Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
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Psychological First Aid: Supporting people affected by disaster in Australia © Australian Red Cross Third edition published by: Australian Red Cross 2020 155 Pelham St, Carlton, Victoria 3053 and Australian Psychological Society Level 11, 257 Collins St, Melbourne, Victoria 3000 Photography copyright: All images are referenced within and remain the property of the Australian Red Cross, stated photographer, or other parties as noted. Within this resource, the term ‘emergency’ is used and can apply to any form of emergency incident or disaster. Where the term ‘disaster’ is used, this is interchangeable to ‘emergency’ and connotations of one term over the other should not be made. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form, or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written consent of the publisher. Cover image: ©Australian Red Cross
Contents Foreword 4 Psychological first aid for children 30 Additional guidance for supporting children 32 Psychosocial reactions to crisis situations 8 Common reactions 10 Psychological first aid for people with physical or Complex reactions 12 mental health conditions or intellectual disabilities 34 Understanding psychological first aid 14 Self care for people working in the field 38 What is psychological first aid? 15 Reducing stress 39 What psychological first aid isn’t 16 Look, Listen, Link for self care 40 The aim of psychological first aid 17 Supporting your colleagues 41 Five elements of psychosocial support 18 Useful organisations 42 Providing psychological first aid 22 References and resources 44 Who benefits from psychological first aid? 23 Who delivers psychological first aid? 24 Acknowledgments 48 Where is psychological first aid given? 25 End Notes 50 When do you provide psychological first aid? 25 Psychological first aid action principles 26 Fundamental Principles 52 Preparing to provide psychological first aid in the field 28 2 3
Foreword This psychological first aid guide is This guide sets out to simply outline After an emergency, people can lose It has been recognised both in Australia for people working in disaster how psychological first aid can be confidence in the norms, networks, and and internationally that psychosocial preparedness, response and recovery. operationalised in Australia. The guide is trust in the society that is supposed to support in emergencies is best delivered It provides an overview of best also used in conjunction with psychological protect them.1 Until the late 1970s, the as a community-based activity.1 Providing first aid training delivered by Australian psychosocial aspect of emergencies was coordinated psychosocial support in practice approaches to psychological Red Cross. often ignored. Emergency management emergencies has now become a critical first aid following disasters and activities focused more on the rebuilding part of preparing for, responding to and traumatic events. Emergency is the generic term used in of towns damaged by floods, fire or recovering from an emergency. Australia to describe disruptive and/ storms and healing the physical wounds of In Australia, each state and territory or destructive events that cause loss of This guide is in line with the those injured. has plans to deal with the health life, property and livelihoods, injury and following resources: impacts of disasters. Included in these damage to communities. For the individual Disaster mental health and the A Guide to Psychological First Aid plans are arrangements that cover the this may mean the loss of: identification of post-traumatic stress (International Federation of Red Cross mental health impacts of emergencies. disorder led to a shift in approaches to Red Crescent Societies, 2018) and • Loved ones or significant others emergency management. Responses during Psychological first aid: Guide for field • Control over one’s own life and future this period focused on applying clinical workers (World Health Organization, War • Hope and initiative mental health skills in emergency settings, Trauma Foundation and World Vision • Dignity for which they were never intended. International, 2011). • Social infrastructure and institutions It was then recognised that most people • Access to services did not develop serious mental health • Property and belongings issues after emergencies. Most people recover well with some basic support. This • Livelihoods led to the development of psychological • The natural environment, important first aid as a primary tool for supporting cultural sites and other places of people after an emergency. significance. 4 5
Psychosocial reactions to crisis situations People may experience strong These may include situations such as: emotional and physical distress • Personal crises reactions when faced with situations • Social challenges that result in death, or serious injury • Health challenges to themselves or others. Feelings of intense fear and thinking one may • Disasters caused by natural hazards die or be seriously injured can also • Human caused disasters cause intense feelings of distress. • Violence These situations can be either directly • Armed conflict experienced or witnessed. The loss • Forced migration.2 of treasured belongings, community Community-level crisis situations, such icons and connections to place also can as disasters, armed conflict and forced cause psychosocial distress. migration have far-reaching and varied impacts on people and the communities There are many different situations they belong to, geographic or otherwise. that may cause people to experience The impacts of disasters affect all aspects suffering and distress. of wellbeing, degrade quality of life and undermine the social connectivity of communities.3 8 9
Common reactions Remember:5 How people react to difficult experiences • People do not all react at the same time depends on the nature of the experience, or in the same way to a crisis their resilience, their age and personality, their support system and usual coping • Not everyone needs or wants support methods, how much time has passed • Witnesses to a frightening event may since the time of the event, and previous also be strongly affected and need experiences. support However, there are some common • Some people are calm and do not react emotional and physical distress reactions strongly at the time of an event, but Australian Red Cross that can be expected immediately during have strong reactions later and in the days, weeks, months or years • Some people have strong reactions, and after a crisis event.4 These include, but are can manage their situation on their own, not limited to: or have support from other sources. • Feelings of guilt, sadness, relief, anger, fear, anxiety, confusion, uncertainty, Stress hopelessness Stress is a state of pressure or strain that • Feeling numb, increased heartbeat, takes place in many different situations. sweating, shaking, trembling or It can be caused by any change – positive Distress shortness of breath or negative. Stress is an ordinary part of This is when someone is unable to cope everyday life. It is positive when it makes • Difficulty making decisions and with or adapt to the challenges or situation a person perform well, for example, in a comprehending complex information they are facing. Distress leads to physical test or exam. However, stress can also be • Difficulty communicating clearly with and emotional discomfort and suffering. It negative and lead to distress and crisis.6 others can be caused by a one-off crisis event or from stress building up over time.7 • Feelings of helplessness or powerlessness • Feeling overwhelmed. 10 11
