Embedding the World Health Organization's Problem Management Plus (PM+) within Health and Integration Sectors in Switzerland

BackgroundThe prevalence of common mental disorders in resettled refugee populations is nearly three times higher than in the general population. The World Health Organization (WHO) recommends Problem Management Plus (PM+), a brief non-specialist delivered intervention for reducing common mental disorders. To identify key factors to optimise implementation, we conducted a qualitative cross-sectional study to investigate contextual determinants shaping PM+ implementation during a nationwide scale-up of PM+ in Switzerland. MethodsWe conducted in-depth key informant interviews in the German-speaking and French-speaking parts of Switzerland (September 2023 and January 2025). Design and analysis of interviews was guided by the Consolidated Framework for Implementation Research. Themes were added both inductively and deductively and categorised into challenges and opportunities for wide-spread PM+ service delivery. FindingsWe interviewed 30 stakeholders: 12 policymakers, 5 government leaders, 5 specialists and implementers, and 8 non-specialist peer-providers. Whilst stakeholders were enthusiastic about the value of PM+, several limitations to its routine delivery were noted. These related to limited quality standards and control for non-specialist delivered interventions that prevented formal categorisation within the health system. Endorsement by professional associations including best-practice standards was thought to facilitate such formalised recognition. Prioritising mental health indicators within Cantonal integration programs was perceived to facilitate funding via the national integration agenda. All stakeholders pointed towards blended co-financing pathways to ensure to the longer-term sustainability of PM+ in Switzerland. InterpretationThe routine delivery of PM+ within health and integration systems presented substantial challenges and opportunities. Longer term sustainability of PM+ may be feasible with blended financing, tailored Cantonal health and integration agendas, and established quality control standards for PM+ delivery that included formal recognition of non-specialists within the mental health system.