Problem Management Plus (PM+): the WHO intervention behind SPIRIT

Problem Management Plus, usually shortened to PM+, is the core intervention of the Swiss SPIRIT programme. This article explains what PM+ is, how it is delivered, who delivers it, and what the research evidence does and does not show.

What is PM+?

PM+ is a brief psychological intervention developed by the World Health Organization (WHO) for adults impaired by distress in communities exposed to adversity. It was first described by Dawson and colleagues in World Psychiatry in 2015, and the WHO publishes the official PM+ manual.

Two features set PM+ apart:

• It is transdiagnostic. PM+ does not target a single diagnosis. It addresses common problems such as anxiety, low mood and stress, which often occur together.
• It is designed for task sharing. Trained non-specialist helpers deliver the sessions under supervision, so support can reach people where specialists are scarce.

PM+ does not replace psychotherapy. In SPIRIT it is a low-threshold first step in a stepped-care model. The Swiss Red Cross in the canton of Bern states that the programme is for people with mild to moderate distress, and not for people with severe mental illness or acute suicidality.

How PM+ works

PM+ teaches a small set of practical strategies, built around four core components:

1. Managing stress, through a simple breathing technique
2. Managing problems, with a structured, step-by-step approach to practical difficulties
3. “Get going, keep doing”, which uses behavioural activation to reconnect people with meaningful activities
4. Strengthening social support

According to the SPIRIT project page, the programme delivers PM+ as five sessions of around 90 minutes. In the canton of Zurich, the Swiss Red Cross adds three follow-up phone calls of 30–45 minutes after the five in-person sessions. The offer is free.

Who delivers PM+ in Switzerland?

In SPIRIT, PM+ is delivered by helpers who themselves have a refugee or migration background, as peer support in the participants’ first language. According to the SPIRIT project page, helpers need:

• Ongoing or completed higher education, or experience in the social sector
• Language skills at C1 level in German, French or English (for training and supervision)

They complete an eight-day basic training, followed by practice cases under ongoing supervision. SPIRIT lists Arabic, Farsi/Dari/Persian, Kurdish, Pashto, Russian, Tamil, Tigrinya, Turkish and Ukrainian among its community languages.

Quality matters when non-specialists deliver psychological care. SPIRIT uses the competency tools of the WHO–UNICEF EQUIP platform. A 2025 study by Hemmo and colleagues piloted these assessments with 13 Arabic-speaking helpers in Switzerland. It concluded that the tools can identify strengths and areas for improvement and provide useful feedback for training.

What does the evidence show?

Across trials worldwide. A 2023 meta-analysis in World Psychiatry pooled 23 randomised controlled trials with 5,298 participants testing PM+ or its digital adaptation Step-by-Step. It found:

• A small-to-medium reduction in distress (standardised mean difference −0.45)
• A small improvement in positive mental health outcomes (SMD 0.31)
• Both effects remained significant at follow-up

The authors also note substantial heterogeneity between studies and rate the certainty of evidence as very low. More high-quality trials are needed.

Peer-delivered PM+ in a high-income country. In a randomised trial in the Netherlands, 206 Syrian refugees were assigned to PM+ delivered by peers, or to care as usual. At three months, the PM+ group showed greater reductions in depression and anxiety (Cohen’s d = 0.41), PTSD symptoms and self-identified problems. At the 12-month follow-up, effects on psychological distress (d = 0.28) and anxiety were still detectable, but effects on other outcomes were not. The authors suggest booster sessions to make the gains last.

In Switzerland. A pilot randomised trial with 59 Syrian refugees and asylum seekers found PM+ feasible, acceptable and safe. Trial retention was 67.8%, participants attended an average of 3.94 sessions, and there were no serious study-related events. In the canton of Bern, a 2025 evaluation reported by the Swiss Red Cross found that 42% of participants no longer reported severe distress after the programme. That is almost three times the rate at baseline.

Why PM+ fits the Swiss context

The care gap for refugees in Switzerland is driven by language, stigma, interpreter costs and long waits for specialists. PM+ addresses several of these barriers:

• Peers deliver it in participants’ own languages.
• It is short and free.
• It frames support as “problem management” rather than psychiatric treatment, which can reduce stigma.

Combined with screening and triage, PM+ helps direct specialist capacity to the people who need it most. To see how this works at national scale, read SPIRIT: how Switzerland is scaling psychological support for refugees.