Complex reactions8 Prolonged grief is when someone finds Certain factors can increase the risk of it hard to accept and adapt to the loss of developing complex reactions. For example Complex reactions are more serious than someone they loved. The grief then affects if the person: common reactions to distress. A person how the person lives from day to day and with complex reactions often needs referral • Was separated from their family how they relate to other people. It is not for specialised help or other assistance. an immediate reaction. It develops over a • Thought they were going to die Examples of complex reactions are: period of time. It can also lead to extreme • Was involved in a situation where the feelings of distress when the person horror element was high Panic attacks and feelings of experiences new challenges or is somehow • Has had previous traumatic experiences overwhelming anxiety can produce a faster reminded of their grief. • Lost loved ones heartbeat, shortness of breath, and pain in the chest. A person may sweat more than Sleeping problems are very common after • Has an underlying psychological normal, feel dizzy or light-headed and feel crises. Many people find it difficult to fall disorder. like they want to be sick. asleep or experience nightmares. Some people sleep more than usual and find it Anger and aggressive behaviour are hard to wake up. If sleeping problems go familiar reactions to crisis in situations of Feelings of anxiety and anger are common on for many days and nights, it can lead violence, or when people have experienced reactions to crisis. However, some people to physical and psychological problems. immense losses. may experience intense or prolonged Severe sleeping problems interfere with Self-harm and suicide. Self-harm is when a daily living, moods and relationships with feelings that do not resolve as expected. person hurts himself or herself on purpose, other people, and seeking support can These people may benefit from more for example, by cutting or burning their be helpful. specialised support. skin and flesh. Suicide is when someone Flashbacks are when a person feels as if intentionally takes his or her own life. they are back in the moment of the original It is important to always take someone stressful event. Flashbacks often feel real who threatens to harm or kill themselves and can be confusing and frightening. They seriously and not leave the person alone can be a normal reaction to abnormal until more help arrives. experiences. However, the person may still Harmful coping methods include self- need help to manage them. medicating with drugs or alcohol, becoming violent or aggressive, withdrawing or keeping oneself completely apart from other people. 12 13
Understanding psychological first aid What is psychological first aid? stressful experience.11 Psychological first aid can be a useful support activity at these Psychological first aid is a psychosocial times as well, many of which may take support activity that helps people place years after the event. affected by an emergency, disaster Psychological first aid is based on an or traumatic event. It is a ‘humane, understanding that people affected by supportive response to a fellow human disasters will experience a range of early being who is suffering and who may reactions (physical, psychological, emotional need support’.9 and behavioural). These reactions may interfere with their ability to cope.12 These It includes basic principles of psychosocial reactions are normal and understandable support to promote natural recovery. given people’s experiences. Recovery may This involves helping people feel safe, be helped by psychological first aid. connected to others, calm and hopeful, and ensuring access to physical, emotional A small part of an affected population and social support.10 Psychological first will have more complex reactions and will aid aims to reduce initial distress, meet require further mental health support to current needs, promote flexible coping and assist recovery. But most people recover encourage adjustment. well on their own or with the support of compassionate and caring disaster workers, Psychological first aid is useful as the first family and friends. thing that you might do with individuals or families following a disaster. It is most Psychological first aid has a long history.13 widely used in the first hours, days and It has become more popular since weeks following an event. However, there the emergence of research showing can be situations months or years after an the dangers of critical incident stress event that trigger strong stress reactions, debriefing.14 Since 2002, psychological first such as anniversaries of the event or aid has been recommended as a key part experiencing or witnessing something of the provision of psychosocial support similar which reminds someone of the following disasters. 14 15
The aim of psychological • Facilitate people’s social support first aid • Help people understand the disaster and its context Psychological first aid is fundamentally about providing humane and • Help people identify their own strengths Australian Red Cross compassionate care. It addresses emotional and abilities to cope and practical needs and concerns above all • Foster belief in people’s ability to cope else. • Give hope An important aim of psychological first aid • Assist with early screening for people is to build people’s capacity to recover. needing further or specialised help Psychological first aid supports recovery by • Promote adaptive functioning helping people to identify their immediate • Get people through the first period of What psychological first aid isn’t It is important to limit contact at this point needs and their strengths and abilities to high intensity and uncertainty to simple support, like psychological first meet these needs. It is important to clarify what psychological • Set people up to be able to recover aid. People who display marked signs One of the most important research naturally from an event first