WHO releases guidance on mental health care after trauma

WHO is releasing new clinical protocols and guidelines to health-care workers for treating the mental health consequences of trauma and loss.  Mental disorders are common, disabling and usually untreated, and WHO’s “Mental Health Global Action Programme (mhGAP)” was developed in 2008 to scale-up care for mental, neurological and substance use disorders with simple treatment protocols that can be offered by primary health-care doctors and nurses.  Now, WHO is extending this programme by including care for post-traumatic stress disorder (PTSD), acute stress and bereavement within its global programme.

“We have received numerous requests for guidance for mental health care after trauma and loss” says Dr Oleg Chestnov, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. “Primary health-care providers will now be able to offer basic support consistent with the best available evidence. They will also learn when to refer to more advanced treatment.”

Using the new protocol primary health-care workers can offer basic psychosocial support people exposed to trauma or loss in other situations.  Types of support offered can include psychological first aid, stress management and helping affected people to identify and strengthen positive coping methods and social supports.  In addition, referral for advanced treatments such as cognitive-behavioural therapy (CBT) or a new technique called eye movement desensitization and reprocessing (EMDR) should be considered for people suffering from PTSD. These techniques help people reduce vivid, unwanted, repeated recollections of traumatic events. More training and supervision is recommended to make these techniques more widely available.

Primary health care staff are also warned against certain popular treatments. For example, benzodiazepines, which are anti-anxiety drugs, should not be offered to reduce acute traumatic stress symptoms or sleep problems in the first month after a potentially traumatic event.  There is no evidence on the benefits of benzodiazepines, a common anti-anxiety drug, on symptoms of traumatic stress after a recent potentially traumatic event. Benzodiazepines may slow down the time to recover from potentially traumatic events.  Key concerns about the use of benzodiazepines are that many people develop tolerance to their effects, gain little therapeutic benefit from chronic consumption, become dependent on them and suffer a withdrawal syndrome when they stop taking them.