Self-Help Plus (SH+) is a WHO-developed psychological intervention designed to reduce stress and prevent common mental disorders in group settings. It combines a self-help book with weekly audio sessions delivered by trained non-specialists, making it suitable for refugees, asylum seekers, and other populations facing high distress but needing accessible care. SH+ does not require mental health specialists and has been tested in large trials showing reductions in psychological distress, disability, and health costs. It remains relevant today because scalable, low-cost mental health support is still a priority in refugee and migrant health policy, including the WHO Global Action Plan on refugee and migrant health extended to 2030.

What is Self-Help Plus?

Self-Help Plus, often written as SH+, is a group self-help intervention developed by the World Health Organization. It is designed for people experiencing high psychological distress but who do not have a diagnosed mental disorder. The intervention is built around two core components: a printed self-help book and a series of audio recordings that participants listen to together in weekly group sessions.

The book covers stress management techniques, coping strategies, and practical guidance on how to handle difficult emotions. The audio sessions are designed to be listened to in a group, with a facilitator guiding discussion and reflection after each recording. Sessions typically last 60 to 90 minutes and run over five to six weeks.

SH+ is classified as a scalable psychological intervention. This means it can be delivered at scale without requiring specialist mental health professionals. Instead, it is implemented by trained non-specialists, such as community workers, cultural mediators, or volunteers, who may have a refugee or migrant background themselves.

Who is SH+ designed for?

SH+ was developed for populations facing high levels of stress but where access to specialist mental health care is limited. Its primary target groups include:

• Refugees and asylum seekers resettled in new countries
• People living in low-resource or emergency settings
• Communities with high psychological distress but low rates of diagnosed mental disorders
• Groups where language, culture, or cost barriers make traditional therapy difficult to access

In the context of the RE-DEFINE project, SH+ was adapted specifically for adult refugees and asylum seekers showing increased psychological distress but no mental disorder. Participants in these trials were recruited across multiple countries inside and outside Europe, with adaptations made for gender, age, language, religion, and regional diversity between ethnic groups.

SH+ is not designed for people with severe mental illness requiring specialist psychiatric care. It is intended as a preventive intervention to reduce the risk of common mental disorders such as depression, anxiety, and post-traumatic stress disorder.

How does SH+ work in practice?

The intervention follows a structured format. Participants attend a group session once a week for five to six weeks. Each session begins with the group listening to an audio recording together. The recording contains guided exercises, stories, and practical advice on managing stress and building resilience.

After the audio, the facilitator leads a discussion. Participants are encouraged to share their experiences, ask questions, and practice the techniques they have learned. The facilitator does not provide therapy but supports the group in engaging with the material and applying it to their own lives.

The self-help book is given to each participant at the start. It is designed to be read between sessions, with each chapter corresponding to a weekly audio session. Participants are encouraged to revisit the material and practice the exercises in their daily lives.

Facilitators are trained non-specialists. In the RE-DEFINE trials, facilitators were cultural mediators with a refugee or migrant background, or individuals from the same or similar culture as the participants. This helps ensure that the intervention is culturally sensitive and that participants feel understood.

Why does SH+ matter for refugees and migrants?

Refugees and asylum seekers face unique stressors that increase their risk of mental health problems. These include trauma before and during migration, uncertainty about the future, language barriers, social isolation, and difficulties accessing health services. Many experience high psychological distress even if they do not meet the criteria for a diagnosed mental disorder.

Traditional mental health care is often difficult to access for these populations. Services may be expensive, require long waiting times, or be unavailable in the person’s language. Cultural barriers can also make people reluctant to seek help from specialist providers.

SH+ addresses these challenges by offering a low-cost, group-based intervention that can be delivered in community settings. It does not require specialist clinicians, which means it can be scaled more easily. The group format also provides social support, which is important for people who may feel isolated.

From a health economics perspective, SH+ is designed to reduce the economic burden of common mental health symptoms. The RE-DEFINE project included a health economic evaluation to determine whether implementing SH+ reduces costs related to psychological distress, disability, and health service use.

What evidence exists for SH+?

SH+ has been tested in multiple randomised controlled trials. The RE-DEFINE project carried out two large, pragmatic RCTs to evaluate the cost-effectiveness and acceptability of the SH+ programme for refugees and asylum seekers. These trials assessed whether SH+ could be implemented within mental health systems and measured outcomes such as reduction in psychological distress, disability, and health costs.

Research has shown that SH+ can reduce common mental disorders in asylum seekers and refugees. Studies have also examined how trauma affects asylum seekers receiving WHO psychological interventions, with mediation models showing the role of distress reduction in improving outcomes.