aid is not to differentiate it from of risk (e.g. suicidal ideation) should be earlier forms of post-disaster support, most findings is that a person’s belief in their • Reduce the risk factors of mental illness referred to formal mental health services. ability to cope can predict their outcome. notably critical-incident stress debriefing. such as posttraumatic stress disorder as Psychological first aid is: Typically people who do better after a result of the event. It is not useful – and may be harmful – to trauma are those who are optimistic, directly encourage disaster survivors to talk • NOT debriefing positive and feel confident that life and about what happened to them if they do • NOT obtaining details of traumatic self are predictable, or who display other not want to. If a person wants to discuss experiences and losses hopeful beliefs.16 their experiences, it is useful to provide • NOT treating them with support. But this should only be The goals of psychological first aid include • NOT labelling or diagnosing efforts to: in a way that does not push them to discuss more than they want.15 • NOT counselling • Calm people • NOT something that only professionals • Reduce distress Post-emergency settings are not clinical can do environments and it is inappropriate • Make people feel safe and secure to conduct a clinical or psychological • NOT something that everybody who • Identify and assist with current needs assessment within the setting. has been affected by an emergency will need. • Establish human connection 16 17
Five elements of 1. Ensuring safety psychosocial support People’s experience of negative psychological reactions following disasters There are five basic elements to or mass violence will continue while they psychosocial support that have been drawn are under threat, in danger or perceive a from research on risk and resilience, field threat to themselves or loved ones. Studies experience and expert agreement.17 These have shown this to be the case across elements underpin the psychological cultures. When safety is reintroduced first aid approach. When providing negative reactions have been shown to psychological first aid people should keep gradually reduce over time. Ensuring safety these principles in mind. may include: The elements of psychosocial support are: • Removing people from, or reducing their • Ensuring safety exposure to, the threat of harm • Promoting calm • Helping people meet basic needs for • Promoting connectedness food, water, shelter, financial and material assistance • Promoting self-efficacy and group efficacy • Helping people obtain emergency medical attention • Instilling hope. • Providing physical and emotional comfort • Providing repeated, simple and accurate information, through a range of methods, on how to get these basic needs met. 2. Promoting calm Some anxiety, distress and negative psychological reactions are normal and are healthy responses following a traumatic event. Most people will return Australian Red Cross to manageable levels of emotions within 18 19
days or weeks. However, ongoing negative 3. Promoting connectedness 4. Promoting self-efficacy symptoms may lead to the development Following crises, having access to social Having a sense of control over positive Self-efficacy is the belief that one’s actions of longer term mental health disorders. It support activities and networks increases outcomes in one’s life is generally are likely to lead to positive outcomes, is important to normalise stress reactions. opportunities for emotional understanding, psychologically beneficial. Following crises and feeling able to help oneself. Other ways of promoting calm may include: knowledge to be shared, to normalise people may feel as though they lack the • Stabilising people who are overwhelmed reactions, and solve problems. Research competency to handle tasks ahead. Most or disoriented across cultures has found that social survivors of disasters and mass violence support is related to better emotional had the capacity to cope with and manage • Providing an environment, as far as wellbeing and recovery following mass day-to-day problems prior to the crisis. practical, removed from stressful trauma. Re-establishing connections with In the aftermath, it is not so much about situations or exposure to sights, sounds loved ones and fostering social connections building self-efficacy but reminding people and smells of the emergency as quickly as possible in the aftermath of their efficacy. Promoting self-efficacy • Listening to people who wish to share of crisis is critical to recovery. Promoting may include: their stories and emotions, without connectedness may include: forcing them to talk • Engaging people in meeting their own • Helping people contact friends and needs • Remembering that there is no right or loved ones • Assisting with decision making, and wrong way to feel • Keeping families together helping them to prioritise problems and • Being friendly and compassionate even • Keeping children with parents or carers solve them. during difficult interactions with people • Offering accurate information about the • Helping establish contacts with support 5. Instilling hope disaster or trauma and the relief efforts people (friends, family or community) Those who remain optimistic in times underway to help survivors understand • Offering practical help to people to of crisis are more likely to experience the situation address immediate needs and concerns favourable outcomes following trauma. • Providing information on stress and • Providing information and directing This is because people can retain a coping people to those services that are reasonable degree of hope for their future. • Reminding people when they express available Instilling hope may include: fear or worry, that more help and • Linking people with available services • Conveying an expectancy that people services are on the way (if you know). • Respecting cultural norms regarding will recover gender, age, family structures and • Being there/being willing to help religion. • Reassuring people that their feelings are normal. 20 21
