The authors ensured minimum level of competency of nonspecialists prior to being selected to deliver Group PM+ and employed a standardized supervision protocol for ongoing quality assurance. These important design strengths are essential to enable replication of quality intervention delivery and the positive study findings across other settings. However, nonspecialist supervision represents a major bottleneck to scaling up brief psychological interventions, given the costly requirement for expert supervisors, and continued reliance on in-person or group-based supervision [10]. While the assessment of nonspecialist competency using the ENACT scale is an important strength, this scale only covers general skills in delivering psychological interventions [11] and may not capture the treatment specific skills necessary to deliver Group PM+ effectively. Future avenues for supervising delivery of specific aspects of Group PM+ may also align with understanding of the mechanism of action. Nonspecialist supervision and assessment of competencies could reflect the importance of effectively teaching participants how to practice and apply the program skills in their day-to-day lives, as these appear essential for experiencing benefits.

Another often-overlooked aspect of nonspecialist delivered interventions is the mental health and well-being of the nonspecialists themselves. This is likely to be especially important in the context of humanitarian settings where the nonspecialists come from the same communities as the patients they serve and therefore have also experienced the same impacts of the disaster or emergency. There is mounting research showing that delivery of psychological treatments can contribute to risk of burnout, stress, and exhaustion [12,13], emphasizing the need for approaches to consider the needs of the nonspecialists. This may be critical for ensuring that they can continue to successfully deliver these programs in their communities.

Technology may yield new opportunities to scale up access to programs when in-person contact is not possible, such as in conflict settings with significant security risks, or when the logistics are too difficult to coordinate, such as in rural areas or communities isolated due to natural disasters, and when in-person contact may not be permitted, such as during the COVID-19 pandemic [14]. Recent studies have reported on the increasing viability of digital approaches for supporting delivery of mental health services even in conflict settings and in severely resource-limited contexts at risk for humanitarian emergencies [15]; yet, there remains a substantial digital divide, particularly in impoverished communities and among women compared to men. Moreover, digital tools could allow opportunities to capture data from nonspecialists and participants to assess the treatment mechanism of action, facilitate remote supervision, and enable ongoing support for nonspecialists to ensure effective delivery of psychological interventions such as Group PM+. A key challenge will be adapting and translating nonspecialist-delivered psychological treatments to a digital format where clinical effectiveness is retained, while ensuring quality and safety for patients and equity of access given the challenging conditions in humanitarian crises.