Abstract
Mental health care access remains limited in low- and middle-income contexts, prompting innovation in task-shifting interventions that leverage existing social networks. This randomized controlled trial (RCT) evaluates the Heal by Hair program in Lomé, Togo (2024), which trains hairdressers, trusted community actors, to deliver mental health promotion and basic support. The intervention comprises two arms: (1) a core training (3-day workshop + follow-up sessions) T1, and (2) an augmented "Heal by Hair Cercles" component, wherein trained hairdressers provide structured peer support to clients exhibiting severe symptoms (T2). Using a cluster-randomized design, we assign 800 hairdressers and 4,000 of their clients to either treatment (T1 or T2) or control groups. Primary outcomes include mental health knowledge (hairdressers), self-reported symptoms (hairdressers/clients), as well as a range of validated psychometric instruments (e.g., PHQ-9, GAD-7) collected during 12- and 24-month follow-up surveys. To address potential reporting bias, a subsample (n = TBD) will undergo clinical validation via 30-minute psychological assessments conducted by trained psychologists. Secondary analyses will explore heterogeneous effects by baseline predictors of our main outcomes using Generalized Random Forest. By testing a scalable, salon-based model, this study advances evidence on (1) the efficacy of mental health interventions led by lay mental health providers and (2) the incremental benefits of structured peer support ("Cercles"). Findings will contribute to literature on task-shifting in global mental health and inform policies on integrating mental health services into informal community networks in low income countries.