Improving outcomes for people who are homeless and have severe mental illness in Ethiopia, Ghana and Kenya: overview of the HOPE programme

Charlotte Hanlon, Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Caroline Smartt, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Victoria N. Mutiso, Africa Institute of Mental and Brain Health, Nairobi, Kenya.
Peter Yaro, BasicNeeds-Ghana, Tamale, Ghana.
Eleni Misganaw, Mental Health Service User Association, Addis Ababa, Ethiopia.
Ursula Read, School of Health and Social Care, University of Essex, Colchester, UK.
Rosie Mayston, Department of Global Health & Social Medicine, King's College London, London, UK.
Ribka Birhanu, College of Health Sciences, School of Medicine, Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity-Building, Addis Ababa University, Addis Ababa, Ethiopia.
Phyllis Dako-Gyeke, Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana.
David M. Ndetei, Africa Institute of Mental and Brain Health, Nairobi, Kenya.
Laura Asher, Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham, UK.
Julie Repper, Imroc (Charity Reg No. 1207904), Nottingham, UK.
Julian Eaton, CBM Global, UK.
Kia-Chong Chua, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Abebaw Fekadu, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Ruth Tsigebrhan, College of Health Sciences, School of Medicine, Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity-Building, Addis Ababa University, Addis Ababa, Ethiopia.
Cecilia Ashaley Fofo, BasicNeeds-Ghana, Accra, Ghana.
Kimberly Kariuki, Centre for Clinical Research, Division of Mental Health, Kenya Medical Research Institute, Nairobi, kenya.
Sauharda Rai, Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA.
Sisay Abayneh, College of Education and Behavoural Studies, Arsi University, , Arsi Asela, Ethiopia.
Caroline Reindorf Amissah, Deputy Chief Executive, Mental Health Authority, Accra, Ghana.
Amma Mpomaa Boadu, Mental Health Department, Institutional Care Division, Ghana Health Service, Accra, Ghana.
Priscilla Makau, Kitui County, Ministry of Health, Nairobi, Kenya.
Agitu Tadesse, Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia.
Philip Timms, National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK.
Martin Prince, Department of Public Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Graham Thornicroft, Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Brandon Kohrt, Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA.
Atalay Alem, Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Document Type

Journal Article

Publication Date

4-21-2025

Journal

Epidemiology and psychiatric sciences

Volume

34

DOI

10.1017/S2045796025000186

Keywords

community mental health; mental illness stigma; minority issues and cross-cultural psychiatry; psychosis; social inclusion

Abstract

AIM: HOPE (National Institute for Health and Care Research Global Health Research Group on Homelessness and Mental Health in Africa) aims to develop and evaluate interventions that address the unmet needs of people who are homeless and have severe mental illness (SMI) living in three African countries in ways that are rights-based, contextually grounded, scalable and sustainable. METHODS: We will work in the capital city (Addis Ababa) in Ethiopia, a regional city (Tamale) in Ghana, and the capital city (Nairobi) and a rural county (Makueni) in Kenya to understand different approaches to intervention needed across varied settings.We will be guided by the MRC/NIHR framework on complex interventions and implementation frameworks and emphasise co-production. Formative work will include synthesis of global evidence (systematic review, including grey literature, and a Delphi consensus exercise) on interventions and approaches to homelessness and SMI. We will map contexts; conduct focused ethnography to understand lived experiences of homelessness and SMI; carry out a cross-sectional survey of people who are homeless (n = 750 Ghana/Ethiopia; n = 350 Kenya) to estimate prevalence of SMI and identify prioritised needs; and conduct in-depth interviews and focus group discussions with key stakeholders to understand experiences, challenges and opportunities for intervention. This global and local evidence will feed into Theory of Change (ToC) workshops with stakeholders to establish agreement about valued primary outcomes, map pathways to impact and inform selection and implementation of interventions. Intervention packages to address prioritised needs will be co-produced, piloted and optimised for feasibility and acceptability using participatory action research. We will use rights-based approaches and focus on community-based care to ensure sustainability. Realist approaches will be employed to analyse how contextual variation affects mechanisms and outcomes to inform methods for a subsequent evaluation of larger scale implementation. Extensive capacity-strengthening activities will focus on equipping early career researchers and peer researchers. People with lived experience of SMI and policymakers are an integral part of the research team. Community engagement is supported by working closely with multisectoral Community Advisory Groups. CONCLUSIONS: HOPE will develop evidence to support action to respond to the needs and preferences of people experiencing homelessness and SMI in diverse settings in Africa. We are creating a new partnership of researchers, policymakers, community members and people with lived experience of SMI and homelessness to enable African-led solutions. Key outputs will include contextually relevant practice and policy guidance that supports achievement of inclusive development.

Department

Psychiatry and Behavioral Sciences

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