King's College London

The project, entitled ‘HOPE’, will be co-led by Professor Charlotte Hanlon, Co-Director of the Centre for Global Mental Health (CGMH) at King’s College London, and Professor Atalay Alem of Addis Ababa University. Project partners include BasicNeeds-Ghana (Peter Yaro), University of Ghana (Dr Phyllis Dako-Gyeke), the Africa Mental Health Research and Training Foundation (Professor David Ndetei and Dr Victoria Mutiso), the Centre for Innovative Drug Development and Innovative Trials for Africa at Addis Ababa University (CDT-Africa; Professor Abebaw Fekadu), representative organisations for people with lived experience of mental illness, Ministry of Health Representatives from Ethiopia, Ghana and Kenya, and colleagues from CGMH, the World Health Organization, CBM Global, University of Nottingham, University of Warwickand George Washington University, USA.

Co-occurrence of homelessness and SMI, including schizophrenia, bipolar disorder and severe depression, is a health and social emergency affecting an estimated 28-36 million people in low- and lower middle-income countries (LLMIC). However there is no high-quality evidence to show which interventions are effective in these settings.

The HOPE project will develop and test community-based interventions to address the needs of people who are homeless and have SMI. A total of £2,999,974 NIHR funding was awarded for the project to run in sites across Ethiopia, Ghana and Kenya from September 2022 to September 2026. The project will create a new partnership of researchers, policy makers, community members and people with lived experience of SMI and homelessness. It will work in a capital city (Addis Ababa) in Ethiopia, a regional city (Tamale) in Ghana, and a rural county (Makueni) in Kenya to understand the different approaches needed across varied settings.

People who experience homelessness and SMI are at high risk of human rights violations, premature mortality and social exclusion, but the absence of evidence on effective interventions is a potent barrier to global action. Previous work from the Ethiopia team working with CGMH has shown that two in five homeless people assessed in Addis Ababa had SMI, and that one in three people with SMI in rural Ethiopia had slept unsheltered. There is a clear need to develop partnerships and capacity for Africa-led research to tackle this complex problem.

The project will work in three phases: phase one will map existing contexts, lived experience, needs, priorities and opportunities through ethnography and surveys; phase two will co-produce and pilot intervention packages; phase three will test the intervention packages in specific geographic areas to reach 350 people experiencing homelessness and SMI per site.

By the end of the project, researchers hope to have:

1. Developed evidence-supported interventions to improve the lives of people who are homeless and have SMI relevant for diverse settings in Africa.
2. Produced a manual on how to adapt and implement the programme in different settings.
3. Developed methods, ethical frameworks and the capacity of early career researchers and other stakeholders in Ethiopia, Ghana and Kenya to work in this area.
4. Built a strong collaboration of multi-sector partners to sustain future in-country work and longer-term high-quality research on this neglected topic.

The NIHR Global Health Research Portfolio uses UK aid to fund high quality applied health research and training in areas of unmet need for the direct and primary benefit of people in low- and middle-income countries (LMICs). The Global Health Research Groups programme aims to generate the scientific evidence that can improve health outcomes for people in low resource settings through improving practice and informing policy. The programme also strengthens research and research management capacity and capability to support the future sustainability of research in partner countries.

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