Special section on PM+
Problem Management Plus (PM+) itself was developed by the World Health Organization for use in settings affected by adversity and in humanitarian crises. In individual and group format, PM+ is an innovative, fast, cost-effective, transdiagnostic, evidence-based, psychological intervention that aims to improve mental health, functioning and psychosocial wellbeing of adults impaired in communities exposed to adversity.
Learning from the Challenges of COVID-19
As might be expected after the rigours of 2020, several articles refer to the challenges raised by COVID-19 in planning or implementing PM+.
- McBride et al. focus directly on the adaptation of PM+ for remote training in a variety of settings.
- Sabry et al. provide a personal reflection on their team’s experience of providing counselling by phone to refugees living in Cairo, Egypt, when the pandemic hit.
- The field report written by Rodríguez-Cuevas et al. also touches on the impact of the pandemic − in this case in a rural setting, in Chiapas, Mexico
Improving access to brief psychological interventions entails providing interventions that contribute to the psychological wellbeing without overlooking their cultural background, values and norms.
- Akhtar et al. describes the process and results of making a cultural adaption of Group PM+ for two groups of Syrian refugees, one living in camp settings in Jordan and the other in urban settings in Turkey within the framework of the STRENGTHS Consortium.
- Coleman et al. in their article detail the process that Partners in Health use as an international nongovernmental organisation in Rwanda, Peru, Mexico and Malawi across multiple public sector primary care and community settings in partnership with Ministries of Health.
- Ghimire and Shrestha document their experiences of introducing Group PM+ in Nepal in their personal reflection. Identifying metaphors which made sense in Nepal helped participants to understand the four core strategies used in PM+.
Training, Supervision and Implementation
Ensuring quality is one of the key issues in training lay providers and keeping the knowledge transfer sustainable.
- Gebrekristos et al., writing about the work done in Ethiopia particularly highlight the importance of supervision in contexts where training participants come from the same communities as their clients.
- Chiumento et al. describe very well the testing and implementation of PM+ within a large study in the UK in training peer lay helpers who have lived experience of seeking refuge or of migration.
- Pedersen et al. by reports on a structured competency rating tool for use with observed role plays which was piloted with the Centre of Victims of Torture programme in Ethiopia.
- The case studies presented by Nemiro et al. in their field report featuring Ethiopia, Syria and Honduras indicate how vital a strong supervision system is within humanitarian organisations along with practising the intervention before it is delivered.
- Dozio et al. present results on outcomes for internally displaced persons, using both quantitative and qualitative methods, as well as some information on their adaptation procedures and the cultural acceptance of the intervention in CAR.
Developments in PM+
In this special issue, there are two articles from the STRENGTHS Consortium which discuss innovations in relation to PM+.
- Woodward et al. proposes a system innovation perspective on scaling up new psychological interventions for refugees arguing for change within existing mental health systems to integrate new interventions in a sustainable way.
- Fuhr et al. is a commentary on the neglected issue of alcohol misuse in conflict-affected populations. It describes a proposed programme of work to be implemented in Uganda and the Ukraine, complementing PM+ with components addressing alcohol misuse.
Reflections about PM+
Three personal reflections feature the voices of refugees.
- Basil et al., the Syrian authors − now living in Rotterdam, The Netherlands − write about the benefits and challenges in doing a PM+ training.
- Ali and Ari, one a MHPSS officer and the other a psychosocial support community worker, both share their stories about the PM+ training in the Kurdistan region of Iraq.
- Goloktionova and Mukerjee describe the experience of two mental health programme coordinators supporting the implementation of PM+ in conflictaffected Eastern Ukraine.