The current COVID‐19 pandemic is an invisible threat unprecedented in its global reach and extended, uncertain nature. No individual or community is left without impact, whether it is infection risks, COVID‐19 illness, loss of a loved one, disrupted employment, or financial strains. Much of the world has experienced an extended and uncertain time period of quarantine and/or social distancing restrictions that substantially interfere with usual work and social routines, cultural and religious customs, work and leisure activities, and the availability of services. For healthcare and other frontline workers, there is ongoing risk of morbidity and mortality for themselves and their families as a result of their service. Although this specific pandemic is larger than previous pandemics and has resulted in more deaths than the Attacks on September 11, 2002 (Center for Disease Control, 2020), there is much that the mental health field knows from military, disaster settings, and other types of trauma exposures that can help guide how we support our health professionals working in this extremely stressful environment (VA/DOD, 2017). Investments in efforts to support mental health and provide indicated prevention and intervention may decrease long‐term risk for negative mental health outcomes, including for healthcare workers and other staff on the front lines of the pandemic.

Many are predicting that the mental health impact will be grim. We agree that the mental health impact will be significant, but also feel confident that for most, the pandemic and its aftermath will be a significant stressor that people cope with in real time and even if highly distressed acutely, will eventually naturally recover and move on to a new normal and satisfying life. The mental health response must be measured and not overly emphasize a belief and expectation of an epidemic of unmanageable long‐term negative mental health impacts. Instead, while planning to address mental health needs that will arise, we should project hope and have confidence that most people will recover with time. Data from the field of trauma and bereavement strongly support that resilience is the modal outcome even for severe challenges (Bonanno et al., 2002; Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992). Nonetheless, a shortage of access to effective mental healthcare was already a problem before the pandemic and will worsen even if only a small percentage require intervention (Thomas, Ellis, Konrad, Holzer, & Morrissey, 2009). As such, planning needs to consider efficient use of resources and possibly stepped care models to provide the most effective and least resource‐intensive course of care to respond adequately (Richards et al., 2012; Zatzick et al., 2013). Helping people cope acutely while assuring access to those in need of higher levels of mental health intervention are critically important goals. Although the evidence base for prevention intervention is less clear about optimal approaches, there are nonetheless many helpful strategies that may help reduce both short‐ and long‐ term distress, and their targets are guided by relevant clinical and research lessons learned over many years. Key to any mental health response to the current pandemic or other extended potentially highly distressing and/or traumatic events is a response that simultaneously considers both timing (referred to as phase) and associated distress and/or functional impairment (referred to as level). As defined below, the framework includes three phases (initial, post, and longer‐term) and three levels (system level, self‐directed level, and mental health supported brief intervention).

The Phased Approach to COVID‐19 Mental Health Response (PAC), now freely downloadable on the Anxiety and Depression Association of America website (https://adaa.org/sites/default/files/PhasedApproachtoCovid‐19.ver1.1%20(002).pdf), is a framework for COVID‐19 mental health response (see Table 1). This framework of phased interventions and resources is intended to assist health systems and programs impacted by the pandemic to plan for how to address current mental health issues arising as well as to prepare and plan for the continued needs of their communities, patients, and staff. In addition, many of the resources presented may be used by healthcare professionals and others on the front lines of care, as well as anyone being significantly impacted by COVID‐19 as they see fit. The framework provides a model for response over time and across the wide range and severity of potential impact of the pandemic, including program design considerations and examples of evidence‐guided resources when available. For specific areas where previous resources were not freely available, select evidence‐informed brief interventions were created and are downloadable from the Framework posting on the ADAA website (mask desensitization [with colleagues from the University of Chicago, Emory University School of Medicine, and New York University]), self‐directed difficult experience exposure (created by the authors and Dr. Jeffrey Cigrang), and assessment protocol with brief intervention for an MH provider adapted from Rothbaum et al. (2012).