Scalable interventions for refugees remain an active area of research. Most refugees are hosted in low- and middle-income countries where there is a lack of resources and mental health providers. SH+ and similar interventions are designed to address this gap by providing accessible support that does not depend on specialist Clinicians.

While results are promising, it is important to note that SH+ is not a cure for severe mental illness. It is a preventive intervention aimed at reducing distress and preventing the onset of common mental disorders.

How has SH+ been adapted for different cultures?

The RE-DEFINE project included a translation and adaptation phase where SH+ was adapted for the context and needs of refugees and asylum seekers. The translation was guided by a situational assessment to identify migration flows across different countries and local needs related to gender, age, language, religion, and regional diversity.

SH+ was translated into three languages based on this assessment. The cultural adaptation followed the adaptation protocol developed by the WHO and partners, which ensures that the process is systematic, well-documented, and focused on understandability, acceptability, and relevance. This phase relied on ethnographic input from partners and stakeholders, recognising local and cultural elements, religious perspectives, and linguistic idiosyncrasias as key aspects for meeting mental health needs.

This multicultural adaptation approach is important because refugees and asylum seekers come from diverse backgrounds. A one-size-fits-all intervention would not be effective across different ethnic groups or cultural contexts.

What is the current status of SH+ in refugee mental health?

SH+ remains part of the WHO’s portfolio of scalable psychological interventions for refugees and migrants. The WHO Global Action Plan on promoting the health of refugees and migrants, extended to 2030 by the Seventy-sixth World Health Assembly in 2023, continues to prioritise improving health outcomes for these populations. This includes promoting access to mental health support that is accessible, culturally appropriate, and scalable.

The European Union Agency for Asylum (EUAA) has also highlighted mental health conditions and needs in the asylum procedure as an important issue. Their guidance includes practical guides on mental health and well-being for applicants for international protection, reflecting the ongoing need for accessible psychosocial support.

In the UK, while SH+ is not yet widely implemented in NHS services, the principles it embodies—accessible, group-based, low-intensity support—are aligned with approaches such as talking therapies and community mental health initiatives. The intervention offers a model that could be considered for refugee and migrant support services in the future.

Common misconceptions about SH+

There are several misunderstandings about what SH+ can and cannot do:

• SH+ is not therapy. It is a self-help intervention delivered by non-specialists. It does not replace psychotherapy or psychiatric care for people with diagnosed mental disorders.
• SH+ is not a cure for trauma. It is designed to reduce psychological distress and prevent common mental disorders, but it does not treat severe trauma or PTSD on its own.
• SH+ does not require specialist clinicians. This is one of its main advantages. It can be delivered by trained cultural mediators, community workers, or volunteers.
• SH+ is not just for refugees. While it was developed for refugees and migrants, it can be adapted for other populations facing high stress in low-resource settings.

FAQs

Is Self-Help Plus available in the UK?

SH+ is not currently widely implemented in NHS services or mainstream refugee support programmes in the UK. However, the principles it embodies—group-based, low-intensity, accessible support—align with approaches used in talking therapies and community mental health initiatives. Some refugee support organisations may be exploring similar models.

How long does SH+ take to complete?

The standard SH+ programme runs for five to six weeks, with one group session per week. Each session lasts 60 to 90 minutes, including audio listening and facilitated discussion. Participants are expected to read the self-help book between sessions.

Who can deliver SH+?

SH+ is delivered by trained non-specialist facilitators. These can include cultural mediators, community workers, volunteers, or individuals with a refugee or migrant background. Facilitators do not need to be mental health specialists but receive training in delivering the intervention.

Is SH+ free to use?

The SH+ materials, including the self-help book and audio recordings, are developed by the WHO and are generally available free or at low cost. Implementation costs depend on training facilitators, running group sessions, and adapting materials for local contexts.

Does SH+ work for people with diagnosed mental disorders?

SH+ is designed for people with high psychological distress but no diagnosed mental disorder. It is a preventive intervention. People with severe mental illness or diagnosed conditions such as major depression or PTSD should access specialist mental health care.

How is SH+ different from other self-help resources?

SH+ is structured around weekly group sessions with a trained facilitator, combining audio recordings with a self-help book. This group format provides social support and guided discussion, which is different from individual self-help resources that people use alone.

Self-Help Plus offers a practical model for reaching people who need mental health support but cannot access traditional services. Its focus on scalability, cultural adaptation, and cost-effectiveness continues to align with the priorities of refugee and migrant health policy, and it remains a relevant intervention for organisations working with displaced populations.