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PreprintCited by 11Homelessness and Social IssuesPsychiatric care and mental health servicesUrban and Rural Development Challenges

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

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Hanlon, Charlotte, Smartt, Caroline, Mutiso, Victoria, Yaro, Peter, Misganaw, Eleni, Read, Ursula, Mayston, Rosie, Birhanu, Ribka, Dako-Gyeke, Phyllis, Ndetei, David, Asher, Laura, Repper, Julie, Eaton, Julian, Chua, Kia-Chong, Fekadu, Abebaw, Tsigebrhan, Ruth, Fofo, Cecilia Ashaley, Kariuki, Kimberly, Rai, Sauharda, Abayneh, Sisay, Amissah, Caroline Reindorf, Boadu, Amma Mpomaa, Makau, Priscilla, Tadesse, Agitu, Timms, Phil, Prince, Martin, Thornicroft, Graham, Kohrt, Brandon, Alem, Atalay·2024·Epidemiology and Psychiatric Sciences
DOI 10.1101/2024.11.28.24318066PMC PMC7617600

Preprint — published as 10.1017/s2045796025000186 · Paper page

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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. Formative work will include synthesis of global evidence (systematic review, including grey literature, and a Delphi consensus exercise) on interventions and approaches to improving outcomes for people who are homeless and have SMI. We will map contexts; conduct a focused ethnographic study to understand lived experiences of homelessness and SMI; carry out a cross-sectional survey of people who are homeless (n=750 in Ghana and Ethiopia; n=350 in 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 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 in each country with people who are homeless and have SMI, and will be 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 multi-sectoral Community Advisory Groups. Conclusions: HOPE will develop evidence to support action to respond to the needs and preferences of people who are homeless and have SMI in diverse settings in Africa. We are creating a new partnership of researchers, policy makers, community members and people with lived experience of SMI and homelessness to lead this work in and for the Global South.

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Metadata

Authors
Hanlon, C., Smartt, C., Mutiso, V., Yaro, P., Misganaw, E., Read, U., Mayston, R., Birhanu, R., Dako-Gyeke, P., Ndetei, D., Asher, L., Repper, J., Eaton, J., Chua, K.-C., Fekadu, A., Tsigebrhan, R., Fofo, C. A., Kariuki, K., Rai, S., Abayneh, S., Amissah, C. R., Boadu, A. M., Makau, P., Tadesse, A., Timms, P., Prince, M., Thornicroft, G., Kohrt, B., & Alem, A.
Affiliations
  • Addis Ababa University (ET)
  • King's College London (GB)
  • University of Essex (GB)
  • University of Nairobi (KE)
  • University of Nottingham (GB)
  • Liverpool School of Tropical Medicine (GB)
  • Brighton and Sussex Medical School (GB)
  • Kenya Medical Research Institute (KE)
  • George Washington University (US)
  • Arsi University (ET)
  • Mental Health Authority (GH)
  • Ghana Health Service (GH)
  • Ministry of Health (KE)
  • Federal Ministry of Health (ET)
Corresponding author
Hanlon, Charlotte
ORCID
Venue
Epidemiology and Psychiatric Sciences
Publisher
openRxiv
Published
2024-11-29
Volume
34
Pages
e26-e26
ISSN
2045-7960 (ISSN-L)
DOI
10.1101/2024.11.28.24318066
PMC
PMC7617600
OpenAlex
W4409622058
Cited by
11
References
1
Citations by year
2026: 8 · 2025: 3
FWCI
13.81
Type
journal article
Language
en
Open access
Licence
Locations
  • Epidemiology and Psychiatric Sciences (publishedVersion, cc-by)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, cc-by)
  • LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
  • Open Access at Essex (University of Essex) (acceptedVersion)
  • PubMed Central (acceptedVersion, cc-by)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
  • Wellcome Trust (222154, 222154/Z/20/Z, 223615/Z/21/Z, 223615, 223615/Z)
  • Government of the United Kingdom (223615/Z/21, 222154/Z20/Z, 223615/Z/21/Z)
  • National Institute for Health and Care Research (NIHR134325)
  • Department of Health and Social Care (NIHR134325)
  • Public Health England
  • Foreign, Commonwealth and Development Office
  • National Institute of Mental Health (R01MH120649)
Topics
  • Social Sciences › Sociology and Political Science › Homelessness and Social Issues
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Urban Studies › Urban and Rural Development Challenges
Keywords
homelessness, severe mental illness, complex interventions, rights-based approach, community-based care, co-production, theory of change, realist evaluation, lived experience, community participation, capacity building, peer researchers, mental health policy, Ethiopia, Ghana, Kenya
MeSH terms
Mental Disorders, Cross-Sectional Studies, Ethiopia, Ghana, Ill-Housed Persons, Humans, Kenya, Mental Health Services, Program Evaluation, Focus Groups

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