Advancing mental health equity: a community-based adaptation of problem management plus (PM+) on a mobile health clinic.

Abstract

Mental health inequities persist in underserved communities due to systemic barriers to care. Healthy Roads, a mental wellness support program developed by the mobile clinic The Family Van, adapted the World Health Organization's Problem Management Plus (PM+) curriculum to address these disparities with support from Partners In Health. PM+ is a brief, evidence-based psychological intervention designed for trained non-specialists to deliver in low-resource settings. This community case study describes the adaptation, implementation, and early lessons learned from delivering PM+ with trained community health workers (CHWs) among racially and linguistically diverse communities in Boston, Massachusetts. Data were collected from 49 participants who engaged in 173 sessions between January 2021 and December 2023. Quantitative outcomes were measured using the Psychological Outcomes Profiles (PSYCHLOPS) tool, alongside qualitative insights from session notes and client feedback. Participants who completed the program experienced a 25.4% reduction in mental health distress 95% CI [13.1, 37.9%], with those attending at least one session experiencing an 11.4% reduction 95% CI [5.8, 17.0%]. This program also demonstrates how community-based mental health initiatives can contribute to broader systems of collaborative learning where frontline providers, participants, community members, and institutional partners jointly adapt and refine program delivery to inform equitable adaptation and dissemination of mental health practices. As the first adaptation of PM + in a community-based mobile clinic in the United States, Healthy Roads offers implementation insights for community health programs on building a mental health workforce reflective of the community, centering community expertise, adapting program delivery for cultural relevance, and ensuring proper staffing to sustain quality care.