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New WHO Treatment Guide for Mental Health Trauma

Pakistani psychiatrist Mian Iftikhar Hussain talks to a woman who suffers from severe depression after her cousin was killed by a mortar, at a local hospital in Peshawar, July 3, 2012.
Pakistani psychiatrist Mian Iftikhar Hussain talks to a woman who suffers from severe depression after her cousin was killed by a mortar, at a local hospital in Peshawar, July 3, 2012.
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Lisa Schlein
New guidelines by the World Health Organization show primary health care workers how to treat patients suffering from trauma and loss.  The guidelines, jointly published with the U.N. High Commissioner for Refugees, also recommend advanced treatments for people suffering from post-traumatic stress disorder. 

This is the first time the World Health Organization has issued guidelines dealing with the mental health consequences of trauma and loss.  Five years ago, WHO published guidelines for the treatment of mental, neurological and substance use disorders.  They did not tackle problems of post-traumatic stress disorder, acute stress and bereavement.

Traumatic events and loss are common in people’s lives.  They can result from experiences such as war, natural disasters, sexual violence, and the death of a loved one.  A WHO study finds an estimated 3.6 percent of the world population suffer from post-traumatic stress disorder, or PTSD.

This 270-page report is geared toward nurses, doctors and other health workers who do not specialize in mental health disorders. 

Dr. Mark van Ommeren, a scientist in the WHO Department of Mental Health and Substance Abuse, said this was important.  He noted very few countries had psychologists and psychiatrists, so non-specialized health care workers were the ones who had to deal with mental problems.  He said primary health care workers can provide a lot of the basic care.

“One of the things they can do after trauma is provide something that is called psychological first aid, which involves listening to people, asking for their needs and concerns, strengthening their social supports and protecting them from further harms - discouraging them from making rash decisions in a moment when something bad happens,” said the scientist. 

Dr. Van Ommeren said basic health workers can provide people with stress management techniques, including breathing exercises for relaxation.  They can help people identify and strengthen positive coping methods and social supports.  He said they can comfort people by explaining their symptoms so they feel less anxious and do not think they are going crazy.

He said the guidelines stressed the importance of psychological care.  Unlike the treatment of other mental health problems, he said medicines played a relatively small role in the care of people suffering from trauma and loss.

“In particular, there is a very popular treatment of benzodiazepines or anti-anxiety drugs, which doctors all around the world like to give to people for sleeping better, for anxiety although they actually are very unhelpful.  So we are making a recommendation against them…We are concerned about their overuse,” he said.

Dr. Van Ommeron said 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.  He said their use prevented people from confronting their problems head-on, so they were unable to overcome the fear they were experiencing.

The guidelines promote two advanced treatments.  One is cognitive-behavioral therapy, which helps people think more helpfully about the traumatic event so they stop unduly blaming themselves.  This therapy helps patients understand the thoughts and feelings that influence behavior.  It teaches them to behave in less destructive, more positive ways. 

The second advanced treatment is called eye movement desensitization and reprocessing, which WHO says should be considered for people suffering from PTSD.  This treatment does not rely on talk therapy or medications.  It uses patients' own rapid, rhythmic eye movements to lessen the power of emotionally charged post-traumatic events.

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