Prioritizing COVID ‐19 vaccination for people with severe mental illness

World Psychiatry 20:1 February 2021 Another approach that has been shown to be ineffective, and indeed potentially harmful, is the use of psychological debriefing, or post-trauma counselling, delivered in the days after a traumatic event has occurred. Well-accepted PTSD management guidelines are clear in recommending against the use of such approaches. This evidence is highly relevant during the current pandemic, when mental health professionals want to support their “frontline” physical health colleagues, or assist individuals recovering from serious COVID-19 infection. Whilst both aspirations are laudable, it is important to avoid causing harm. On the other hand, there is strong evidence that training supervisors to implement supportive and empathetic communication techniques with their team members is highly beneficial to employees’ post-trauma mental health and is associated with a reduction in their sickness absence. Good evidence also exists that formal peer support programs can protect the mental health of trauma-exposed employees. Furthermore, it may be useful to ensure that trauma-exposed staff are actively monitored, provided with time away from trauma-prone workplaces, and encouraged to engage in reflective practice protecting them against the onset of moral injury. For people who do develop PTSD, there are some evidencebased treatments available. Whilst demand for these interventions is likely to be high, given the scale of the pandemic, it remains highly important that evidence-based approaches are utilized. Most evidence exists for trauma-focused cognitive behavioral psychotherapy and eye movement desensitization and reprocessing. Most people will experience substantial improvement from 8 to 12 sessions of cognitive behavioral psychotherapy, although those with more complex presentations of PTSD are likely to require more prolonged treatment. For those who do not accept or respond to psychotherapy, antidepressant medications may help, and they may be especially useful for people who present a comorbid depressive disorder. As with other mental health conditions, it is important that treatment for PTSD begins early on, before people lose their selfesteem, important relationships or employment, or develop other mental health disorders, including substance misuse. Given the likely increased global incidence of PTSD as a result of the pandemic, the routine use of the effective preventive measures and the dissemination of the evidence-based psychotherapies outlined above should be seen as a priority.