First aid is the first and immediate assistance given to any person suffering from either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. Psychological first aid is defined as a compassionate and supportive presence designed to mitigate acute distress and assess the need for continued mental health care (Everly & Flynn, 2005). It is not a therapeutic process or diagnostic process; it is designed to provide immediate help to deal with the situation.
There is a need for psychological service as the frequency of natural disasters has increased; global destabilization and armed conflicts will likely cause a number of disasters and the surge for mental health services will increase. To enhance surge capacity, psychological interventions are made to increase perception of personal resilience and preparedness, and to increase community resilience. The applicability of psychological first aid is for mass disasters, military, workplace, suicide or homicide, community violence, faith-based organization and public health settings.
The current situation of COVID-19 is a global crisis and psychological first aid skills are required to deal with people’s mental health. The need and importance of psychological first aid in current situations is understood through WHO articles and Johns Hopkins Psychological First aid course.
HISTORICAL CONTEXT OF PFA (Psychological First Aid)
The term psychological first aid was first used in a 1954 article in APA about Monograph on Psychological First Aid. It talks about the stress and disturbances faced by people during community disasters and the effect and coping of disaster workers and affected people. After 40 years, a disaster mental health initiative was fielded by the American Red Cross which consists of licenced professionals for psychological intervention and first aid. The first deployment was done in 1992 under Hurricane Andrew.
Later on, the importance of mental health support was identified and understood during the 2005 gulf coast in the US. These show that providing services of psychological first aid during disasters in the US helped the distressed. There are some countries that also include this facility during disasters but many countries which are either developing or underdeveloped have not included it. It shows that mental health services are always needed during disasters but the identification and provision of service and facilities is lacking.
On the continuum of providing mental health care, psychological first aid is the first step towards providing care. The training in psychological first aid is important for the people who are the first responders or helpers like public health personnel, public health educators, emergency responders and disaster workers. The psychological first aid model which is suggested by Johns Hopkins University professors is based on their research of over 60 countries during a disaster.
They identified the psychological first aid help that is required by them which is applicable across all cultures. The book “Johns Hopkins Guide to Psychological First Aid” by George S. Everly, JR & Jeffrey. M. Lating describes their research and model in detail. They provide a RAPID model as a psychological first aid model which is culture-free and effective during crises.
This is the model of psychological first aid provided by Johns Hopkins University. It is considered as a culture fair and effective during crisis situations. RAPID model is –
R – Rapport and reflexive listening
A – Assessment of needs
P – Prioritization
I – Intervention
- RAPPORT AND REFLEXIVE LISTENING
The goal of this first step is to make contact, provide an introduction, build a rapport and use active listening techniques like paraphrasing to establish some degree of empathy. Rapport is a great skill during crisis situations and generally for human beings also. The reflective listening also known as active listening is the specialization technique designed to make listening more effective. Reflective listening is an on-going process used throughout the entire interaction with a person who is in crisis or in the wake of some adversity.
This technique helps in conveying that the person is understood as understanding often conveys trust and trust conveys compliances. Establishing rapport as quickly as possible is essential in the wake of disaster, what is said initially depends upon the situation but you generally start by introducing yourself, your role and an initial question. The well phrased questions lead to a sense of value and participation in the solution from the person and also conveys a sense of support. The essence of reflective listening is to paraphrase and reflect back on it. The context of rapport depends upon being present, listening, allowing catharsis, not rushing into solutions, not arguing and not trying to make them feel better by diminishing their concern.
When rapport is formed, assessment of physical and psychological need is derived from the guided conversation which involves the survivors own narratives. It is important to identify what happened and what reaction person has to provide for further intervention. There are three groups of survivors based on their narratives about the situation and reactions with the identification of their needs.
Eustress group which faces an optimal amount of stress but is motivated and has resources to deal with the situation and doesn’t require any help. The distress group consists of around 60 %-90% of the survivors, and the dysfunctional group consists of 4-49% of the survivors. The need and intervention of the people depends upon the survivor group they are identified with.
It refers to the prioritization of the people and those needs which require emergent care. It is an extension of assessment which represents basic triage principle. There are two approaches to triage – evidence-based and risk-based. The evidence-based triage is a diminished cognitive capability and ability to understand which leads to self-injurious, helpless or hopeless and inability to perform necessary functions of living. The risk assessment is based on 3Ds i.e. death, dislocation and disabling impact. The risk-based triage should never be used in the absence of evidence-based triage to formulate your triage plan.
It is based upon the assessment and prioritization of needs to address. This intervention is designed to address basic needs, mitigate acute distress and restore acute functional capacity. Social support is the most effective way to enhance resilience. There are two types of intervention. The first one deals with the psychological instability of a person by removing provocative cues, allowing catharsis, encouraging task focus, using distractions and delaying impulse. The second one deals with mitigating acute distress and fostering the ability to function by educating, normalizing, reassurance, reframing, stress management and problem solving techniques, if required.
It is the function of effectiveness in the wake of adversity; a decision is made concerning the need to facilitate access to a higher level of care. The following are important, if followed leads to the third time which means a person can’t handle the situation and requires a higher level of care.
The psychological first aid process could be affecting the mental health of first responders like exhaustion, burnout, guilt, can’t function effectively and compassion fatigue. It is important for them to identify the symptoms and follow self-care techniques while the disaster situation is happening.
This article explains about the meaning, nature and historical context of psychological first aid. It discussed in detail the RAPID model of psychological first aid which is culture fair and effective. It provides detailed steps of following the process. The importance of self-care for the first responders is highlighted. It is a helpful and a readily available tool for immediate care of the survivors.
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