Feasibility of Problem Management Plus to Improve Refugee Psychological Support in the U.S. Midwest

Community-engaged approaches to addressing mental health concerns have reduced health inequities experienced by refugee communities. Problem Management Plus (PM+)-a brief psychological intervention developed by the World Health Organization-has shown effectiveness in improving mental health and well-being of adults experiencing distress. This paper documents lessons learned during the implementation of the first PM+ pilot program among refugee communities in the United States. In 2019, with support from the State of Iowa Bureau of Refugee Services, we worked in partnership with refugee community leaders using community-based participatory research (CBPR) methods to identify refugee mental health needs in three counties in eastern Iowa. From January to April 2020, we trained eight community members to become PM+ facilitators to address these needs. The facilitators were immigrants/refugees and did not have a professional mental health background. Three licensed counselors acted as PM+ supervisors. The beneficiaries receiving PM+ were refugees from the Democratic Republic of Congo, Sudan, and Burma/Myanmar. By September 2020, we completed the PM+ intervention with six refugee clients using a combination of on-line video and in-person sessions. We conducted in-depth interviews with PM+ supervisors (n = 3), PM+ facilitators (n = 7), and clients (n = 2). We found that PM+ had a perceived positive impact on refugee communities by developing skills to handle stress, prompting mental health conversations, and reducing stigma. Other key learnings included making the training more inclusive and culturally relevant, overcoming challenges related to recruitment of clients, connecting PM+ to other community resources, and clarifying responsibilities of PM+ facilitators and supervisors. Our findings can be used to reduce the impact of structural oppression and inform the scale-up of PM+ for refugees and other populations in similar settings around the world.