Table 1.

A stress- and trauma-informed stepped-care model for public mental healthcare during the pandemic.

Governmental measures	Primary objectives of mental health interventions	Mental health interventions at different levels
Universal prevention: Addressing mental health needs in the general population
Governmental policies promoting protective factors at a general population level via transparent and consistent policies of pandemic management, efficient communication, etc.	Enhancing resilience and positive coping in general population via • informing • capacitating	Low-intensity high-reach public health interventions: At societal level: public information campaign promoting self-care and positive coping (e.g. setting up daily routines, focusing on the positive things in a day) At organizational level: promoting a stress- and trauma-informed organizational culture, introducing staff care practices, enabling supervisors to conduct mental health conversations At individual level: information sheets, apps, websites, and online training for self-care and healthy living
Selective prevention: Addressing mental health needs of at-risk groups
Governmental policies promoting protective factors for at-risk groups via economic support measures, social support measures, improving access to education, provision of personal protective equipment, etc.	Enhancing resilience and positive coping in at-risk groups via • informing • capacitating • counselling	Public mental health low-intensity high-reach interventions: At-risk groups/vulnerable communities level: enhancing group resilience interventions (e.g. information sheets, online training of community activists, youth self-help and peer support) Organizational level: enhancing organizational resilience for personnel working in potentially traumatic conditions; training of personnel for coping with staff mental health problems, peer support programmes including prevention of moral injury, stigma, etc. Individual level: apps, information sheets, web-based self-help, counselling, etc.
Indicated prevention and early intervention: Addressing mental health needs of individuals with mental health symptoms and/or diagnosis
Governmental policies promoting equal access to mental healthcare via developing corresponding infrastructure (mental healthcare services, internet access, etc.)	Enhancing resilience and positive coping in individuals with mental health symptoms or diagnosis via • informing • capacitating • counselling • psychological therapies	Public mental health low-impact high-reach interventions and advanced interventions (individual and/or family level): • Individual level: web-based and face-to-face skills-based interventions to reduce persistent distress and to promote recovery; evidence-based methods for enhancing emotional regulation; evidence-based transdiagnostic interventions for youth, etc. If more intense mental health intervention is needed, referral to specialized evidence-based psychological treatment (e.g. grief or trauma-focused therapy)• Family level: online or face-to-face couple or family counselling, etc.
	Treatment
	Providing treatment and appropriate care to individuals in need of mental health treatment	Online or face-to-face psychotherapy, pharmacological treatment, multidisciplinary case management, etc.
	Continuous care
	Providing treatment and psychosocial rehabilitation to individuals in need of continuous mental healthcare	Online or face-to-face psychotherapy, pharmacological treatment, multidisciplinary case management, community-based outreach interventions, etc.