PM+ (Problem Management Plus) is a WHO-developed low-intensity psychological intervention that has been adapted and implemented for refugees in Norway since 2021. The current research phase, PEIL-FORSK, is funded by the Research Council of Norway and runs from 2023 to 2026 in Bergen and Fredrikstad municipalities. The initiative has also inspired two parallel adaptations within NAV (the Norwegian Labour and Welfare Administration): a group-based format of PM+ developed in collaboration with NAV NySjanse in Bergen, and an integration of PM+ as part of a broader weekly skills course at NAV Grünerløkka — the latter funded by IMDi (the Norwegian Directorate of Integration and Diversity). These developments reflect the growing interest in adapting PM+ across different welfare and employment settings in Norway.
Organiser /service provider
PEIL-FORSK is led by Valeria Markova and the main service provider is the Centre for Migration Health (Senter for Migrasjonshelse, SEMI), Bergen Municipality. The project is carried out in close collaboration with Migrasjonshelse in Fredrikstad Municipality and the Society and Workplace Diversity Research Group, including the Departments of Clinical Psychology and Psychosocial Science at the University of Bergen.
Other key Norwegian partners include NAV NySjanse and Bergen Learning Centre (Nygaard School). As the project expanded into NAV settings, RVTS Vest (Regional Resource Centre on Violence, Traumatic Stress and Suicide Prevention, Western Norway) joined as a partner, contributing expertise in trauma-informed practice and implementation support. The two parallel PM+ adaptations within NAV are led by NySjanse (Bergen Municipality) and NAV Grünerløkka, Flyktningavdelingen (Bydel Grünerløkka, Oslo).
The initiative is connected to an international network of PM+ implementers through the MHPSS Academy (European PM+ Community of Practice), the STRENGTHS consortium at Vrije Universiteit Amsterdam, the Danish Institute Against Torture (Dignity), and colleagues implementing PM+ in Switzerland and Ukraine.
Funding has been provided by IMDi across three consecutive grant rounds (2021–2024) and by the Research Council of Norway (NFR) for the current PEIL-FORSK phase (2023–2026).
Summary
Problem Management Plus (PM+) is a WHO-developed, evidence-based, low-intensity psychological intervention designed to reduce distress and improve daily functioning in adults affected by adversity. Since 2021, SEMI — the Centre for Migration Health in Bergen — has pioneered its adaptation and implementation for newly resettled refugees in Norway, making this the first sustained trial of PM+ in a Norwegian municipal context.
The intervention is delivered by trained lay helpers with lived refugee experience and shared cultural and linguistic backgrounds with participants, under structured supervision by qualified clinical supervisors. What makes the Norwegian model distinctive is that refugee experience itself becomes a resource — helpers and participants meet as equals. As demand has grown, PM+ has also been tested in group format and is now being adapted within NAV employment services, demonstrating its potential as a scalable, sustainable tool for meeting mental health needs while reducing pressure on specialist services.
Target group
The initiative targets newly resettled adult refugees (18+) experiencing mild to moderate psychological distress — including depression, anxiety, post-traumatic stress reactions, and post-migration living difficulties — who do not require or are not yet accessing specialist mental health services. The service is free of charge.
Language groups served depend on the current refugee population in Norway and the languages spoken by available helpers. To date this has included Arabic, Kinyarwanda, Farsi, Russian, Ukrainian, and Tigrinya, among others. As new refugee groups arrive, the model allows for training of new helpers accordingly, making the initiative flexible and responsive to changing needs.
Both women and men can participate. There are no requirements for Norwegian language proficiency, as sessions are conducted in the participant’s own language.
Importantly, the lay helpers themselves constitute a secondary target group. Research shows that the helper role can strengthen sense of coherence, build professional competencies, and support helpers’ own mental health — particularly when they receive adequate compensation and structured supervision (Lavdas, Sandal et al., 2025). Several helpers in Norway have gone on to secure permanent positions in municipal health services.
Description of activity and expected results and effects
PM+ consists of five structured weekly individual sessions of 90 minutes, preceded by a psychosocial assessment and followed by a post-intervention assessment. The intervention integrates four core evidence-based strategies: problem-solving, stress management through slow breathing and grounding exercises, behavioural activation, and strengthening of social support networks. An optional sixth session is available for consolidation. Where further support is needed, additional sessions with the clinical supervisor are arranged to facilitate referral to specialist mental health care.
