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We’ve discussed some of the issues surrounding post-trauma mental health here in the past, including:
Disaster’s Hidden Toll
Surviving A Different Kind Of Aftershock
Psychological First Aid: The WHO Guide For Field Workers
Post Disaster Stress & Suicide Rates
PTSD (Post Traumatic Stress Disorder) is increasingly recognized as a serious factor in the wake of any traumatic event, and early recognition and treatment can be invaluable in reducing its impact.
The World Health Organization has just released new guidelines on the treatment of PTSD, acute stress, and bereavement, which you can access at the link below:
Publication details
Number of pages: 273
Publication date: 2013
Languages: English
ISBN: 978 92 4 150540 6Downloads
Overview
These WHO mhGAP guidelines were developed to provide recommended management strategies for conditions specifically related to stress, including symptoms of acute stress, post-traumatic stress disorder and bereavement.
The guidelines were developed by an independent Guidelines Development Group and inform a new mhGAP module on the Assessment and Management of Conditions Specifically Related to Stress.
Of note: Included in these guidelines is advice against the use of benzodiazepines (popular anti-anxiety drugs) during the first 30 days following a traumatic event, as they may actually slow recovery and have the potential to become addictive.
For more background on these new guidelines we have the following press release:
WHO releases guidance on mental health care after trauma
New clinical protocol and guidelines to enable effective mental health care for adults and children exposed to trauma and loss
News release
6 August 2013 | GENEVA - 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.
New care protocols for post-traumatic stress disorder and others
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.”
Traumatic events and loss a common experience
Traumatic events and loss are common in people’s lives. In a previous WHO study of 21 countries, more than 10% of respondents reported witnessing violence (21.8%) or experiencing interpersonal violence (18.8%), accidents (17.7%), exposure to war (16.2%) or trauma to a loved one (12.5%). An estimated 3.6% of the world's population has suffered from post-traumatic stress disorder (PTSD) in the previous year, the study showed.
Using the new protocol, which is co-published with the United Nations High Commissioner for Refugees (UNHCR), primary health-care workers can offer basic psychosocial support to refugees as well as 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.
Warnings against some popular treatments
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.
“PTSD needs to be managed along with other common mental disorders” reports Dr Mark van Ommeren, Scientist in the WHO Department of Mental Health and Substance Abuse. “This new, simple WHO-UNHCR treatment protocol will guide health workers around the world to help adults and children who suffer from conditions specifically related to stress.” The new guidelines and protocol were published today in an article in "The Journal of the American Medical Association".
Additional information
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.
Thus, the WHO recommendation is that benzodiazepines should not be offered to adults to reduce acute traumatic stress symptoms associated with significant impairment in daily functioning in the first month after a potentially traumatic event.
The WHO recommendation also notes that benzodiazepines can have their use for other mental disorders.
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