Digital screening and triage in SPIRIT: how the Spirit X platform supports care and research

Brief peer-delivered interventions like PM+ only work if the right people reach them, and if people who need more get referred onwards quickly. That is the job of screening and triage. This article explains the role screening plays in SPIRIT and how Spirit X, the digital platform the SPIRIT network uses with its partners, supports both care and research.

Why screening and triage matter in stepped care

SPIRIT follows a stepped-care model. PM+ is the low-threshold first step, intended for people with mild to moderate distress. It is not suitable for people with severe mental illness or acute suicidality. Each person who comes into contact with the programme therefore needs a structured assessment to answer three questions:

• Is PM+ appropriate?
• Is something more needed?
• Is anything urgent?

This is why screening is one of SPIRIT’s four pillars. According to the programme website, systematic screening is meant to detect psychological distress early, so that people are referred according to their needs. SPIRIT also aims to use assessors who speak participants’ first language, to improve the quality of these assessments (project page).

The scale is significant. For 2020–2025, SPIRIT reports more than 2,000 pre-PM+ evaluation assessments, more than 500 post-PM+ assessments and more than 350 triage referrals to further services.

What Spirit X does

Spirit X is a CE-marked software as a medical device (SaMD), certified under EU MDR as Class IIa. It runs as a Progressive Web App in the browser on desktop or mobile, and its core functions are:

• Digitised validated questionnaires. Standardised mental health instruments, with automated scoring that replaces paper forms and manual calculation.
• Automated triage. Results are classified by severity, urgency and syndromal pattern, with alerts for signs that need timely clinical attention, including indicators of suicidal tendencies.
• Longitudinal monitoring. Repeated assessments, such as before and after PM+, show how symptoms change over time.
• Multi-role workflows. Separate views for clients, assessors, helpers, field coordinators and administrators, so each organisation sees what its role requires.
• Care navigation. Where configured, pointers to regional therapy and support services help turn a triage result into a referral.

In SPIRIT, this means a participant can be assessed in their own language and triaged consistently. If more than PM+ is needed, they can be referred onwards, and their progress can be measured with the same instruments in every canton. See the Spirit X product page for capabilities, and the Instructions for Use for the regulated documentation.

Supporting research and evaluation

SPIRIT is accompanied by independent research:

• An overall evaluation by B&A
• The BRIGHT impact study in Zurich, with ETH Zurich and UNSW
• A growing body of peer-reviewed publications

Research at this scale depends on consistent, comparable data: the same validated instruments, administered the same way, across organisations, cantons and languages. Spirit X provides this shared data foundation for the SPIRIT network and its partners. Partners record screening and outcome assessments in one regulated system rather than in separate spreadsheets or paper forms.

This matters beyond any single study. Stakeholders interviewed for a 2025 preprint on embedding PM+ in Switzerland named limited quality standards and quality control as a barrier to formal recognition of non-specialist interventions in the health system. An earlier qualitative study likewise identified quality control during delivery as a requirement for scale-up. Structured outcome data is one of the ingredients of that quality assurance. Competency tools for helpers, such as those piloted with EQUIP, are another.

Safeguards and limits

Digital tools support clinical judgement; they do not replace it. Spirit X’s intended use sets clear boundaries:

• Not for emergencies. It must not be used for emergencies, life-threatening conditions or intensive care settings.
• Not the sole basis for decisions. Diagnostic or therapeutic decisions must not rest solely on questionnaire results, and local protocols and qualified clinical judgement always apply.
• Users must understand it. It is not for people who cannot understand the software or the questionnaires, although a helper or caregiver may assist.
• Privacy and compliance. Data handling is aligned with the Swiss Federal Act on Data Protection (FADP), the GDPR and the MDR.

The bigger picture

Switzerland’s refugee mental health care gap will not close through any single intervention. SPIRIT combines several elements:

• Peer-delivered PM+
• Systematic screening
• Awareness work
• Regional networks of partners

Digital screening and triage connect these elements. They help send every person to the right level of care, and they give programmes the evidence they need to secure long-term funding.

Interested in using Spirit X for a mental health programme? Contact us.