How can I support a patient with PTSD who is reluctant to engage in treatment?

Supporting a patient with PTSD who is reluctant to engage in treatment involves several key strategies.

• Build trust and acknowledge feelings: Recognise that people with PTSD may feel apprehensive, anxious, or ashamed, and may avoid treatment due to beliefs that PTSD is untreatable or difficulty developing trust. Approach discussions with empathy and reassurance that PTSD is a treatable condition.

• Provide flexible access and follow-up: Offer multiple points of access to services, including self-referral, and allow flexibility in attendance policies. Follow up proactively when appointments are missed to encourage engagement.

• Offer information and peer support: Inform patients about peer support groups facilitated by trained individuals, which can provide information and help access services without exacerbating symptoms.

• Consider social and personal factors: When discussing treatment options, take into account social or personal factors that may affect engagement, such as previous trauma, cultural challenges, or family dynamics.

• Involve family and carers: With the patient’s consent, provide information and support to family members or carers to help them encourage treatment engagement and understand PTSD.

• Offer alternative treatment options: If the patient declines psychological therapies, discuss the option of drug treatment (e.g., SSRIs or venlafaxine) as an alternative or adjunct, especially if there is significant comorbid depression or severe symptoms preventing engagement.

• Maintain a safe and supportive environment: Avoid exposing the patient to trauma triggers or stressful environments that could worsen symptoms or deter treatment engagement.

These approaches aim to reduce barriers to treatment and support gradual engagement tailored to the patient’s needs and preferences.

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