Send in the therapists?
Identifieur interne : 000386 ( Pmc/Corpus ); précédent : 000385; suivant : 000387Send in the therapists?
Auteurs :Source :
- The Lancet. Psychiatry [ 2215-0366 ] ; 2020.
Url:
DOI: 10.1016/S2215-0366(20)30102-4
PubMed: 32199496
PubMed Central: 7103927
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<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet Psychiatry</journal-id><journal-id journal-id-type="iso-abbrev">Lancet Psychiatry</journal-id><journal-title-group><journal-title>The Lancet. Psychiatry</journal-title></journal-title-group><issn pub-type="ppub">2215-0366</issn><issn pub-type="epub">2215-0374</issn><publisher><publisher-name>Elsevier Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32199496</article-id><article-id pub-id-type="pmc">7103927</article-id><article-id pub-id-type="publisher-id">S2215-0366(20)30102-4</article-id><article-id pub-id-type="doi">10.1016/S2215-0366(20)30102-4</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Send in the therapists?</article-title></title-group><contrib-group><contrib contrib-type="author" id="au10"><name><surname>The Lancet Psychiatry</surname></name></contrib></contrib-group><pub-date pub-type="pmc-release"><day>19</day><month>3</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>4</month><year>2020</year></pub-date><pub-date pub-type="epub"><day>19</day><month>3</month><year>2020</year></pub-date><volume>7</volume><issue>4</issue><fpage>291</fpage><lpage>291</lpage><permissions><copyright-statement>© 2020 Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>Elsevier Ltd</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions></article-meta></front><body><p id="para10">Public health emergencies, such as coronavirus disease 2019 (COVID-19) and the bush fires in Australia, highlight the inequalities in our societies and the failures of our institutions. The poor suffer the brunt of any new pandemic, earthquake, or flood, while elected leaders seem unfazed and continue to call for policies that will likely lead to more long-term vulnerabilities and suffering. But emergencies also have a way of amplifying the dedication of clinicians, scientists, and public health professionals. One of the most remarkable responses to these recent events has been the emphasis that groups and governments have placed on the mental health consequences of these disasters. Examples include the Australian Government putting AU$76 million of funding specifically towards mental health and wellbeing, and the calls by researchers and clinicians in China for better mental health services for those impacted directly and indirectly by COVID-19.</p><p id="para20">Even a few decades ago, such calls for an increased focus on mental health during a physical health crisis would have been unlikely from clinicians, and these calls being heeded by governments and public health officials would have been even more unlikely. This change in behaviour coincides with, and undoubtedly has been influenced by, the awareness and sensitivity to trauma of the psychiatric field and the general public, a concept in mental health that has extended beyond post-traumatic stress disorder and the soldiers for whom the disorder was originally formulated. This evolution also reflects an encouraging trend in our thinking about wellbeing: that mental and physical health are intertwined and should be managed on equal footing.</p><p id="para30">But, in our zeal to help during public health emergencies, we should remind ourselves of a few difficult facts. Although the mental health field's interest in trauma has greatly expanded in recent decades, our scientific understanding of trauma has lagged far behind, including our understanding of its definition and aetiology, and, importantly, of how to effectively intervene. High-quality evidence of the effectiveness of acute psychological interventions for disaster-related trauma is scarce. Even more concerning is the fact that the potential risks and adverse reactions in response to therapy in the immediate aftermath of a disaster are not well studied.</p><p id="para40">When implementing measures to help those dealing with disasters, we should be cautious in reducing trauma to a simple matter of exposure and response prevention, and instead take a more complex view of trauma that incorporates pre-existing and comorbid mental health problems. For example, the epidemiological evidence we do have about disaster-related trauma suggests that most people are highly resilient, with longer lasting negative outcomes in individuals as a result of trauma reflecting existing mental health problems and socioeconomic status. But, even if efforts are made to target those most vulnerable to disaster-related trauma, our lack of knowledge on long-term outcomes and processes also raises the question of how much we should expect from short-term infusions of funding and effort.</p><p id="para50">Culture and context should also be considered when devising plans for delivering mental health care in disaster settings, but are rarely discussed in calls to action during emergencies. Communities most susceptible to the lasting impact of a disaster are also those most likely not to have access to mental health care in their daily lives. How effective will a single session of therapy be when delivered by an outsider? How will members of these communities respond when all of the specialists fly back home and they are left with the day-to-day struggles in mental and physical health that were there before, and will be around long after, the headlines?</p><p id="para60">This is not to say that the mental health community should stop focusing on the importance of trauma or calling for action in the wake of disasters; efforts on both fronts should be applauded and scaled up when appropriate. However, health-care providers and governments need to remember that psychiatry's history is littered with good intentions that turned out poorly in practice, and interventions that seemed intuitively correct but did not work, or even exacerbated conditions, on contact with reality. The concept of trauma also needs to be removed from its silo and integrated with the complexities of other mental health disorders and persistent social factors such as poverty. In brief, we need holistic action plans informed by evidence, and implementation strategies that see beyond the short term. Emergencies are not just crises to be contained, but opportunities to build sustainable health systems.</p><p id="para70"><fig id="f10"><graphic xlink:href="fx1_lrg"></graphic><permissions><copyright-statement>© 2020 Microgen Images/SciencePhoto Library</copyright-statement><copyright-year>2020</copyright-year><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions></fig></p></body></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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