Around the world, studies show that individuals with Severe Mental Illness (SMI) are disproportionately represented among homeless populations- Barry et al. (2024) in JAMA Psychiatry). In Addis Ababa, Ethiopia, for instance, two in five homeless people were found to be living with SMI. The unmet needs of individuals with Severe Mental Illness are wide-ranging; spanning human rights protections, access to shelter, food, sanitation, health care, safety, social reintegration, and economic recovery.
To address these gaps, the “Improving outcomes for people who are homeless and have severe mental illness in Africa” HOPE Project, a four-year research initiative, is investigating the realities of homeless persons with SMI. Funded by the UK’s National Institute for Health and Care Research (NIHR), the project is being implemented in Ghana, Ethiopia, and Kenya to design context-specific approaches that improve the lives of people living with both conditions.
The HOPE Project brings together researchers, policymakers, community members, and people with lived experience of SMI and homelessness. The project focuses on addressing unmet needs in Low- and Middle-Income Countries (LMICs) through approaches that are rights-based, contextually relevant, and scalable.
The project’s objectives include:
- Identify priority needs, valued outcomes, and intervention opportunities/challenges for
homeless persons with SMI - Integrate global and local evidence to co-produce and pilot interventions for feasibility
and acceptability - Evaluate intervention impact on human rights, outcomes, costs, and implementation
processes. - Develop methods and ethical frameworks for research with homeless persons with SMI.
PROGRESS IN GHANA
In Ghana, the project has mapped homeless populations in Tamale, profiled 72 individuals with SMI, and conducted ethnographic studies, interviews, and focus group discussions. Training workshops have been organised to equip people with lived experience with skills in advocacy, research participation, and storytelling. The Country Management Group (CMG) and the Community Advisory Board (CAB) are two key structures that have been established to guide and strengthen the project’s implementation. The CAB includes five people with lived experience of mental illness alongside HOPE project team members. These platforms bring together stakeholders, service users, and community representatives to ensure research findings translate into meaningful policy and interventions. Ghana has also participated in systematic peer reviews and grey literature reviews to examine evidence on the effectiveness, feasibility, and acceptability of interventions for homeless people with SMI in LMICs.
Ghana is currently working on a participatory intervention plan, structured in three phases:
- Outreach, Initial Identification, Assessment and Triage
- Stabilization
- Care Pathways and Linkage
So far, Ghana has contributed to three international scientific conferences under the HOPE Project:
- 2023 – Addis Ababa
- 2024 – Nairobi
- 2025 – Accra
The project involves a wide network of collaborators, including King’s College London, University of Nottingham, University of Warwick, Addis Ababa University, BasicNeeds-Ghana, and University Mental Health Research Foundation in Kenya, George Washington University (USA), and CMB-Global.