Sessions are delivered in the participant’s own language by a trained lay helper with shared cultural and migration experience, under structured weekly supervision from a qualified clinical supervisor using the EQUIP supervision protocol. All materials have been translated and culturally adapted to the Norwegian context and into multiple languages in collaboration with refugee community members.
Participants are expected to experience reduced psychological distress, strengthened coping skills, and improved ability to manage daily post-migration challenges. Beyond symptom relief, the goal is to increase autonomy and problem-solving capacity so that participants can better navigate life in their new country, for example find work or continue study. For lay helpers, the role builds professional competencies and employability, and research shows that adequately compensated and supervised helpers maintain significantly better mental health trajectories over time (Lavdas, Sandal et al., 2025).
Theory and knowledge
PM+ is grounded in cognitive-behavioural therapy (CBT), integrating behavioural activation, problem-solving therapy, and Antonovsky’s salutogenic model (sense of coherence). Developed by the WHO as part of the mhGAP programme, it enables trained lay workers to deliver brief, structured psychological support — a model now increasingly tested in high-income countries.
The international evidence base is strong. Pivotal RCTs demonstrate effectiveness in conflict-affected populations in Pakistan (Rahman et al., 2016, JAMA) and Kenya (Bryant et al., 2017, PLoS Medicine), and among refugees in high-income settings in the Netherlands, with sustained effects confirmed at one-year follow-up (de Graaff et al., 2023; 2024). Cost-effectiveness has also been demonstrated, showing reduced pressure on specialist services.
The Norwegian implementation is further grounded in local research showing that refugees consistently prefer support from peers with shared cultural and migration experience (Brea Larios et al., 2022; Markova & Sandal, 2016) — directly validating the peer-helper model central to PM+.
Competences
PM+ helpers are multicultural community workers with lived refugee experience who share the cultural background and language of participants. No prior Norwegian professional qualification is required. Training consists of a standardised 9-day manual based programme, combining didactic instruction, video demonstrations, structured role-play, and competency-based assessment. A full WHO-endorsed manual supports delivery.
A particular strength of the Norwegian model is the recruitment (when possible) of helpers with medical or health professional backgrounds from their home countries who cannot obtain Norwegian authorisation due to differences in education systems. These individuals bring substantial existing competence, adapt quickly to the helper role, and several have gone on to develop into supervisors — gaining meaningful employment closely aligned with their original training and professional identity.
Helper training has been conducted at both Centre for Migration Health, Bergen Learning Centre, and NAV, embedding the role within the integration pathway. Training has further benefited from international exchange through the MHPSS Academy, a European PM+ Community of Practice, enriching both the cultural adaptation process and the supervision model.
Clinical supervisors are qualified health professionals trained to WHO master-trainer level, providing weekly supervision using the EQUIP framework. SEMI has also developed a three-day foundational training in basic helping skills for all newly hired multicultural staff.
Economy
The initiative has been funded through several sources. The pilot phase (2021–2022) was funded by IMDi (Norwegian Directorate of Integration and Diversity), which has continued to fund the parallel adaptations within NAV Grunnerløkka. Adoptation in NAV, NySjanse if funded by Country Governor (Statsforvalteren). The current research phase, PEIL-FORSK, is funded by the Research Council of Norway (NFR) with NOK 7 million for the period 2023–2026.
Core costs include staff salaries for project leadership, coordination, and clinical supervision; training of helpers and supervisors; translation and cultural adaptation of materials into multiple languages; and monitoring and evaluation activities in collaboration with the University of Bergen. Facilities are provided within existing municipal health services, keeping overhead costs low.
A key cost-efficiency of the model is the use of trained lay helpers rather than qualified clinicians as primary deliverers, significantly reducing per-session costs. Evidence from the Netherlands further demonstrates that PM+ is cost-effective at the system level by reducing pressure on specialist mental health services — an important consideration in the Norwegian context where demand increasingly exceeds capacity.
Assessments of providers and views of participants
Participant views are systematically collected through pre- and post-intervention assessments using validated instruments (HSCL-25, WHODAS 2.0, PSYCHLOPS), as well as qualitative interviews conducted as part of ongoing quality assurance work. A scientific article based on data from the individual PM+ intervention is currently submitted for publication in collaboration with the University of Bergen. The first group PM+ trial at NAV NySjanse (2026) was evaluated through individual and small-group interviews with seven of eight participants immediately after the intervention, as part of structured quality assurance work — findings from this are summarised in an internal evaluation report.
