A new study with the involvement of the University of Fribourg shows how refugees trained as mental health helpers can offer vital psychological support to others in their communities. With the right tools and feedback, they can help close a persistent gap in mental health care – both in Switzerland and beyond.

Switzerland has one of the world's leading mental health care systems. Nevertheless, it often fails to reach those who need them most – especially refugees and asylum seekers facing language, cultural and systemic barriers. But what if people from those very communities could become part of the solution?

A new study puts this idea to the test. Thirteen Arabic-speaking refugees, most of them Syrian, were trained to deliver Problem Management Plus (PM+), a brief psychological intervention developed by the WHO to reduce symptoms of stress, anxiety, and depression. The study used EQUIP, a WHO-UNICEF platform, to assess the helpers’ skills and offer targeted feedback.

Measurable Competence, Meaningful Impact
The results were promising: 95% of PM+ technical skills and 65% of general therapeutic competencies were demonstrated at a high level: The helpers showed strong skills in Problem Solving and Stress Management strategies as well as Rapport Building, Verbal and Non-Verbal Communication skills. The EQUIP assessments also helped identify training gaps – particularly in complex areas like suicide risk assessment – and provided constructive feedback for further development.

The tool was also well received by the helpers, who unanimously described the feedback as fair, clear, and immediately applicable. Comments such as «I am grateful for this experience», «I really needed this assessment», and «This is very useful to me» reflect this positive response. The assessment now serves as a foundation for developing tailored training measures aimed at sustainably improving the quality of care.

Improving Refugee Care Across Switzerland
Through the SPIRIT project (Scaling-up Psychological Interventions in Refugees in Switzerland) at the University Hospital Zurich (USZ), PM+ is being implemented in more than ten languages. Supported by the Federal Office of Public Health, Health Promotion Switzerland, the State Secretariat for Migration, CARITAS, and the Swiss Red Cross, all training and quality assurance measures are based on insights gained through EQUIP. Mahmoud Hemmo, lead author of the study, explains: «PM+, in combination with EQUIP, enables scalable, culturally sensitive, and high-quality psychological care where it is urgently needed. Our work in Switzerland is inspiring other countries to adopt similar community-based approaches.»

This study is part of Hemmo’s doctoral research at the University of Fribourg. Further publications on the implementation of PM+ and EQUIP in Switzerland and the Middle East are already planned. Initial findings have contributed to the development of international WHO and UNICEF standards for crisis and refugee response. This model could be applied far beyond Switzerland: in refugee camps, urban centers, or anywhere mental health services struggle to meet demand.

Study
Hemmo, Mahmoud et al. 2025. “Piloting Competency Assessments for an Evidence-Based Brief Psychological Intervention with Arabic-Speaking Non-Specialists in Switzerland.” Cambridge Prisms: Global Mental Health: 1–32. doi: 10.1017/gmh.2025.10023.