当前的 COVID-19 大流行是一种无形的威胁，其全球范围和扩展性、不确定性是前所未有的。任何个人或社区都会受到影响，无论是感染风险、COVID-19 疾病、失去亲人、就业中断或财务压力。世界上大部分地区都经历了长时间且不确定的隔离和/或社交距离限制，这些限制严重干扰了正常的工作和社交活动、文化和宗教习俗、工作和休闲活动以及服务的可用性。对于医疗保健和其他一线工作人员来说，他们的服务会导致他们自己和家人的发病和死亡风险持续存在。尽管这次特定的大流行比以前的大流行更严重，并且导致的死亡人数比 9 月 11 日的袭击事件还要多， 2020 年），心理健康领域从军事、灾难环境和其他类型的创伤暴露中了解到的很多信息可以帮助指导我们如何支持我们的卫生专业人员在这个极度紧张的环境中工作（VA/DOD，  2017 年）。投资于支持心理健康并提供有针对性的预防和干预措施，可能会降低负面心理健康结果的长期风险，包括医护人员和大流行前线的其他工作人员。

许多人预测，心理健康的影响将是严峻的。我们同意对心理健康的影响将是巨大的，但也相信对于大多数人来说，大流行及其后果将是人们实时应对的重大压力源，即使极度痛苦，最终也会自然恢复并继续前进新的正常和令人满意的生活。必须衡量心理健康反应，而不是过分强调对无法控制的长期负面心理健康影响的流行的信念和期望。相反，在计划解决将出现的心理健康需求时，我们应该寄予希望并相信大多数人会随着时间的推移而康复。来自创伤和丧亲领域的数据强烈支持即使面对严峻挑战，复原力也是模态结果（Bonanno et al., 2002；罗斯鲍姆、福阿、里格斯、默多克和沃尔什，  1992 年）。尽管如此，在大流行之前，缺乏有效的精神保健就已经是一个问题，即使只有一小部分需要干预，这种问题也会恶化（Thomas、Ellis、Konrad、Holzer 和 Morrissey，  2009 年）。因此，规划需要考虑资源的有效利用和可能的阶梯式护理模式，以提供最有效和资源最少的护理过程，以充分应对（Richards 等人，  2012 年；Zatzick 等人，  2013 年））。帮助人们迅速应对，同时确保能够接触到需要更高水平的心理健康干预的人是至关重要的目标。尽管关于最佳方法的预防干预证据基础尚不清楚，但仍有许多有用的策略可能有助于减少短期和长期痛苦，其目标是以多年来获得的相关临床和研究经验为指导。对当前大流行或其他扩展的潜在的高度痛苦和/或创伤性事件的任何心理健康反应的关键是同时考虑时间（称为阶段）和相关的痛苦和/或功能障碍（称为水平）的反应。如下所述，该框架包括三个阶段（初始阶段、后期阶段和长期阶段）和三个级别（系统级别、

COVID‐19 心理健康反应 (PAC) 的分阶段方法，现在可在美国焦虑和抑郁协会免费下载网站（https://adaa.org/sites/default/files/PhasedApproachtoCovid‐19.ver1.1%20(002).pdf）是 COVID‐19 心理健康应对的框架（见表 1）。这个分阶段干预和资源框架旨在帮助受大流行影响的卫生系统和项目规划如何解决当前出现的心理健康问题，并为其社区、患者和工作人员的持续需求做好准备和规划。此外，提供的许多资源可供医疗保健专业人员和其他一线护理人员使用，以及任何受 COVID-19 显着影响的人都可以在他们认为合适的情况下使用。该框架提供了一个模型，用于随着时间的推移以及大流行潜在影响的广泛和严重程度，包括项目设计考虑和可用的循证资源示例。对于以前资源无法免费获得的特定领域，我们创建了精选的循证简短干预措施，并可从 ADAA 网站上发布的框架中下载（口罩脱敏 [与芝加哥大学、埃默里大学医学院的同事和 New约克大学]），自我指导的困难经历暴露（由作者和 Jeffrey Cigrang 博士创建），以及改编自 Rothbaum 等人的 MH 提供者的简短干预评估方案。( 选择有证据的简短干预措施已创建并可从 ADAA 网站上发布的框架下载（口罩脱敏[与芝加哥大学、埃默里大学医学院和纽约大学的同事]）、自我导向的困难经历暴露（由作者和 Jeffrey Cigrang 博士创建），以及针对 MH 提供者的简短干预的评估方案，改编自 Rothbaum 等人。( 选择有证据的简短干预措施已创建并可从 ADAA 网站上发布的框架下载（口罩脱敏[与芝加哥大学、埃默里大学医学院和纽约大学的同事]）、自我导向的困难经历暴露（由作者和 Jeffrey Cigrang 博士创建），以及针对 MH 提供者的简短干预的评估方案，改编自 Rothbaum 等人。(2012 年）。