Problem Management+ and related interventions

The techniques used in PM+ are not new. The programmes draw upon well-known and evidence-based strategies: problem solving counselling combined with selected behavioral techniques. In combining these strategies, the programmes address both psychological problems (for example, stress, fear, feelings of helplessness) and, where possible, underlying practical problems (for example, livelihood problems, conflict in the family and so on).

All modules have or will undergo strict testing under real conditions by academic researchers to make sure that they work and are safe. PM+ Individual has been tested with very good results in Pakistan and Kenya. PM+ Group, PM+ Early Adolescent Skills for Emotions (EASE) and Step by Step are still being tested. The STRENGTHS project will contribute to the testing and further development of these three modules.

The STRENGTHS project goes a step further in the research by also looking at the cost effectiveness of the intervention and at strategies for implementation in different contexts.

Global access to care for common mental health problems following adverse experiences can be significantly improved by developing, implementing, and evaluating scalable interventions. As highlighted within WHO’s mental health Global Action Program (mhGAP), there is a large gap between prevalence of mental health problems and evidence-based service availability and use in the vast majority of communities of the world.

Therefore, in communities affected by adversity where this gap is larger, the case for low intensity interventions is especially strong. Communities facing the highest rates of adverse events also tend to be communities with the least developed mental health care systems and the greatest number of barriers preventing people from accessing available services.

Potential barriers include underdeveloped or damaged health infrastructure, limited availability of professionals and poverty. Although each of these issues can prevent people from accessing care, adverse events often exacerbate existing challenges. These can then intensify and worsen, ultimately resulting in services being far out of reach for the majority of people.

In recent years, a range of low intensity interventions have been found to be effective for people suffering high levels of stress, depression, and anxiety. Although much of this work has been done in high-income countries, there is an increasing momentum to develop and test similar interventions for low-income settings.

Scalable psychological interventions are sometimes also called “low intensity interventions”. They are modified, evidence-based psychological treatments, such as:

• Brief, basic, paraprofessional-delivered versions of existing evidence-based psychological treatments (e.g., basic versions of cognitive-behavioural therapy, interpersonal therapy).
• Self-help materials drawing from evidence-based psychological treatment principles, in the form of: – Self-help books – Self-help audiobooks or videobooks – Online self-help programs.
• Guided self-help in the form of individual or group programs guiding clients in the use of above mentioned self-help materials.

The term “low intensity” indicates a less intense level of specialist human resource use. It means that the intervention has been modified to use much less resources compared to conventional psychological treatments by specialists. As a result, aspects about the intervention are changed to make them feasible in communities that do not have many specialists. Such modifications can thus create more accessible mental health care that reaches a larger number of people. Even when low intensity interventions are somewhat less effective than conventional models of psychological treatment, such differences may be acceptable in exchange for the increased coverage and accessibility gained in return. This compromise can be assessed using cost-effectiveness research methods from the field of health economics.