SPIRIT: how Switzerland is scaling psychological support for refugees

SPIRIT, short for Scaling-up Psychological Interventions in Refugees in Switzerland, is a nationwide programme that aims to strengthen the resilience of refugees and give them equal access to adequate mental health care. This article explains how SPIRIT is organised, how it is funded, and what it has achieved so far.

Origins and aims

SPIRIT was initiated by University Hospital Zurich (USZ), which also leads the project nationally. The SPIRIT network is run by USZ together with the University of Zurich (UZH). It builds on the European research programme STRENGTHS, which adapted and tested the WHO’s scalable psychological interventions for Syrian refugees in Europe and the Middle East.

According to the project page, SPIRIT aims to:

• Improve access to psychosocial support for refugees
• Strengthen participants’ resilience
• Establish PM+ as the first step in a stepped-care model
• Use assessors who speak participants’ first language
• Build lasting capacity within communities
• Create a Swiss network of organisations working with refugees

Four pillars

The programme website describes four connected areas of work:

1. PM+. The WHO’s Problem Management Plus intervention, delivered as peer support by trained helpers with a refugee background. Since the war in Ukraine, SPIRIT has also used the WHO’s EASE programme for Ukrainian children and adolescents.
2. Screenings. Systematic screening for early detection of psychological distress, so that people are referred according to their needs.
3. Awareness campaign. Raising awareness of mental health among refugees and professionals, and promoting the PM+ offer.
4. Networking. Regional, interprofessional networks linking the health, migration and social sectors, including an online map of services.

Nine cantons, one model

In its first phase, from 2020 to 2025, SPIRIT was implemented by partners in nine cantons: Bern, Basel-Landschaft, Basel-Stadt, Lucerne, Thurgau, Schaffhausen, Schwyz, Vaud and Zurich. Most cantonal programmes are run by branches of the Swiss Red Cross. Others are run by cantonal integration services, Caritas Switzerland or, in Vaud, the organisation ActLab. Learn who does what in The partners behind SPIRIT.

What this looks like for participants varies slightly by canton. In Zurich, the Swiss Red Cross offers SPIRIT on these terms:

• Who: people aged 16 and over with a migration or refugee background (permits N, F, S, or B for refugees and family reunification)
• Languages: 13, from Arabic and Dari to Tigrinya and Ukrainian
• Format: five in-person sessions of 90 minutes, then three follow-up phone calls
• Cost: free, with travel costs covered

In Bern, SPIRIT has been offered in collective accommodation centres since the end of 2023.

Funding

The project page states that SPIRIT is funded by Gesundheitsförderung Schweiz, through its project funding for prevention in health care (PGV), and by USZ. According to the partner list, cantonal implementation is co-funded by:

• The State Secretariat for Migration (SEM)
• Cantonal integration and health departments
• Foundations, such as the Christoph Merian Stiftung in Basel and the Humanitarian Foundation of the Swiss Red Cross in Bern

Long-term financing is the main open question. The Swiss Red Cross in Bern reported in April 2025 that its funding was secured until the end of 2025 and that it was looking for a sustainable model. A 2025 preprint by Keyan and colleagues interviewed 30 stakeholders, from policymakers to peer helpers. They pointed to blended co-financing across the health and integration sectors as the route to sustainability. This study has not yet been peer-reviewed.

Results so far

The SPIRIT project page reports these figures for 2020–2025:

Indicator	Number
Trained PM+ trainers and supervisors	more than 10
Trained PM+ helpers	more than 120
Pre-PM+ evaluation assessments	more than 2,000
Completed PM+ interventions (five sessions)	more than 1,200
Post-PM+ evaluation assessments	more than 500
Triage referrals to further services	more than 350

Participants report significant reductions in anxiety, depression and PTSD symptoms, fewer physical complaints, and better quality of life and self-efficacy. The programme says these interim results are consistent with international PM+ studies.

At cantonal level, the Swiss Red Cross in Bern delivered more than 150 SPIRIT consultations with 14 trained counsellors. In the 2025 evaluation, 42% of participants no longer reported severe distress after the programme, almost three times the baseline rate, and the improvements remained stable over time.

Two independent evaluations accompany the programme:

• B&A (Beratungen und Analysen) conducts the overall evaluation.
• The BRIGHT study, with ETH Zurich and the University of New South Wales (UNSW), examines the impact in the canton of Zurich.

From pilot to routine care

SPIRIT’s stated long-term goal is integration into regular health care. Stakeholders interviewed for the Keyan et al. preprint were enthusiastic about PM+. They also named what routine delivery still requires:

• Quality standards for non-specialist interventions
• Endorsement by professional associations
• Mental health indicators in cantonal integration programmes

Digital infrastructure for consistent screening, triage and outcome measurement is part of that foundation. See Digital screening and triage in SPIRIT.