Are local or global situations causing you to feel distressed or anxious? Perhaps you’re at direct risk of social unrest, disease epidemics, terrorism, conflict, or police violence. This might be a recent emergency, or represent historic and systematic abuse and neglect. You may be being specifically targeted because of your race, gender, disability, sexuality, faith, or other factors beyond your control. You may have had some forewarning about events -or they may have come as a sudden shock. The threats you’re facing may be in the form of immediate financial, physical or emotional harm. Alternatively, it may be exposure to events via the media, through conversations with friends, or awareness of world events that are making you feel unhappy or afraid. If you already have an existing physical or mental health condition this may be exacerbated by knowing about other hazards that could be affecting you – or those you love. Maybe you aren’t even immediately familiar with people facing maltreatment but you are still distraught on hearing about their situation and wish to do something practical to help.
Below are a number of resources for you to use to help yourself, or to share with others who might benefit from them. All are designed to be adapted to suit different circumstances depending on where you are and what the problem(s) are that you are facing.
The Black Cross Health collective have specifically designed resources for those providing first aid during protests, demonstrations and periods of unrest. The BBC have produced these resources for First Aid in Hostile Environments, while the International Red Cross have produced First Aid in armed conflicts and other situations of violence available in multiple languages. Hesperian have a range of health guides in multiple languages on a variety of health and development topics for those who lack access to affordable and accessible services. Their most famous text Where there is no doctor may be essential to you or your community in emergency situations. Mental and physical health resources are also linked to alongside personal care and safety materials in What to do instead of calling the police (this is more of a US-focused guide but may still be adaptable to other country settings). In general the advice for anyone at risk of physical harm or with health problems is to call the emergency services (fire service, paramedics, police, or coastguard). Noting, also, that these may not be available – or that you may not feel you can trust such services.
It’s common during and after a crisis to not know what to do or feel so weighed down by events you cannot concentrate or care for yourself or others. These two guides may help. The first is from me, writing in the Telegraph, about how to cope when life seems frightening and upsetting the other is by therapist Tania Glyde on When the world has changed forever – self care in a collective crisis. Both of these posts provide ideas for tackling loneliness, isolation, fear and distress – with links to additional sources of support and help. They are particularly focused on those who are living in times of uncertainty or unrest.
Meanwhile, regardless of wider social or cultural situations happening around you, other life events can also keep on happening. These might be positive or negative – but you may still require assistance in coping with them – in which case a list of support services and helplines can be found here.
Psychological First Aid, or PFA, may not be a term you’re familiar with, but it may well be something you’ve given or received. The Australian Psychological Society explain it as a “humane, supportive response to a fellow human being who is suffering and who may need support”. And while developed for people who’ve survived disasters (floods, fires, war, forced migration, earthquakes, mass shootings, or disease) it is effectively a set of tools that may benefit anyone who has experienced trauma. That may include civilians of all ages, journalists, healthcare staff, aid workers or others dealing with disaster.
The aim of PFA is to appropriately respond to another person’s needs to help them, when needed, at any point following a traumatic event. That may be around enabling them to feel safe and supported immediately after a disaster, allowing them to talk if they want to, and to reduce distress at any point following trauma. Importantly the point of PFA is to help people identify what services and facilities may benefit them during and after a crisis, enable them to connect with social support, assist them to feel in control, and empowered to try and recover from what has happened to them. Rather than telling people what they should do or how they ought to feel, the aim of PFA is to allow people to prioritise and address their own needs in their own time.
Following large and small-scale disasters we may focus on the physical injuries and deaths that may occur. We may not consider the impact of trauma on individuals who have lived through an event or the effects this may have on those who are front line or support service staff. PFA is used here to both reduce the likelihood of post traumatic stress disorder (PTSD) developing, and to give people the strength to cope at a time when they may feel bewildered, afraid or angry.