Providing psychological first aid Who benefits from psychological • Were exposed to events where the first aid? horror element was high • Thought they were going to die The sudden, disruptive nature of • Have experienced traumatic emergencies means that people will bereavement be exposed to uncertainty and stress. • Have had serious losses of property, People will experience different livelihoods, or disruption to degrees of distress. Any person communities and networks. in distress should have access to There will also be some complex situations psychological first aid, where possible. where people have an immediate need This includes adults, adolescents and for more care than can be provided by children, as well as disaster relief and psychological first aid. These people need recovery workers and first responders. to be promptly referred to specialised support. This includes people who are: How people respond and cope depends on a variety of factors, including their • Seriously injured and needing experience of the emergency, their health, emergency medical care their personal history and their available • People who have suffered sexual and supports. gender-based violence Some people may have more complex • So distressed that they are unable to reactions and may be more at risk of perform the basic activities of daily life negative consequences than others. These • Threatening harm to themselves may include those people who: or others. • Have had previous traumatic • Children experiencing child abuse/ experiences neglect. • Have underlying mental illnesses 22 23
It is important to remember that not In Australia, this coordinated response It is useful to differentiate between general When do you provide psychological everyone who experiences an emergency could include: health and allied health psychological support and the way all first aid? will have emotional distress or problems professionals, teachers and other emergency responders provide help in during or after the crisis. Not everyone who education professionals, members of the responsible ways. Responsible helping Psychological first aid can help at different experiences a crisis will need psychological clergy and other faith-based organisations, respects the dignity and capacity of times after a crisis event. Most people need first aid. Some protective factors include:18 Red Cross psychosocial support volunteers, survivors. The primary role of psychological psychological first aid during or shortly other trained responders from community first aid is to protect and promote the after a crisis. Others may feel distress much • Good level of functioning later: weeks, months or even years after organisations, and local government staff. mental health and psychosocial wellbeing • Social support of survivors. an event. New challenges or reminders The principles of psychological first aid of the crisis, such as anniversaries of the • Ability to cope mean that support can be offered by a date, may set off memories and lead to • Strong moral belief systems wide variety of people in the community – Where is psychological first distress.21 • Returning to normal life from emergency personnel to neighbours aid given? • Reducing disruption. and volunteers – in addition to trained Psychological first aid can be delivered in responders. diverse settings. Psychological first aid can Some people will need much more support than psychological first aid. It is important Psychological first aid is a humane, be delivered at the scene of the emergency that helpers know their limits and ask for supportive and practical response to a or at places where affected people gather, help from others who can provide medical person who has been exposed to serious such as: or other assistance when required. stresses and may need support.19 Most • Evacuation / relief centres people responding to an emergency are • Recovery centres Who delivers psychological able to provide this type of assistance, comfort and support to people in distress.20 • Hospitals first aid? • Humanitarian assistance centres The principles of psychological first aid are Anyone can provide support to people in • Homes an important grounding for all emergency distress. However, in large scale disasters personnel responding to an emergency. • Schools psychological first aid should be delivered Their primary focus will be on responding • Businesses by appropriate agencies as part of to the emergency. But these people are coordinated response mechanisms. • Shopping centres usually the first contact survivors have with This means that responses can be the ‘system’. So they have an important role • Airports undertaken in a coordinated manner and to play in assisting in helping to promote • Train stations that psychosocial support is provided as recovery in safe and effective ways. • Memorial services a key part of the emergency response. • Community centres. 24 25
Psychological first aid action principles22 LOOK LISTEN LINK LOOK refers to the safety of helpers and LISTEN refers to the way that helpers LINK has practical outcomes in terms of When providing psychological first aid, the identifying and prioritising who may be communicate with people in distress from the helper giving information and helping actions helpers take will depend on the most in need of support.25 the moment they approach and start to people attend to basic needs and access situation and needs of the people being interact with them.27 the resources they need to cope with their assisted. There are three basic sets of To do this, PFA helpers need to gather situation. actions – LOOK, LISTEN, and LINK – that information on what has happened and To do this, PFA helpers must consider guide the psychological first aid approach. what is happening, and assess.26 how they:28 To do this, helpers support people to:29 These action principles provide guidance • Who needs help • Approach someone • Access information for how to view and safely enter an • Safety and security risks • Introduce oneself • Connect with loved ones and social emergency situation and determine • Physical injuries • Pay attention and listen actively support who requires assistance (LOOK) in order • Tackle practical problems to understand the needs of affected • Immediate basic and practical needs • Accept others’ feelings people (LISTEN) and link them with the • Emotional reactions. • Calm the person in distress • Access services and other help. information and practical support they • Ask about needs and concerns need (LINK).23 • Help the person(s) in distress find It is important to note that in reality solutions to their immediate needs and helpers may have to go through these problems. actions in different ways and sequences.24 For example, helpers may have to repeat actions from ‘Look’ or ‘Listen’ several times. It depends on the situation and needs of the affected persons. 26 27
