Publications
Publications from researchers working across the Global Mental Health Collaborative
Programmes for people who are homeless and have severe mental illness in low-income and middle-income countries: a systematic review
In September 2025, the HOPE research team published this report in The Lancet Psychiatry, The aim of this systematic review was to synthesise existing evidence on programmes for people experiencing homelessness and severe mental illness in LMICs.
In this review, the HOPE team identifies 80 sources describing 45 programmes across ten LMICs. Programme components spanned seven domains: service models, basic needs, health care, outreach, empowerment, community level, and macro level.The team identified programmes that show promise and can serve as starting points for future programme design that considers local contexts and population-specific needs.
The research reported in this systematic review was funded by the NIHR through the NIHR Global Health Research Group on Homelessness and Mental Health in Africa (NIHR134325) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Charlotte Hanlon also receives support from Wellcome grants 222154/Z20/Z and 223615/Z/21/Z.
Improving outcomes for people who are homeless and have severe mental illness in Ethiopia, Ghana and Kenya: overview of the HOPE programme
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.
The research reported in this publication is funded by the National Institute for Health and Social Care Research (NIHR) through the Global Health Research Group on Homelessness and Mental Health in Africa (NIHR134325), using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care or Public Health England.
“They treat us like rabid dogs”: Stigma and discrimination as experienced by people living with psychosis and their caregivers in Malawi—A photovoice study
Psychosis in Malawi presents significant challenges for individuals living with psychosis and their caregivers, compounded by stigma, discrimination, and systemic barriers to healthcare access. This study employed a participatory photography method (photovoice) to explore the lived experiences of individuals with psychosis and their caregivers in the Chiradzulu and Salima districts. Sixteen participants, comprising eight People with Lived Experience (PWLE) of psychosis and eight caregivers, documented their experiences and perceptions through photographs. Photovoice participants reported stigma and discrimination in the form of social and economic exclusion and dehumanisation. Love, care, and self-reliance were identified and described as essential to recovery and combating exclusion. In contrast, healthcare access was described as both a facilitator and a challenge to recovery and caregiving. This study underscores the need for targeted community-based and policy-driven interventions to combat stigma and discrimination through intersectoral and multisectoral approaches. It also calls for integrated healthcare services such as task-sharing to address systemic barriers experienced by PWLE of psychosis and improved involvement of individuals with lived experience to improve recovery.
The research reported in this paper was funded by Wellcome (www.wellcome.org) grant number 223615/Z21/Z to Professor Stephen M. Lawrie as the Principal Investigator & CH, SJ, LMT, EU, JA, DK, AA, WS, DC, KC, AM, KK, AB, MU as co-investigators. CH receives support from the National Institute for Health Care Research (NIHR) through the NIHR Global Health Research Group on Homelessness and Mental Health in Africa (NIHR134325), using UK aid from the UK government. CH also receives support from Wellcome through grant 222154/Z20/Z. Funders had no role in designing the study, collecting and analysing data, decision to publish, or taking part in the preparation of the manuscript.
Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper
Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery.
Charlotte Hanlon, Atalay Alem, and Eleni Misganaw receive support from the National Institute for Health and Care Research (NIHR) through the NIHR Global Health Research Group on Homelessness and Mental Health in Africa (NIHR134325) and CH also receives support from the SPARK project (NIHR200842) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CH also receives support from WT grant 223615/Z/21/Z. Tessa Roberts receives a fellowship from the British Academy (PF21\210001). Crick Lund receives support from the National Institute for Health Research (NIHR) (using the UK’s Official Development Assistance (ODA) Funding) and Wellcome (grant number: 221940/Z/20/Z) under the Department of Health and Social Care (DHSC)-Wellcome Partnership for Global Health Research. Craig Morgan is part-funded by the ESRC (ESRC Centre for Society and Mental Health at King’s College London: ESRC Reference: ES/S012567/1). For the purposes of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Accepted Author Manuscript version arising from this submission
Pathways to care for psychosis in Malawi
People with psychosis in Malawi have very limited access to timely assessment and evidence-based care, leading to a long duration of untreated psychosis and persistent disability. Most people with psychosis in the country consult traditional or religious healers. Stigmatising attitudes are common and services have limited capacity, particularly in rural areas. This paper, focusing on pathways to care for psychosis in Malawi, is based on the Wellcome Trust Psychosis Flagship Report on the Landscape of Mental Health Services for Psychosis in Malawi. Its purpose is to inform Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE), a longitudinal study that aims to build on existing services to develop sustainable psychosis detection systems and management pathways to promote recovery.
This study is an output of the Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) study funded by Wellcome (223615/Z). R.C.S. also receives funding from the UK Medical Research Council/Global Challenges Research Fund grant to the University of Edinburgh (MR/S035818/1). The views expressed do not necessarily reflect those of the funding agencies.
Malawi has a population of around 20 million people and is one of the world’s most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.
This study is funded by Wellcome Trust (www.wellcome.org) under grant number 223615/Z/21/Z. The Principal Investigator is Professor Stephen Lawrie (SL). Charlotte Hanlon (CH) receives support through the National Institute for Health and Care Research (NIHR) with a RIGHT grant (NIHR200842) and an NIHR global health research group on homelessness and mental health in Africa (HOPE; NIHR134325). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care, England. CH is also funded by the Wellcome Trust through grants 222154/Z20/Z (SCOPE). Martin Pickersgill (MP) contributions are additionally supported through the AHRC [AH/W011417/1], MRC [MR/S035818/1], and Wellcome Trust [209519/Z/17/A]. Robert Stewart (RS) and Angus MacBeth (AMB) are supported by MRC GCRF MR/S035818/1. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
PROMISE in Action: Fostering Inclusive Research through Lived Experience Engagement in Malawi
This is an article published in the World Association for Psychosocial Rehabilitation Bulletin entitled "Recovery and rights-based approaches in mental health." It discusses The Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) study and its approach to engage persons with lived experience in research activities.
We gratefully acknowledge the generous support provided by the Wellcome Trust for funding the PROMISE Project.