A policy brief on WHO’s Self Help Plus (SH+) intervention and its preventive effects

Around 1 % of the world’s population, or 1 in 97 people, is forcibly displaced.1 Refugees and asylum seekers are at a higher risk than the general population for developing mental health conditions because of their adverse life experiences. However, most refugees and asylum seekers with poor mental health do not get effective help. On average only 2% of countries’ health budgets go to mental health. Most refugees do not have access to quality affordable mental health care in their community. This brief provides details of a new psychological intervention: Self Help Plus (SH+), developed by the World Health Organization (WHO) to address this gap. In a recent study called RE-DEFINE (Refugee Emergency: Defining and Implementing Novel Evidence-based psychosocial interventions) with 1,101 refugees and asylum seekers in Turkey and in five countries in Western Europe, SH+ was shown to be effective in reducing psychological distress and preventing the development of mental disorders.

| Published: 01 January 2022


Self-Help Plus (SH+) is WHO’s 5-session stress management course for large groups of up to 30 people. It is delivered by supervised, non-specialist facilitators who complete a short training course and use pre-recorded audio and an illustrated guide (Doing What Matters in Times of Stress) to teach stress management skills. The course is suitable for adults who experiences stress, wherever they live and whatever their circumstances. It has been shown to reduce psychological distress and prevent the onset of mental disorders. The format of SH+ makes it well-suited for use alongside other mental health interventions, as a first step in a stepped care programme, or as a community intervention delivered alongside broader community programming.

| Published: 23 September 2021

New stress management course for people living with adversity

Self-Help Plus is a stress management course intended for groups of up to 30 people who have lived through or are living through adversity, whether due to personal difficulties, work- or family-related stress or issues that affect whole communities such as armed conflict, violence, disease and poverty.

| Published 11 October 2021, www.who.int

Self-help plus for refugees and asylum seekers; study protocol for a series of individual participant data meta-analyses.

Karyotaki E, Sijbrandij M, Purgato M, Acarturk C, Lakin D, Bailey D, Peckham E, Uygun E, Tedeschi F, Wancata J, Augustinavicius J, Carswell K, Välimäki M, van Ommeren M, Koesters M, Popa M, Leku MR, Anttila M, Churchill R, White R, Al-Hashimi S, Lantta T, Au T, Klein T, Tol WA, Cuijpers P, Barbui C.

| First Published: 5 July 2021

Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial.

Purgato M, Carswell K, Tedeschi F, Acarturk C, Anttila M, Au T, Bajbouj M, Baumgartner J, Biondi M, Churchill R, Cuijpers P, Koesters M, Gastaldon C, Ilkkursun Z, Lantta T, Nosè M, Ostuzzi G, Papola D, Popa M, Roselli V, Sijbrandij M, Tarsitani L, Turrini G, Välimäki M, Walker L, Wancata J, Zanini E, White R, van Ommeren M, Barbui C.

| First Published: 20 July 2021

Healing refugees’ mental scars could help them build new lives

Article by professor Richard Gray published in the UN Research & Innovation Magazine, Horizon.

| Version published: 15 July 2019

How do you promote well-being in refugee and asylum-seeking populations? Try the Re-Define tool

Podcast by Ken Gordon from Refugee Voices Scotland. Interview with Dr. Ross White and Mariana Popa from the RE-DEFINE project, at University of Liverpool.

| Version published: 27 May 2019

Effectiveness and cost-effectiveness of Self-Help Plus (SH+) for preventing mental disorders in refugees and asylum seekers in Europe and Turkey: study protocols for two randomised controlled trials

Marianna Purgato, K. Carswell, C. Acarturk, T. Au, S. Akbai, M. Anttila, J. Baumgartner, D. Bailey, M. Biondi, M. Bird, R Churchill, S Eskici, L. Juul Hansen, P. Heron, Z. Ilkkursun, R. Kilian, M. Koesters, T. Lantta, M. Nosè, G. Ostuzzi, D. Papola, M. Popa, M. Sijbrandij, L. Tarsitani, F. Tedeschi, G. Turrini, E. Uygun, M. Anneli Välimäki, J. Wancata, R. White, E. Zanini, P. Cuijpers, C. Barbui, M. Van Ommeren

| First Published: 16 April 2019

The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review

K. Tay, A. Riley, R. Islam, C. Welton-Mitchell, B. Duchesne, V. Waters, A. Varner, B. Moussa, A. N. M. Mahmudul Alam, M. A. Elshazly, D. Silove and P. Ventevogel.

| First Published: 10 March 2019

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis

(The article is written with RE-DEFINE’s partners) G. Turrini, M. Purgato, C. Acarturk, M. Anttila, T. Au, F. Ballette, M. Bird, K. Carswell, R. Churchill, P. Cuijpers, J. Hall, L. J. Hansen, M. Kösters, T. Lantta, M. Nosè, G. Ostuz.

| First Published: 11 February 2019

Loud, Gray, and Arbitrary — The Compounding Trauma of Detention for Asylum Seekers

Katherine C. McKenzie, M.D.

| First Published: 28 February  2019

The International Trauma Questionnaire: development of a self‐report measure of ICD‐11 PTSD and complex PTSD

Cloitre, M. Shevlin, C. R. Brewin, J. I. Bisson, N. P. Roberts, A. Maercker, T. Karatzias, P. Hyland

Pages: 536-546 | First Published: 03 September 2018

ICD‐11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire

Vallières, R. Ceannt, F. Daccache, R. Abou Daher, J. Sleiman, B. Gilmore, S. Byrne, M. Shevlin, J. Murphy, P. Hyland

Pages: 547-557 | First Published: 24 October 2018

Psychological therapies for the treatment of mental disorders in low‐ and middle‐income countries affected by humanitarian crises 

Marianna Purgato, Chiara Gastaldon, Davide Papola, Mark van Ommeren, Corrado Barbui, Wietse A Tol

Cochrane Systematic Review – Intervention | Version published: 05 July 2018

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