Important questions to ask before entering an emergency site: About the emergency event About safety and security concerns • What happened? • Is the crisis event over or continuing, • When and where did it take place? such as aftershocks from an earthquake, or an unfolding flood event or high • How many people are likely to be bushfire danger period? affected and who are they? • What dangers may be in the Australian Red Cross • How long did it go on for/will go on for? environment, such as debris or damaged About available services and supports infrastructure? • Who are the relevant authorities • Are there areas to avoid entering managing the crisis? because they are not secure (for example, obvious physical dangers) • Who is providing for basic needs or because you are not allowed to like emergency first aid, food, water, be there? material assistance, shelter? Preparing to provide psychological Prior to providing psychological first aid in the field helpers should: • Where and how can people access About your own physical and mental first aid in the field30 these services? preparedness Many emergency situations can be stressful • Learn about the crisis event • Who else is helping? Are community • Do you have everything you might need and often require urgent action. The more • Learn about available services and members involved in responding? to be away from home/office (phone, that people responding to the disaster supports • Is the Register.Find.Reunite. service charger, drink bottle, etc)? know about the situation, and the better • Learn about safety, access and security active to help families reunite? • Have you let family members/friends prepared each person is psychologically, concerns the more effective the support will be. know what you are doing and how • Consider their physical and mental long for? preparedness. • Have you made arrangements for children, people you are caring for and pets? • Do you feel emotionally ready to provide psychological first aid? 28 29
Psychological first aid for children Psychological first aid for children ‘LISTEN’ with additional considerations follows the same action principles as and steps for supporting children: for adults. However, there are some • Approach the child and introduce key differences between helping adults yourself and children, and some additional • Do not instigate touch actions may be required.31 • Calm the child It is hard to focus on taking care of one’s • Pay attention and listen actively children during a crisis, if parents and • Accept and validate the child’s reactions other caregivers are also in distress and and feelings feel overwhelmed. Psychological first aid • Ask about needs and concerns with for children includes helping parents and age-appropriate questions caregivers, so that they can cope better and be able to support their children. • Help the child find solutions to their immediate needs and problems. Look, Listen, Link for ‘LINK’ with additional considerations and supporting children steps for supporting children: ‘LOOK’ with additional considerations • Assess the child’s needs, with the child, and steps for supporting children: if possible • Help the child access protection and • Information on what has happened services for basic needs • Safety and security risks • Give age-appropriate information • Who the child is with or whether • If alone, connect the child with loved the child is alone ones and, if needed, child protection • Physical injuries services. • Immediate basic, practical and protection needs • Emotional reactions. 30 31
Additional guidance for Keep safe supporting children • Protect children from being exposed to any potentially distressing scenes, like • Keep together with loved ones injured people or terrible destruction • When unaccompanied, link children • Protect children from hearing upsetting with a trustworthy child protection stories about the event network or agency. Do not leave the child unattended • Protect children from the media or from people who want to interview them who • Do not allow offers of help with looking are not part of the emergency response. after children from unauthorised strangers Listen, talk and play • Report child protection concerns to child • Listen to children’s views on their protection authorities or, if not available, situation the police • Try to talk with them on their eye level, • Report child protection concerns and use words and explanations they through government organisations chid can understand safeguarding protocols. • Support the caregivers in taking care of their own children • If passing time with children, try to involve them in play activities or simple conversation about their interests, according to their age. Australian Red Cross 32 33
Psychological first aid for people with physical or mental health conditions or intellectual disabilities The following points are important attendant or sign-language interpreter when assisting people who may who may also be present. For example have physical and/or mental health do not say “tell her...” or “can he...” conditions or intellectual disabilities. • Use ‘Person-First’ language in regards to disability. This means to put the • Help people get to a safe space person first rather than the disability • Ask people if they have any health they may have. For example, “John has conditions, or if they regularly take an intellectual disability”, not “John is medication for a health problem disabled.” • Try to help people get their medication • Never speak about the person as if or access medical services, when they are invisible, cannot understand available what is being said or cannot speak • Stay with the person or try to make for themselves. If a person requires sure they have someone to help them if an interpreter or carer to assist them you need to leave. Consider linking the in conversation, make sure there is person with relevant support to assist enough time for the person to absorb them in the longer term32 information and respond on their own • People with a disability, particularly • Disability can be obvious (e.g. walker/ a cognitive disability, may rely upon wheelchair) or invisible (e.g. sight rigid routines in their lives. Disruption impairment/ intellectual disability). to these routines may make them Don’t make assumptions about the highly anxious person’s capacity, instead let the person with the disability direct you • Face and speak directly to the person with regard to volume and speed of rather than through the companion, communication 34 35
• Allow for short breaks if a person needs extra time to process information • Offer several different options for further contact. Some people may feel more comfortable with face to face interaction while others may prefer the telephone or email.33 Remember that people are resilient. With appropriate levels of support when needed all people have the ability to cope. Help people use familiar coping strategies and supports. Australian Red Cross 36 37
