What Is Psychological First Aid?
Psychological First Aid (PFA) describes a humane, empathic and supportive response to a fellow human being who is suffering emotionally/psychologically and who may need support. PFA includes the following:
- Providing practical care and support without imposing or encroaching on the person’s rights and human dignity.
- Assessing needs and concerns;
- Helping people to address basic needs (for example, food and water, information);
- Listening to people, but not pressuring them to talk;
- Comforting people and helping them to feel calm;
- Helping people connect to information, services and social supports;
- Protecting people from further harm.
What is PFA is not?
- Something that only professionals can do.
- Professional counselling.
- “Psychological debriefing”, in that PFA does not necessarily involve a detailed discussion of the event that caused the distress.
- Asking someone to analyze what happened to them or to put time and events in order.
- Pressuring people to tell you their feelings and reactions to an event.
Active Principles of PFA:
There are three active principles:
- Look: Looking (observing) properly is essential to understand if there are any dangers, to see obvious basic urgent needs, and with serious distress symptoms.
- Check for safety.
- Check for people with obvious urgent basic needs.
- Check for people with serious distress reactions.
- Listen: Listening actively (reflectively) to people you are helping is essential to understand their situation and needs, to help them to feel calm, and to be able to offer appropriate help.
- Approach people who may need support.
- Ask about people’s needs and concerns.
- Listen to people, and help them to feel calm.
- Link: Linking people with basic service providers is an essential component of ensuring that basic urgent needs are met.
- Help people address basic needs and access services.
- Help people cope with problems.
- Give trustworthy information.
- Connect people with loved ones and social support.
Who is PFA for?
- PFA is for distressed people who have been recently exposed to a serious crisis event like the mudslide and flooding in Freetown, Sierra Leone. You can provide help to both children and adults, and this can include frontline service providers (such as nurses, and social workers), community members and children.
- However, not everyone who experiences a crisis event will need or want PFA.
- Do not forces help on people who do not want it, but make yourself easily available to those who may want support.
Are there limits to the service provided by PFA Workers?
There may be situations when someone needs much more advanced support than PFA alone. Know your limits and get help from others, such as medical personnel, mental health workers, counselors, your colleagues or other people in the area, local authorities, or community and religious leaders.
What categories of people would need more immediate advance support?
- People whose family members have died as a result of disasters such as the Freetown mudslides and flooding.
- Distressed health professionals working crisis communities or situations.
- People who are so upset that they cannot care for themselves or their children.
- Panic stricken people and those in denial of the reality of the effect of the disaster they were involved in.
- People who are full of fear.
- People who may hurt themselves or others.
When PFA is needed?
- Although people may need access to help and support for a long time after an event, PFA is aimed at helping people who have been very recently affected by a crisis event.
- You can provide PFA when you first have contact with very distressed people. This is usually during or immediately after an event. However, it may sometimes be days or weeks after, depending on how long the event lasted and how severe it was.
- Research has shown that PFA can assist people affected by a crisis event to avoid long term mental health problems, including Post Traumatic Stress Disorders (PTSD).
Where PFA is needed?
You can offer PFA wherever it is safe enough for you to do so. This is often in
- Community settings;
- Places where distressed people are served, such as health centres, shelters or camps, schools, etc.
- Distribution sites for food or other types of help;
Remember basic principle to stay safe:
Ideally, try to provide PFA where you can have some privacy to talk with the person when appropriate. When delivering PFA it is essential to respect confidentiality and the person’s dignity.
When you take on the responsibility to help in situations where people have been affected by a distressing event, it is important to act in ways that respect the safety, dignity and rights of the people you are helping.
- Avoid putting people at further risk of harm as a result of your actions.
- Make sure, to the best of your ability, that the adults and children you help are safe and protect them from physical or psychological harm.
- Treat people with respect and with humility.
- Make sure people can access help fairly and without discrimination.
- Help people to claim their rights and access available support.
- Act only in the best interest of any person you encounter.
Try to keep these principles in mind in all of your actions and with all people you encounter, whatever their age, gender or ethnic background. Consider how you would like to be treated in the same situation and treat people that way.
It is important for all to know that there are ethical principles to observe when providing PFA at all times and these must be practiced.
- Be honest and trustworthy.
- Respect people’s right to make their own decision.
- Be aware of and set aside your own biases and prejudices.
- Make it clear to people that even if they refuse help now, they can still access help in the future.
- Respect privacy and keep the person’s story confidential, if this is appropriate.
- Behave appropriately by considering the person’s culture, age and gender.
- Don’t exploit your relationship as a helper.
- Don’t ask the person for any money or favor for helping.
- Don’t make false promises or give false information.
- Don’t exaggerate your skills.
- Don’t force help on people, and don’t be intrusive or pushy.
- Don’t pressure people to tell you their story.
- Don’t share the person’s story with others.
- Don’t judge the person for their actions or feelings.
- Don’t give false hope.
Much of PFA is ensuring that the people have access to the right information and sharing the correct information. Therefore it is essential when offering PFA that you are aware of what other agencies are doing, where survivors or affected persons should seek help, who they should ask for, who is responsible for child protection issues, case management, food, mental health and other forms of health care (what to do with treatment for other illnesses besides mental health and psychosocial issues and how to minimize risks of potential outbreaks – Hence a clear referral path to holistic care).
Helping responsibly means also that you have to look after yourself and your own mental wellbeing. As a helper, you may also be affected by the crisis event or have family, friends and colleagues who are.
It is important to pay extra attention to your own wellbeing and be sure that you are physically and emotionally able to help others. Take care of yourself so that you can best care for others. If working in a team, be aware of the wellbeing of your fellow helpers as well.
- Sit face to face if culturally appropriate.
- Find a quiet place where the person feels free to talk.
- Lean towards the person.
- Nod or use facial expressions or gestures to encourage the person to say more or to let them know you understand.
- Notice the person’s body posture.
- Notice the facial expression.
- Look for what is not said as well as what is said.
- Find the real feelings behind the story and body language.
Listen Carefully and Try to Remember What the Person Says
- Re-state what has been said to show you understand.
- Ask to clarify or to understand the person better.
- Give appropriate feedback – reassurance, suggestions, encouraging responses.
Tips on Active Listening Skills
- Avoid interruptions or distractions.
- Show interest in the person.
- Be kind and respectful.
- Concentrate on the person, not on your problems or what you want to say.
- Be patient. Give time to the speaker – allow pauses and silences to take effect.
- Be a trustworthy person who keeps secrets. (Confidentiality)
- Be empathic and approachable.
- Be tolerant and accept the person without being judgmental.
- Avoid keeping in mind rumors about your speaker that will influence your listening.
- Have courage to tolerate reactions or behavior that is off-putting (there’s a reason someone behaves that way).
- Believe there is good in every person.
- Undermine or minimize what the person says
- Give advice or solutions (listen to the solution of the speaker)
- Immediately tell your story of a similar experience
- Lie or tell half-truths
- Promise things that you cannot afford (you will lose trust)
- Discipline or use an intimidating voice
- Interpret what they say without clarifying it