Summary description: Self-Help Plus (SH+) is a 5-session stress management course from WHO designed for groups of up to 30 people. Led by trained, non-specialist facilitators, SH+ uses pre-recorded audio and an illustrated guide, Doing What Matters in Times of Stress, to teach essential stress management skills. This program effectively reduces psychological distress and helps prevent mental disorders, making it suitable for adults experiencing stress. SH+ can complement other mental health interventions, serve as an initial step in a stepped care program, or be used as a community-based intervention in broader programs.
**Access to the intervention manual: **Full open access
Access to training: https://www.who.int/publications/i/item/9789240035119
Intended users/ Implementers: Trained and supervised non-specialist provider
Therapeutic strategies: SH+ is based on Acceptance and Commitment Therapy (ACT), a form of CBT with distinct features. It provides training in five skills used to help people manage stress. These five core skills are – Grounding in stressful situations, Unhooking from difficult thoughts and feelings, Acting on your values, Being kind - related to social support, Making room, a mindfulness exercises.
Intervention format: SH+ is a large-group self-help intervention that delivers key information through pre-recorded audio, with facilitators guiding discussions and addressing questions. This program is specifically designed for use with hard-to-reach populations.
Target population: Populations affected by adversity, including refugees and people affected by a humanitarian emergencies
Significant effects found on symptoms of: Psychological distress, depression, anxiety, functional impairment, post-traumatic stress, self-identified problems. Importantly some RCTs showed that SH+ may help to prevent the development of mental disorders.
Key innovative or differentiating features of this intervention: SH+ can be delivered to large groups (up to 30 people). The use of pre-recorded materials ensures consistency and means training and supervision may eb shorter compared to other psychological interventions.
Summary of Evidence: SH+ has been evaluated in three randomized controlled trials (RCTs) across diverse refugee and asylum seeker populations. These studies included South Sudanese refugees in Uganda, Syrian refugees in Türkiye, and refugees from various countries across multiple European nations. Findings demonstrate that SH+ significantly reduces psychological distress, enhances well-being, and may prevent the onset of mental health disorders. The RCTs highlight SH+ as a scalable, accessible intervention that provides measurable mental health benefits, even when delivered by non-specialist facilitators.
A meta-analysis of individual participant data found that, at 5-6 months post-randomization, SH+ was significantly more effective than Enhanced Care As Usual (ECAU) in improving depression symptoms, self-identified problems, and overall well-being. Interestingly, no immediate post-intervention difference was found between SH+ and ECAU, though SH+ showed notable benefits for particularly vulnerable participants, such as those unemployed or with lower initial mental well-being.
Different populations where the intervention has been used: Refugees and asylum seekers in middle and high income settings.
Restrictions or requirements for its use: SH+ is not suitable for people who have a severe impairment related to a mental, neurological or substance use disorder, or are at imminent risk of suicide (e.g. people with a plan to end their life in the near future). It may be considered as an additional itnervention, when other needsd are fully addressed. Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions or guided self-help. See the SH+ manual and training manual for more information.
Requirements / qualifications for trainers and supervisors: Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions or guided self-help. See the SH+ manual and training manual for more information.
Examples of implementation outside of RCT contexts: SH+ has been scaled up in Ukraine as part of the national mental health response and deployed in Türkiye and Northwest Syria as part of earthquake relief efforts. It has also been implemented in northern Uganda as part of community programming under a program called SH+ 360.
https://www.elrha.org/project/scaling-up-self-help-plus-sh-through-humanitarian-partnerships/
Information provided Ken Carswell on 26 October 2024. He is WHO focal point for SH+.