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. 2025 Apr 21:34:e26.
doi: 10.1017/S2045796025000186.

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

Charlotte Hanlon  1   2 , Caroline Smartt  3 , Victoria N Mutiso  4 , Peter Yaro  5 , Eleni Misganaw  6 , Ursula Read  7 , Rosie Mayston  8 , Ribka Birhanu  9 , Phyllis Dako-Gyeke  10 , David M Ndetei  4   11 , Laura Asher  12   13 , Julie Repper  14 , Julian Eaton  15   16 , Kia-Chong Chua  17 , Abebaw Fekadu  2   18 , Ruth Tsigebrhan  9 , Cecilia Ashaley Fofo  19 , Kimberly Kariuki  20 , Sauharda Rai  21 , Sisay Abayneh  22   23 , Caroline Reindorf Amissah  24 , Amma Mpomaa Boadu  25 , Priscilla Makau  26 , Agitu Tadesse  27 , Philip Timms  28   29 , Martin Prince  30 , Graham Thornicroft  31 , Brandon Kohrt  21 , Atalay Alem  32
Affiliations

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

Charlotte Hanlon et al. Epidemiol Psychiatr Sci. .

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.

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

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Overview of the HOPE project
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