Participants consistently report high acceptability: stable attendance, valued stress management and problem-solving strategies, and a wish to continue meeting after the course. The mixed-language group format was experienced as a strength, fostering peer solidarity around shared challenges such as work, housing, and family life.
Providers describe PM+ as the most concrete tool available for reaching refugees who would otherwise fall between the cracks of the health system. A qualitative study of eight PM+ helpers found that lived refugee experience is a genuine professional resource — enabling empathy, cultural understanding, and the ability to meet clients with dignity and without judgement.
From a participant (group PM+, NAV NySjanse, 2026):
”I feel very good after this course. Now I can talk about my problems — before, I was maybe a little shy to talk about my problems.”
— Participant, group PM+, NAV NySjanse Bergen (translated from Arabic)
From a helper (qualitative study, PEIL-FORSK):
”Eventually, when the refugees arrived because of the war, which we had also fled from, I thought that my experiences as a refugee could also help others.”
— PM+ helper, PEIL-FORSK
Evaluation, studies and monitoring
The initiative has been evaluated at multiple levels since the pilot in 2021.
Pre- and post-intervention assessments are conducted systematically with all participants using internationally validated instruments: the Hopkins Symptom Checklist (HSCL-25) for depression and anxiety, the WHO Disability Assessment Schedule (WHODAS 2.0) for functional impairment, and the patient-generated PSYCHLOPS measure. Session-level data on working alliance are collected using the Working Alliance Inventory (WAI task subscale) after each session.
The current research phase, PEIL-FORSK (funded by the Research Council of Norway, 2023–2026), includes an embedded PhD candidate who began in March 2024. Approximately 200 refugees across Bergen and Fredrikstad have to date started or completed the intervention. A scientific article based on data from the individual PM+ intervention is currently submitted for publication in collaboration with the University of Bergen.
The first group PM+ trial at NAV NySjanse (2026) was evaluated through qualitative interviews with participants and supervisors as part of structured quality assurance work, resulting in an internal evaluation report with recommendations for further scale-up.
A qualitative study examining how PM+ helpers draw on their own lived experiences in their professional role has been conducted with eight helpers across two municipalities, and findings are being prepared for publication.
Six-month follow-up data collection is underway — an advantage unique to Norway as a permanent resettlement country, where longitudinal follow-up is feasible in contrast to transit or camp settings.
Project documentation: https://prosjektbanken.forskningsradet.no/project/FORISS/341410
Learnings and dissemination, implementation nationally/in the Nordics
The Norwegian implementation has demonstrated potential for national scale-up. SEMI has established a national network of approximately ten municipalities that have participated in information seminars and expressed interest in implementing PM+ since 2022. A Norwegian-language training package — including all materials, supervision protocols, assessment instruments, and training guides — will be available during 2026. SEMI (Centre for Migration health) has delivered train-the-trainer sessions to Fredrikstad Municipality , which is now implementing PM+ independently, establishing a workable cascade model for national dissemination.
Key learnings from the Norwegian experience: sustainable implementation requires (1) clear integration with existing municipal health, employment, and integration services rather than operating as standalone projects; (2) structured, ongoing supervision protecting both fidelity and helper wellbeing; and (3) political anchoring at the municipality level
Nordic and international relevance
The Norwegian model is directly relevant to other Nordic countries given shared welfare state structures, comparable refugee resettlement systems, and analogous challenges in mental health access. SEMI has good experience from collaborating with Denmark (Dignity — Danish Institute Against Torture) and the Netherlands (STRENGTHS consortium, Vrije Universiteit Amsterdam). Knowledge exchange with PM+ implementers in Switzerland and Ukraine has been facilitated through the MHPSS Academy — a European Community of Practice providing training, shared tools, and implementation support across national contexts.
For Nordic colleagues interested in replicating the model, SEMI offers the Norwegian-language training package, the EQUIP supervision framework, cultural adaptation protocols, and ongoing experience-sharing through the national PM+ network.
Read more and contact information
https://prosjektbanken.forskningsradet.no/project/FORISS/341410
Peer provided psychological interventions for refugees | UiB
Official WHO page: Problem management plus (PM+): individual psychological help for adults impaired by distress in communities exposed to adversity (Norwegian translation will be available during 2026)
Contact information:
Valeria Markova, projektledare
valeria.markova@helse-bergen.no
Photo: Johnson Rutsinda