Self care for people working in the field Supporting people following an Reducing stress emergency can be very rewarding Stress will not resolve spontaneously. for those involved in the emergency People need to take steps to break the response. However, it can also be cycle of stress. It is important to identify very challenging and stressful. It is what causes stress for you and put in place not uncommon for disaster workers some steps to reduce stress. This sort of to feel stressed, distressed, tired, self care is especially important if we wish overwhelmed, troubled, or frustrated to support others during times of crisis.35 in the course of their work. • Think about what has helped you cope in the past and what you can do to stay Stress is the body’s way of getting energy strong to operate outside our normal comfort zone. Stress is caused by stressors, these • Try to take time to eat, rest and relax, can be internal, such as thoughts or even for short periods feelings or external, such as poor health, • Try to keep reasonable working hours conflict, noise etc. If it is not possible so you do not become too exhausted to relax between demands, or there is • Consider, for example, dividing the not enough time to unwind between workload among helpers, working in the problems, the stress builds up. It is shifts during the acute phase of the not the actual difficulty of the task that crisis and taking regular rest periods causes chronic stress; it may be the sheer • People may have many problems after a quantity or continuity of work.34 crisis event. You may feel inadequate or frustrated when you cannot help people with all of their problems. Remember that you are not responsible for solving 38 39
all of people’s problems. Do what you and volunteers’ working conditions and reach out for support from others, for can to help people help themselves organisational issues, as well as to personal example, through peer support or by distress in seeing the impact of a crisis on contacting your team leader or manager. • Minimise your intake of alcohol, caffeine affected populations. You might need to begin activities that will or nicotine and avoid non-prescription help you feel better as part of a self care drugs Questions to consider: plan such as taking walks, spending more • Check in with fellow helpers to see how • Are there physical, emotional, mental, time with your friends, or taking a regular they are doing, and have them check spiritual or behavioural signs that may break from work, etc. in with you. Find ways to support each be a cause for concern? other Supporting your colleagues • Have you noticed changes or new signs • Talk with friends, loved ones or other within yourself which could indicate a Just as you can use ‘Look, Listen, Link’ people you trust for support. concern? to help you with your own self care you • Are certain symptoms not going away? can use psychological first aid to support Look, Listen, Link for self care36 your colleagues. The next step is in LISTENing to how these When providing psychological first aid to reactions are impacting how you feel about This could include: others, the principles ‘Look, Listen, Link’ your work. It is like listening to an inner • Using the PFA Action Principles (Look, can help you recognise risk factors in voice. Listen, Link) to support a colleague who relation to your own wellbeing, what your Are you having thoughts similar to: is distressed personal limitations are, and what kinds of situations may be overwhelming or • Keeping an eye on a colleague for signs • “I am too busy to take a break” of stress particularly stressful for you. This can help • “This was too difficult for me. I don’t • Listening to a colleague if they need to you to build awareness of your strengths really know what I’m meant to be talk and weaknesses as a helper, and know doing” when to call for help from others. • Helping a colleague to feel calm after a • “I don’t think I’m the right person to distressing experience The first step you can take in self care be here” is in observing, or LOOKing at, your • Helping restore someone’s confidence if • “I’m not coping as well as everyone else” they are feeling useless own reactions to the circumstances you are facing in responding to crisis LINKing with others or engaging in • Referring a colleague for further support situations. From experience we know that activities is the vital third step in helping or assistance. reactions are commonly related to staff you care for yourself. You may want to 40 41
Useful organisations Australian Child & Adolescent Trauma, Loss & International Federation of Red Cross and Grief Network (ACATLGN) Red Crescent Societies Reference Centre for www.earlytraumagrief.anu.edu.au Psychosocial Support www.pscentre.org Australian Institute for Disaster Resilience www.aidr.org.au National Center for PTSD www.ptsd.va.gov Australian Psychological Society (APS) www.psychology.org.au National Child Traumatic Stress Network (NCTSN) Australian Red Cross www.nctsn.org www.redcross.org.au National Institute of Mental Health (NIMH) beyondblue www.nimh.nih.gov www.beyondblue.org.au Phoenix Australia – Centre for Posttraumatic Department of Human Services (DHS), State Mental Health Government of Victoria www.phoenixaustralia.org/ www.dhs.vic.gov.au/emergency Sphere Standards Humanitarian Charter Emerging Minds and Minimum Standards in Humanitarian www.emergingminds.com.au Response Inter-Agency Standing Committee (IASC) www.spherestandards.org www.interagencystandingcommittee.org Substance Abuse and Mental Health Services International Committee of the Red Cross Administration (SAMHSA) (ICRC) www.samhsa.gov www.icrc.org World Health Organization (WHO) International Federation of Red Cross and www.who.int Red Crescent Societies www.ifrc.org Australian Red Cross 42 43
References and resources ACPMH 2009, Community Recovery Following Hobfoll, SE, Watson, P, Bell, CC, Bryant, RA, immune function after Hurricane Andrew’, Raphael, B 1977b, ‘The Granville train Disaster: Training for Community Support Brymer, MJ, Friedman, MJ et al. 2007, ‘Five Psychosomatic Medicine, vol. 59, pp. 128–41. disaster: Psychological needs and their People – Workshop Guide and Resource, essential elements of immediate and mid- management’, Medical Journal of Australia, Jacobs, G 2010, Roundtable discussion Australian Centre for Posttraumatic Mental term mass trauma intervention: Empirical vol. 1, pp. 303–5. between Professor Jerry Jacobs and various Health & beyondblue, Melbourne, Australia. evidence’, Psychiatry, vol. 70, pp. 283–315. Australian emergency management experts, Raphael, B 1986, When Disaster Strikes – Australian Institute for Disaster Resilience, Inter-Agency Standing Committee (IASC) 19 July 2010, Australian Psychological Society, How Individuals and Communities Cope with 2018. Community Recovery Handbook 2. 