of service utilization: predominantlyFTH users, Predominantly Boimedical service users and those who use both sercvicesrno study IIIwill be a follow up of participants in study II to examine short-term (six months) patientlevel outcomes (clinical, social and economic) and pathways in care in relation to baseline FTH usernpattern; ando study IVwill examine, on purposivelyselected sample of FTHs and BMPs,behavioraldeterminantof collaboration between FTHs and BMPs (beliefs, attitudes, subjective norms and perceivedbehavioral control as well as intention towards collaboration) and the changes in thesedeterminants.rnAssessments:A set of assessment tools will be used to establish diagnosis, symptomatic and functionalstate as well as costs. Qualitative assessment will consist of face-to-face interview using semistructured questionnaire, Focus Group Discussions, In-depth interviewand observations using guidesand checklists. Quantitative datawill be entered in epiData version 3 and analyzed using SPSS version17 and STATA 8.Thematic content analysis will be used for qualitative data.rnEthical consideration: Ethical approval will be sought from the Scientific Committee of theDepartment of Psychiatry and theInstitutional Review Board of the College of Health Sciences, AddisAbaba University. Official permission will be secured from the Sodo district health office andhealthinstitutions.Every selected respondent will be briefed about the purpose of the study and informedwritten consentwill be soughtfromeach participant. All papers, computers, external hard drives, andUSB memory sticks containing data will be password protected and kept in secure (locked) locations toensure confidentiality of information.rnExpected outcome:The results of the study would provide more objective determination of the impactof FTHs utilization on patient level outcomes.The findings would allow development of possiblemodels of broader collaboration and interventions to improve access to quality mental healthcare andhence improve the mental health status of people with SMDs.rnBudget:Part of the cost for the study will be covered by aPRIME fellowship to the candidate. But thestudy will be nested within the larger PRIME (â€˜PRogramme for Improving Mental health carE) project.rnResearch plan:The research proposal will be submitted inMarch2013 for ethical approval and datacollection is expected to begin in May2013.The whole research work will be finalized in early 2015.