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The Importance of Psychological First Aid in India

 “Trauma creates change you don’t choose. Healing creates change you do choose”
– Michelle Rosenthal

Disasters and crises seem to be an inevitable part of the world we live in today. Some or the other part of our planet is constantly facing large-scale and small-scale crisis. India has been no different and has been frequently witnessing natural disasters such as earthquakes, flash floods, landslides,tsunamis, cyclones as well as terrorist attacks in various parts of the nation.The Global Climate Risk Index Report 2019 lists India as the 14th most vulnerable country in the world in relation to weather related events(Eckstein, D., Hutfils, M. L., &Winges, M., 2018). Such disastrous and traumatic events often resultin displacement of people and communities,carrying with them tremendous emotional, social and physical consequences. Such traumatic events leave people with grief, a sense of shock anda fear of the unknown future.Trauma can also result from being kidnapped, taken hostage, terrorist attacks, being tortured, accidents, domestic violence or being diagnosed with a life-threatening illness. Most of us have at some point or the other noticed a friend, family member, or co-worker in psychological distress and has wanted to offer support in order to ease their pain. Such attempts are sometimes successful and other times they are not despite our best efforts,making it worse. Traumatic events bring with them inevitablemental health issuessuch as reduced quality of life, depression, increased risk of suicidal attempts, adjustment disorders, anxiety disorders and susceptibility to medical illnesses. Although ensuring physical safety is of utmostimportance, it is also imperative to provide psychological aid in the wake of a traumatic event.The American Journal of Psychiatry states the importance of an early intervention approach by providing empathetic and practical psychological support shortly after a traumatic event based on an assessment of need(Bisson, Brayne, Ochberg, & Everly, 2007).

Psychological First Aid can be defined as “a supportive and compassionate presence designed to do three things: 1) stabilize (prevent the stress from worsening) 2) mitigate (de-escalate and dampen) acute distress and 3) facilitate access to continued supportive care, if necessary” (Everly, G.S., 2018).The American Red Cross has been pivotal in leading the way by providing disaster mental health services and behavioural health services in the wake of the disastrous Hurricane Katrina in 2005(American Red Cross, (2015). The techniques and method used in Psychological First Aid can be learned and carried out by anyone who comes in contact with someone affected by trauma and is not limited to mental health professionals. It is slowly gaining popularity and spreading across borders. Every individual’s reaction to trauma is different hence, it is vital to address them accordingly. No two interventions are the same as no two people are the same. However, one can keep a basic outline of the Psychological First Aid in mind with the following steps to ensure survivors cope better:

1.      Listen reflectively – To begin with, try and find a quite place to talk with minimized distractions.  Also be sure to maintain a distance depending on gender and culture. Listening reflectively is one of the most important aspects of Psychological First Aid.It includes being empathetic and establishing a body language wherein the person feels comforted and heard. Things like leaning into the chair, tapping on the table or playing with a pen while having a conversation shows disinterest on the part of the listener. One needs to be mindful in the aspect of not being impatient but be fully present in the moment with the focus on what the survivor is sharing. Listening reflectively also includes paraphrasing. An example would be if the survivor says, “My life is over”, it can be paraphrased by saying, “So you think that there’s not enough in this life for you to be motivated anymore?” Remember that paraphrasing brings a sense of acknowledgement.

2.      Normalize the situation – Normalizing the situation implies making the affected person aware that it’s okay to be responding in the way they are. The feelings that they are going through right now are normal to feel. This is important because until the need of mental health service is normalized, people are most likely to be skeptical and scared. Acknowledge the person’s strength and how they have managed to help themselves through one of their most difficult times.

3.      Segregate – This is the part where one has toassess and identify the severity of the situation. It is the ability to observe the impact an event has had on a person.  This determines the level of help that is required for the person. There will always be three categories of people:

Category 1- These are the positive and motivated ones. They are dealing well and are able to do the activities of their daily living.

Category 2- These are the mild and benign ones and need moderate help. This is the group where one can help as a first responder.They may be experiencing temporary confusion, inability to concentrate or frustration. These are some symptoms one can expect and also expect them to fade with time.Primarily, they are the ones who need someone to just listen to them and make them feel validated. It is important that they feel heard and acknowledged.They may have some adjustment difficulty in the beginning but will sustain or quickly regain functional capacities with a little help.They are the people one would need to identify, assess, and monitor further until they get better. In cases where the symptoms are persistent or growing with time without any relief, it is advisable to re-categorize them into the next group.

Category 3- This groupincludes people with severe conditions.They may experience lasting effects or various dysfunctions. They may exhibit anxiety symptoms, such as sweating profoundly or nauseous, show impatience or seem disconnected with reality. Identify if there are any major changes in their daily routine, such as sleeping or eating habits. Not being able to enjoy things as they generally would earlier is also an indicator. Other things to be taken into consideration are their mood in general and social interaction. All these are to be included and assessed for any abnormality. If identified, they are to be referred to a health professional. These are the ones most in need of help and have to be motivated and directed towards professional help.

According to the World Health Organization, people from all sections of the society are being trained in Psychological First Aid such as NGOs and government staff in Sri Lanka, psychiatrists, psychologists and emergency staff in Sudan, UNHCR protection officers in Iraq, national defense force, police, embassy staff in Japan, psychosocial support staff of local agencies in Europe to name a few(World Health Organization, Psychological First Aid For All, 2016).

There is an incessant need right now in providing helping hands to people struggling with mental health due to various trauma in India. This need can be addressed by training people in psychological first aid to better equip them in dealing with anyone who has faced a traumatic situation as it will prove to be a significant act in prevention transition to severe mental illness.

Written by:
Kavita Kashyap
Intern, Brain Behaviour Research Foundationof India

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