2007, IASC Guidelines on Mental Health and Melbourne, Australia. Catastrophe, Basic Books, New York, USA. Bisson, JI, Brayne, M, Ochberg, FM & Everly, Psychosocial Support in Emergency Settings, Johns Hopkins Bloomberg School of Public Raphael, B, Stevens, G & Taylor, M 2009, GS 2007, ‘Early psychological intervention IASC, Geneva, Switzerland. Health & International Federation of Red Disaster Response and Resilience Research following traumatic events’, American Journal International Federation of Red Cross and Red Cross and Red Crescent Societies 2008, Group, University of Western Sydney, of Psychiatry, vol. 164, pp. 1016–19. Crescent Societies 2019, A Short Introduction Public Health Guide in Emergencies, 2nd edn, Australia. Bisson, JI & Lewis, C 2009, Systematic Review to Psychological First Aid for Red Cross and Geneva, Switzerland. Rose, S, Bisson, J & Wessley, S 2003, ‘A of Psychological First Aid, commissioned by Red Crescent Societies, IFRC Reference Centre ‘Does early psychological intervention systematic review of single psychological the World Health Organization. for Psychosocial Support, Copenhagen. promote recovery from posttraumatic stress?’, interventions (‘debriefing’) following Brymer, M, Jacobs, A, Layne, C, Pynoos, R, International Federation of Red Cross and Psychological Science in the Public Interest, trauma – Updating the Cochrane review and Ruzek, J, Steinberg, A, Vernberg, E & Watson, Red Crescent Societies 2018, A Guide to vol. 4, pp. 45–79. implications for good practice’, in RJ Orner P 2006, Psychological First Aid – Field Psychological First Aid for Red Cross and Red & U Schnyder (eds) Reconstructing Early National Institute of Mental Health 2002, Operations Guide, 2nd edn, National Child Crescent Societies, IFRC Reference Centre for Intervention after Trauma Innovations in the Mental Health and Mass Violence – Evidence- Traumatic Stress Network & National Center Psychosocial Support, Copenhagen. Care of Survivors, pp. 24–9, Oxford University based early Psychological Intervention for for PTSD, USA. Press, Oxford, UK. International Federation of Red Cross and Victims/Survivors of Mass Violence, NIMH Carver, C 1999, ‘Resilience and thriving: Red Crescent Societies 2009, Psychosocial publication No. 02-5138, US Government Ruzek, JI, Brymer, MJ, Jacobs, AK, Layne, Issues, models and linkages’, Journal of Social Handbook, IFRC Reference Centre for Printing Office, Washington DC, USA. CM, Vernberg, EM & Watson, PJ 2007, Issues, vol. 54, pp. 245–66. Psychosocial Support, Copenhagen, Denmark. ‘Psychological first aid’, Journal of Mental Queensland Health (2008) Psychological First Health Counseling, vol. 29, pp. 17–49. Drayer, CS, Cameron, DC, Woodward, WD Ironson, G, Wynings, C, Schneiderman, Aid Core Actions Emergency Management & Glass, AJ 1954, ‘Psychological first aid in N, Baum, A, Rodriguez, M, Greenwood, Unit Fact Sheet. Solomon, Z 2003, Coping with War-Induced community disaster’. Journal of American D et al. 1997, ‘Post-traumatic stress Stress – The Gulf War and the Israeli Raphael, B 1977a, ‘Preventive intervention Medical Association, vol. 156, 1, pp. 36–41. symptoms, intrusive, thoughts, loss, and Response, Plenum, New York, USA. with the recently bereaved’ Archives of General Psychiatry, vol. 34, pp. 1450–4. 44 45
Stevens, G & Raphael, B 2008a, CBRN SAFE: World Health Organization, War Trauma Psychosocial Guidance for Emergency Foundation and World Vision International Workers – Chemical, Biological, Radiological (2011). Psychological first aid: Guide for field & Nuclear Incidents, University of Western workers. WHO: Geneva. Sydney, Australia. World Health Organization (WHO) 2010, Stevens, G & Raphael, B 2008b, CBRN SAFE – Helping in Crisis Situations in Low and Middle Incident Pocket Guide, University of Western Income Countries Guide to Psychological First Sydney, Australia. Aid – currently in draft. Substance Abuse and Mental Health Services Wooding, S & Raphael, B 2010. Psychological Administration (SAMHSA) 2007, Psychological First Aid – Level 1 Intervention Following First Aid – A Guide for Emergency and Mass Disaster, University of Western Sydney, Disaster Response Workers, US Department Australia. of Health and Human Services, Washington, Young, B 2006, ‘The immediate response to DC, USA. disaster – Guidelines for adult psychological Substance Abuse and Mental Health Services first aid’, in EC Richie, PJ Watson & MJ Administration (SAMHSA) 2010, Psychological Friedman (eds) Interventions Following Mass First Aid for First Responders – Tips for Violence and Disasters – Strategies for Mental Emergency and Disaster Response Workers Health Practices, pp. 134–54, Gilford Press, (http://store.samhsa.gov). New York, USA. van Ommeran, M, Saxena, S & Saraceno, B 2005, ‘Mental and social health during and after acute emergencies – Emerging consensus?’, Bulletin of the World Health Organization, vol. 83, pp. 71–6. Watson, PJ, Friedman, MJ, Ruzek JI & Norris, FH 2002, ‘Managing acute stress response to major trauma’, Current Psychiatry Reports, vol. 4, pp. 247–53. Australian Red Cross 46 47
Acknowledgments This guide was first produced by the The second edition, released in 2013, The first edition of the guide was informed Dr Bob Montgomery Australian Psychological Society and included updated information on using by participants at the 2009 roundtable Consultant Psychologist, Past President Australian Red Cross in 2011. The first psychological first aid in the field. This and those that have provided subsequent Australian Psychological Society edition was developed following roundtable information was reproduced courtesy of comments, including: Professor Beverley Raphael discussions on 15 December 2009, co-hosted the World Health Organization, War Trauma Professor Richard Bryant University of Western Sydney and the by Australian Red Cross and the Australian Foundation and World Vision International University of New South Wales Australian National University Psychological Society. The roundtable from the document Psychological First Aid: Brigid Clarke Associate Professor Joseph Reser was attended by representatives of both Guide for field Workers. The second edition Victorian Department of Health Griffith University organisations, the National Mental Health supported Psychological First Aid training Disaster Response Taskforce, Australian developed by Australian Red Cross in 2013. Andrew Coghlan Professor Kevin Ronan Centre for Post traumatic Mental Health and The principal authors of the second edition Charmaine O’Brien University of Central Queensland the Victorian Department of Human Services. were Dr Susie Burke (Australian Psychological Sally Paynter Dr Sally Wooding Society), John Richardson and Shona Whitton Australian Red Cross University of Western Sydney The first edition of the guide was based on discussions at the roundtable and material (Australian Red Cross). Professor Mark Creamer Australian Centre for Post Traumatic The second edition was informed by the developed in the United States by the National This third edition, updated in 2019, includes Mental Health work of: Child Traumatic Stress Network (NCTSN) further guidance on using psychological and National Center for Posttraumatic Stress Greg Eustace Alison Schafer first aid in the field. This edition is informed Disorder, the Substance Abuse and Mental Queensland Health World Vision Australia/International by new material from the International Health Services Administration (SAMHSA) Federation of Red Cross and Red Crescent Dr Rob Gordon Mark van Ommeran and the paper ‘Five essential elements of Societies (IFRC) Reference Centre for Consultant Psychologist to Department of World Health Organisation immediate and mid-term mass trauma Psychosocial Support and six years of Human Services Victoria, and Australian Leslie Snider intervention: Empirical evidence’ by Stevan experience providing psychological first aid Red Cross War Trauma Foundation Hobfoll and colleagues in 2007. The principal after crises in Australia. Heather Gridley authors of the first edition were, Dr Susie The third edition was informed by the work The principle authors of the third edition Craig Wallace Burke (Australian Psychological Society) and of IFRC Psychosocial Reference Centre. were Shona Whitton (Independent Consultant Australian Psychological Society John Richardson (Australian Red Cross). for Australian Red Cross) and Dr Lyn O’Grady (Australian Psychological Society). 48 49
