What is Psychological First Aid?

Psychological First Aid (also known as 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”. Developed for people who’ve survived disasters (floods, famine, fires, war, forced migration, protests, state enforced violence, earthquakes, mass shootings, or disease such as Ebola or Covid-19) PFA is a set of tools that may benefit anyone who has experienced trauma. That may include civilians of all ages, alongside journalists, teachers, health and social care staff, aid workers, emergency service personnel, or others dealing with or witnessing disaster.

What does Psychological First Aid do?

The aim of PFA is to appropriately respond to another person’s needs to help them, when required, 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 self-advocate and 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 rightly focus on the physical injuries and deaths that may occur. However, 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.

Who can deliver Psychological First Aid?

Any of us! By focusing on words like ‘disaster’ we may assume the only time PFA can be employed is by trained 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 chronic 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, it is specifically designed for anyone to use as needed.

This is easier to understand by noting the five goals of PFA. To provide people with:

safety

calm and comfort

connectedness

self-empowerment

hope

I want to start using Psychological First Aid right now!

If you need to get on with using PFA right away the following resources will help you. You may want to study all of them or pick one to begin with.

The World Health Organisation (WHO) has this guide for facilitators (in English, Bengali, Chinese, Estonian, Greek and Ukrainian) that explains what PFA is and how to use it. This may be helpful if you want to learn PFA quickly by yourself or to study it in a group.  The WHO has also created a free downloadable field guide for self-use available in over 30 languages. You can pass this on to anyone in your networks that need it in a crisis (it is particularly good for sharing on social media). 

Alternatively there is a practical guide on the procedures to cover in delivering PFA can be found in this manual created by the National Centre for PTSD, US). This also includes both a free App and handouts for survivors with specific information for children, teenagers and adults (in English). 

Psychological First Aid for children and young people can be found via the National Centre for Child Traumatic stress have this adapted guide for delivering PFA to children and young people plus tools for teachers and health professionals plus this wallet sized reminder of PFA principles. There is also this Field Operations Guide for Schools. 

In addition there’s this guide from ready.gov (US) for teachers about working with pupils following trauma, and these multi-language training resources for those working with children and young people by Save The Children.

R U OK? has a Mateship Manual that’s designed around PFA principles to help people coping following a natural disaster or emergency.

While 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

If you have time to prepare to give PFA you may also want to read and reflect on the following issues…

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 mental health professional to offer PFA. However whether you’re a professional in another field (teaching, 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.

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. (This may be an activity you save for after a disaster, crisis or emergency has passed).

Further resources, courses and tools you can use

Alongside the guides listed above that are designed for rapid use in crisis situations there are a range of free online courses and materials below that may take slightly longer to study. 

Professionals may already be offered PFA as part of their work, but anyone can take this free online training from John Hopkins University. 

FutureLearn have a course on PFA and Covid-19

Minnesota Department of Health has a useful website with links to additional support materials and Apps for PFA. While the University of Minnesota also has a selection of training options on PFA, alongside videos on their YouTube channel.

Plus this Field Operations Guide from the Medical Reserve Corps that comes with an appendices containing multi language public resources.

Vikram Patel’s Where there is no psychiatrist is also worth reading in conjunction with some of the resources listed here.

COVID Trauma Response Working Group have Clinical Guidance for using Psychological First Aid.

This paper “The Johns Hopkins Model of Psychological First Aid (RAPID – PFA): Curriculum Development and Content Validation”  explains more of the evidence base behind PFA teaching. While this one ‘First responders and psychological first aid’ details more of how it works and the history of PFA.

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.

You can also connect with others using PFA and responding to accidents, disasters, war or other crises on the Mental Health and Psychological Support Network.

InSocialWork’s podcast has an episode on psychological capacity building in response to disasters.

Thinking critically about Psychological First Aid

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 or Mental Health First Aid as used within families. This does not mean PFA has no place, more that based on the available evidence we cannot pinpoint which is the most effective intervention to 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.

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.