In focusing on words like ‘disaster’ we may assume the only time PFA can be employed is by mental health professionals following something huge and devastating happening to a community or country. Whereas PFA may be used be individuals and smaller groups and following any situation that might result in grief or trauma. That could include a relationship breaking down, following a bereavement, dealing with a chonic illness, if someone’s lost their job, or after a traumatic birth. Or supporting friends, loved ones or strangers in the disaster situations outlined above (e.g. during war, when coping with widespread infections, or if you are a refugee or supporting refugee communities). You don’t have to be a trained professional to deliver PFA.
This is easier to understand by noting the five goals of PFA. To provide people with: safety, calm and comfort, connectedness, self-empowerment, and hope. A practical guide on the steps you might want to cover in delivering PFA can be found here (courtesy of the National Centre for PTSD, US). Not all of these are always possible to deliver at the same time, but being able to provide some of them may still be beneficial.
How can media advice givers make use of PFA?
For agony aunts and uncles, we may often be a first port of call when someone is in crisis, or be expected to provide emotional and practical support to those who want advice. Advice columns and programmes can fill an immediate role following disasters or conflict – particularly in the case of radio. But on a general level for those wanting to provide advice via media, learning about the principles and applications of PFA can greatly help when offering advice that empowers and enables others to manage their situations.
This 40-minute talk from the Australian Institute of Professional Counsellors outlines some of the basics of PFA and how to use it
On being a good Psychological First Aider
Following any crisis we may want to take care of others, and as with physical first aid there’s the chance we could save a life if we administer psychological first aid correctly. And equally that we could cause more harm if we get it wrong. To that end it is worth noting what PFA is not. It isn’t: debriefing; taking details of traumatic experiences and losses; offering any kind of treatment, counselling or therapy; or imposing labels or diagnoses.
You don’t have to be a professional to offer PFA. However whether you’re a professional (in healthcare, media or so on) or offering care to a loved one, friend or family member it is vital to remember not to impose any kind of care without asking first. If someone’s experienced a trauma they may want to deal with it in diverse ways and not everyone affected by an emergency will require assistance from you or any other support service. If you’re reaching out to people who are different to you in terms of age, sexualities, genders, culture, faith etc they may understand and respond to their trauma in ways that are not like yours. That is okay and being respectful of this and not pushing your way of coping onto them is important. Just as it is vital to ensure you’re not excluding people from help because you don’t know what to do with them or don’t particularly like who/what they represent. There is an excellent discussion of how trauma and care differs globally (and what can go wrong when we try and impose Western approaches onto other cultures) covered here.
Given how common traumatic events are, it is worth finding out more about what PFA is and how we could use it in our own lives. Links to useful resources and guides can be found at the end of this post. To read through, listen to and reflect on everything here will probably take 15-20 hours so you may want to set aside time to do this or come back to it as and when time permits. Professionals may already be offered PFA as part of their work or may want to take this free online training from John Hopkins University (I would include agony aunts and uncles in this group). Returning to the idea of who may be included or excluded by care, it is worth critiquing all of the references and support materials here to think about who created them, who benefits from them, what models of care are being promoted, and who may be brought in or left out by the way PFA is discussed.
If you’ve used PFA in your own work please share your experiences in the comments – whether it’s helped you or not been effective or if you’ve examples of good practice I’d love to hear them. Particularly from communities across the world, and especially if you can help others help themselves during and after any kind of trauma.
Alongside these tools, if you are health professional dealing with physical health as well as psychological health following disasters or crises you may find the resources from Evidence Aid and Hesperian may benefit you and the communities you work with.
New evidence reviewing PFA guidelines suggests that, following a review of existing guidance, there is no strong evidence currently to show the effectiveness of PFA. This does not mean PFA has no place, more that based on the available evidence cannot pinpoint which is the most effective intervention we might use. Given the aims of PFA are about adapting ideas for individual and community support based on circumstance, culture and place it may be sensible for now to critically use and adapt the resources listed above; while noting potential limitations and finding ways to document any interventions and practices so the process of PFA can continue to be improved upon.