End Notes 1 For more information see Inter-Agency 11 International Federation of Red Cross and 21 International Federation of Red Cross 29 International Federation of Red Cross and Standing Committee 2007; International Red Crescent National Societies, 2018, Red Crescent Societies 2019, A Short Red Crescent National Societies, 2018, Federation of Red Cross and Red Crescent A Guide to Psychological First Aid For Red Introduction to Psychological First Aid for A Guide to Psychological First Aid For Red Societies 2009; van Ommeran, Saxena & Cross Red Crescent Societies Red Cross and Red Crescent Societies Cross Red Crescent Societies Saraceno 2005 12 For more information see Brymer et al. 22 World Health Organization, War Trauma 30 World Health Organization, War Trauma 2 International Federation of Red Cross and 2006 Foundation and World Vision International Foundation and World Vision International Red Crescent National Societies, 2018, 13 For more information see Drayer, Cameron, (2011). Psychological first aid: Guide for (2011). Psychological first aid: Guide for A Guide to Psychological First Aid For Red Woodward & Glass 1954, Raphael field workers. WHO: Geneva. field workers. WHO: Geneva Cross Red Crescent Societies 1977a&b and 1986. 23 ibid 31 International Federation of Red Cross and 3 Australian Red Cross, 2015, Emergency 14 For more information see National Institute 24 International Federation of Red Cross and Red Crescent National Societies, 2018, Services training toolkit: Recovery of Mental Health 2002; Rose, Bisson & Red Crescent National Societies, 2018, A Guide to Psychological First Aid For Red 4 International Federation of Red Cross and Wessley 2003; Bisson, Brayne, Ochberg & A Guide to Psychological First Aid For Red Cross Red Crescent Societies Red Crescent National Societies, 2018, Everly 2007; Bisson & Lewis 2009. Cross Red Crescent Societies 32 World Health Organization, War Trauma A Guide to Psychological First Aid For Red 15 For more information see Watson et al. 25 World Health Organization, War Trauma Foundation and World Vision International Cross Red Crescent Societies 2002; Ruzek et al. 2007; McNally, Bryant, & Foundation and World Vision International (2011). Psychological first aid: Guide for 5 International Federation of Red Cross and Ehlers 2003. (2011). Psychological first aid: Guide for field workers. WHO: Geneva. Red Crescent National Societies, 2018, 16 For more information see Carver 1999, field workers. WHO: Geneva. 33 Australian Institute for Disaster Resilience A Guide to Psychological First Aid For Red Ironson et al. 1997, Solomon 2003. 26 International Federation of Red Cross and 2018, Community Recovery Handbook 2 Cross Red Crescent Societies Red Crescent National Societies, 2018, 34 Gordon, R (2005). Information and advice 17 For more information see Hobfoll et 6 International Federation of Red Cross al. 2007, IFRC 2009, SAMHSA 2010, A Guide to Psychological First Aid For Red about stress, trauma and psychological first Red Crescent Societies, 2019, A Short Queensland Health (2008). Cross Red Crescent Societies aid. Introduction to Psychological First Aid for 27 World Health Organization, War Trauma 35 Gordon, R (2005). Information and advice 18 For more information see Johns Hopkins Red Cross and Red Crescent Societies Foundation and World Vision International about stress, trauma and psychological first School of Public Health & International 7 ibid Federation of Red Cross and Red Crescent (2011). Psychological first aid: Guide for aid 8 ibid Societies 2008. field workers. WHO: Geneva. 36 International Federation of Red Cross and 9 The Sphere Project and the Inter Agency 19 For more information see Inter-Agency 28 International Federation of Red Cross and Red Crescent National Societies, 2018, Standing Committee Standing Committee 2007. Red Crescent National Societies, 2018, A Guide to Psychological First Aid For Red A Guide to Psychological First Aid For Red Cross Red Crescent Societies 10 For more information see Hobfoll et al 2007 20 For more information see World Health Cross Red Crescent Societies Organisation 2010. 50 51
Fundamental Principles In all activities, our volunteers, Impartiality Voluntary service members and staff are guided by the It makes no discrimination as to nationality, It is a voluntary relief movement not Fundamental Principles of the Red race, religious beliefs, class or political prompted in any manner by desire for gain. opinions. It endeavours to relieve the Cross and Red Crescent Movement. Unity suffering of individuals, being guided solely by their needs, and to give priority to the There can be only one Red Cross or Red Humanity most urgent cases of distress. Crescent Society in any one country. It The International Red Cross and Red must be open to all. It must carry on its Crescent Movement, born of a desire to Neutrality humanitarian work throughout its territory. bring assistance without discrimination In order to continue to enjoy the confidence to the wounded on the battlefield, of all, the Movement may not take sides Universality endeavours, in its international and in hostilities or engage at any me in The International Red Cross and Red national capacity, to prevent and alleviate controversies of a political, racial, religious Crescent Movement, in which all Societies human suffering wherever it may be or ideological nature. have equal status and share equal found. Its purpose is to protect life and responsibilities and duties in helping each health and ensure respect for the human Independence other, is worldwide. being. It promotes mutual understanding, The Movement is independent. The friendship, co-operation and lasting peace National Societies, while auxiliaries in the amongst all people. humanitarian services of their governments and subject to the laws of their respective countries, must always maintain their autonomy so that they may be able at all times to act in accordance with the principles of the Movement. 52 53
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