Importance of Psychological First Aid

Different kinds of distressing events happen worldwide, such as war, natural disasters, accidents, and interpersonal violence. These distressing events may affect individuals, families, and communities directly or indirectly, either partially or fully. There is a wide range of reactions and feelings a person can have. The nature of reactions and emotions depends upon various factors like the severity of the disaster, coping style or skills, experiences, and sociocultural factors. However, some people are more vulnerable in crises and may need extra help. Psychological first aid is one of the critical tools or measures to provide immediate psychological help to those who are experiencing traumatic events.

Psychological first aid is emerging as the crisis intervention of choice in the wake of critical incidents such as trauma and mass disasters ( Everly et al.2006). Raphel,1977 first coined the term psychological first aid in her discussion of crisis work with an Australian railway disaster. She described various activities that provided caring support, empathic responding, concrete information and assistance, and reuniting social support systems to survivors. It is simply a supportive and compassionate method designed to stabilize and mitigate acute distress, as well as facilitate access to continued care. It does not require diagnosis. It is a systematic set of helping actions that are aimed at reducing initial post-trauma distress and supporting short and long-term adaptive functioning.

Paramount in psychological first aid is attending to Maslow’s needs hierarchy and taking care of survival needs first. It is the primary bone of crisis intervention and is intended to be palliative, not designed to cure or fix anything., but rather to provide nonintrusive physical or psychological support. It is constructed around eight core actions: contact and engagement, safety and comfort, stabilization, information gathering, practical assistance, connection with social supports, information on coping support, and linkage with collaborative services. The basic assumption on which it works is that individuals are resilient to some degree and that severe trauma does not necessarily develop into long-term mental health problems. 

Goals of PFA

The goal of psychological first aid is to

• Provide education and information,
• Provide comfort and enable peer support,
• Increase recovery,
• Promote positive mental health and resilience, and
• Provide access to continued care if needed. 

The Phase of Psychological First Aid:

PFA identifies five imperative phases: assessment phase, stabilization phase, triage phase, communication phase, and hotline phase. The assessment phase is designed to provide immediate access to mental health services for those first responders at high risk for emotional reactions due to the crisis. The stabilization phase includes three priorities: mandatory medical checkups every 12 hours, visible spiritual leadership to sustain morale, and information from media outlets.

During the triage phase, opportunities are provided to the responders for regrouping and peer stress intervention. Group cohesion promotes resilience and a supportive environment. The communication phase is intended to provide information and education on perceived stressors and anticipated stresses. The last hotline phase includes intense follow-up to maintain contact and provide assessments and referrals if needed.

Guidelines for Psychological First Aid

National Child Traumatic Stress Network(2012) suggested some basic guidelines for providing psychological first aid in general and especially in the case of children; these are as follows:

• Be compassionate and provide emotional support
• Connect with individuals in a non-intrusive and non-threatening manner
• Recognize that the relationship between the individual and the clinician is important
• Empower individuals to believe in the notion that they are safe and that they will continue to be safe
•  Encourage individuals to be specific in their immediate
• Focus on heightened emotional states with individuals and attempt to reduce feelings of being overwhelmed and hopeless.
• Help individuals reduce feelings of isolation by connecting them to their family and friends as soon as possible.
• Provide individuals with realistic resources and the practicalities of such resources. 

Importance of Psychological First Aid in Different Settings and with Different Clients

Psychological first aid ( PFA) is grounded in evidence-based research. It provides mental health clinicians with tools to help reduce the beginning stress and trauma caused by a crisis or disaster. It was initially developed for managing trauma or stress following a natural disaster, but now lots of increasing evidence supports its use and efficacy with victims following sexual violence.

Evidence shows it is the most favourable approach for immediate intervention with sexual violence victims. Some of the studies conducted in this regard support that victims of sexual violence who do not get help immediately are more prone to suicide and mental health problems. In this way, it also helps in reducing the chances of suicide and severe mental health problems (McCobe et al.2014). Nowadays, it can be used in a wide variety of settings, with various clients, including children from multicultural backgrounds ( Ruzek et al,2007).

It is also applicable in cases of school violence ( Hu et al.2010). It is effective as a method to provide support, furnish a platform to be heard and valued, dispel rumours, allow catharsis and ventilation of emotions, reactive problem-solving abilities, reduce potential lethality, and restore general stability to the school.

It is probably most easily done in classroom meetings with teachers trained and supported by the school crisis response team(SCRT). It is also used in a school setting as a part of the preparation model and is intended to prepare for and respond to disaster.

It has been shown effectiveness to work with individuals of all ages and in group settings( Every et al 2006). Psychological first aid for children and adolescents uses the same basic core strategies of safety, calm and comfort, connectedness, self empowerment and hope but with modifications to make them developmentally and age-level appropriate.

This approach, in contrast with other helping behaviours, is gentle in nature. In this approach, space is given for open communication, immediate support, focus on the positive and empowerment. It is not intrusive for clients, while it is offered to people inquiring how help can be provided. One variant of psychological first aid is specially designed for military personnel. This is known as the Stress first aid model, which has been designed specifically for use with emergency responders personnel or combat military units exposed to potentially traumatizing missions.

Community-Based Psychological First Aid

Every culture and community also has its ways of coping with stressful events and managing psychological reactions to difficult moments in life. In the past decade, there has been a growing movement in the world to develop a set of skills for coping with stressful events that would work similarly to how first aid is used to cope with physical injury. It is called community-based psychological first aid.

CBPFA provides individuals with skills they can use in coping with the stress in their own lives, as well as stress in the lives of their family, friends, neighbours, classmates, or coworkers. At the core, these skills include knowledge of stress and extreme or overwhelming (traumatic) stress, effective “active listening” skills, and knowledge about how to help someone get other forms of psychological support. The CBPFA model builds on the strengths of the community in which the individual lives and provides a more systematic understanding of coping with difficult moments and periods in life.

One of the necessary consequences of using psychological first aid is that it promotes immediate support as well as strengthens the long-term coping of the client. It has been employed in counselling and mental health for over 60 years, and various elements of it have been around even longer ( Eifling & May 2015). Till now, there is insufficient scholarly research and literature to show the actual effectiveness of its. Lastly, it concluded that psychological first aid is a practical approach that emphasizes the treatment of individuals experiencing a variety of emotional, psychological, behavioural, spiritual and physical reactions to a crisis or disaster.