Scalability of a task-sharing psychological intervention for refugees: A qualitative study in the Netherlands

Mental health systems across the world struggle to meet the needs of present and future populations. People affected by war and forced displacement, such as refugees, have especially high unmet psychological needs. Shifting tasks from mental health specialists to less specialised providers is increasingly opted as an innovative solution to overcome the mental health care gap. Yet little is known about how task-sharing interventions for refugees can be implemented on a larger scale and integrated in existing systems. In this article, we use a system innovation perspective to examine the factors influencing the potential for scaling up a task-sharing psychological intervention for refugees called ‘Problem Management Plus’ (PM+) in the Netherlands. Semi-structured interviews were conducted with individuals (n=42) knowledgeable about PM+ and the Dutch mental health system for refugees. Findings suggest that the feasibility of wider implementation largely depends on whether barriers like stigma, attrition, fragmentation, competition, legal, and financial challenges can be overcome. Formalising the roles of new non-specialist workers will be important, including developing structures for their accreditation and supervision. There are various possibilities for institutional anchoring of the innovation: in asylum centres, formal health care, and communities. The integration scenarios identified in this study need to be tested, evaluated, refined, and reported in future implementation research.