There are currently over 300,000 refugees and asylum seekers in the UK, and due to ongoing global conflicts, this number is expected to rise (UNHCR, 2022). Each one of these individuals has experienced significant trauma, such as imprisonment, torture, and losing loved ones (Hollifield et al 2005). As healthcare professionals, it is crucial to provide care that is tailored to their unique traumas, problems, and cultural contexts.
In line with this, the World Health Organization (WHO) has developed a tool called Self Help Plus (SH+) to support refugees and asylum seekers. This tool consists of five weekly 1.5h-2h long group sessions, designed to help adults manage stress and adversity. It is adaptable to specific cultural contexts and languages, making it suitable for individuals with general distress, regardless of whether they have a mental health diagnosis. The SH+ intervention is based on Acceptance and Commitment Therapy (ACT) and utilizes pre-recorded audio and an illustrated self-help book to teach stress management skills. The intervention is delivered by non-specialist peer facilitators, who undergo a short period of training.
To determine the efficacy of SH+, a recent study (Karyotaki et al, 2023) conducted several randomized controlled trials (RCTs) comparing SH+ with enhanced care as usual (ECAU). The results showed that while SH+ and ECAU did not differ significantly in effectiveness at reducing depressive symptoms immediately post-intervention, SH+ was more effective in improving depressive symptoms, well-being, and self-identified problems in the months following the intervention. Specifically, it was more effective in those who were unemployed and had lower well-being levels.
The study revealed that SH+ is a promising avenue for the management of depressive symptoms, well-being, and self-identified problems in the refugee population, especially for unemployed individuals and those with lower mental well-being levels. The results were supported by high effect sizes and low risk of bias. However, the authors highlighted limitations such as the heterogeneity of the studies, the lack of long-term data, and the focus on participants from specific regions.
Although SH+ is not yet included in national guidelines, this meta-analysis suggests its potential as a first-line intervention for refugees and asylum seekers. There is a need for further research to assess its applicability to individuals with mental health disorders and other vulnerable populations. The implementation of SH+ in healthcare practice would benefit regions with high refugee and asylum-seeker populations and may also prove to be a cost-effective approach.
