After the randomized controlled trial: Implementing Problem Management Plus (PM+) through humanitarian agencies

Organisation: Terre des hommes

Partners: World Health Organization, PSTIC and humanitarian implementation partners: ACF, IMC, IFRC, IRC, UNHCR, IOM, CBM, CVT, MDM, MSF France, TDH

Location: Global

Type of grant: Core – implementation

Status: Ongoing

  • Alison Schafer, PM+ trainer. Credit: Tdh Egypt

  • PM+ training participants, March 2018, Cairo. Credit: Tdh Egypt

  • International Rescue Committee PM+ trainees Yassmin and Ashraf in Amman, Jordan in May 2018.

  • International Rescue Committee trainees Shahed and Dana practice teaching PM+ to other trainees

  • From left to right: Ahlem Cheffi (PS Centre), Joyce Caballero (Colombian Red Cross), Nataly Caldas (Colombian Red Cross), Yosbelly Chaparro (Colombian Red Cross), Leandro Blanco (Colombian Red Cross) and Camila Perera (PS Centre/Trinity College Dublin)

  • IFRC supervisor trainees discussing the five PM+ sessions and learning about supervision techniques.

  • IFRC supervisor trainees discussing the five PM+ sessions and learning about supervision techniques.

Problem Management Plus (PM+) is a brief evidence-based five-session trans-diagnostic psychological WHO intervention employing empirically supported strategies. It can be delivered by non-specialist lay-providers under specialist supervision, to adults impaired by distress.


During and after emergencies and humanitarian crisis, there are large numbers of people who are impaired for prolonged periods by distress. Grief and acute stress are usually transient psychological reactions to adversity and loss, but prolonged states of anxiety and depression may also be triggered by extreme stressors. These chronic problems undermine the functioning of individuals and their communities, which can be essential for their survival and is essential for socioeconomic recovery. In these periods of crisis, the health systems also tend to be overwhelmed and unable to meet the demand for basic services, and often the existing supportive care systems in the communities have also been damaged.


Problem Management (PM+) was found effective in two randomised controlled trials, (RCTs) funded by Elrha’s Research for Health in Humanitarian Crises (R2HC) programme and by Grand Challenges Canada. PM+ can improve mental health, functioning and psychosocial well-being of people in humanitarian settings. It is a scalable, manualised, evidence-based intervention that can be used by both the health and social sector to reduce distress and improve functioning. It has proven to be effective in diminishing depression and anxiety and improving people’s functioning and self-selected, culturally relevant outcomes. Some of its very distinct and innovative features include:

  • a transdiagnostic intervention, addressing a range of client identified emotional (eg depression, anxiety, traumatic stress, general stress) and practical problems
  • designed for low-resource settings
  • designed for people in communities affected by any kind of adversity (eg violence, disasters), not just focussing on a single kind of adversity
  • it is empowering as it teaches adult participants to self-manage their distress for sustainable, long-term solutions.


In collaboration with eight humanitarian organisations, the project will enable them to implement PM+ in their agencies, through a capacity building intervention to use PM+ and thereby provide evidence based care.

The capacity building workshops will focus on (a) cultural adaptation of the manual, (b) training of trainers in an apprenticeship training and supervision approach, with a strong emphasis on on-the-job learning, and (c) regular measurement of outcomes.

The outputs of the capacity training workshop will include:

  • an availability of 20 PM+ trainers, clinical supervisors, programme supervisors
  • PM+ implementation plans in the partnering humanitarian organisations
  • a roster of independent PM+ trainers that can be consulted by agencies that do not have PM+ trainers
  • a community of practice on the intervention
  • three qualitative case studies on the experience of implementing PM+.

Elrha is a registered charity in England and Wales (1177110).

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