Decentralized and Networked Psychological First Aid for Social Resilience
Recently I enjoyed watching the documentary of Apollo 11 at my local movie theater and was really taken with the dynamics of the lunar “sphere of influence,” or gravitational pull of the moon. When Apollo 11 was a certain distance from the moon, the lunar sphere of influence changed the dynamics of its flight.
The concept peaked my curiosity of how a “social sphere of influence” or social pull could help effect change in the number of people in a community willing to have a positive impact during disasters.
What is Psychological First Aid?
Psychological First Aid (PFA) may be simply defined as a supportive and compassionate presence designed to stabilize and mitigate acute distress, as well as facilitate access to continued care.
George Everly and Jeffrey Lating wrote the most used text regarding PFA called “The Johns Hopkins Guide to Psychological First Aid.” At its heart, PFA is designed to reduce the initial distress caused by traumatic events. Since a large-scale emergency will overwhelm existing mental health response resources, psychological first aid — the provision of basic psychological care in the short-term aftermath of a traumatic event — is an important skill set to possess.
The term “psychological first aid” first appeared, of all places, in a 1944 curriculum developed by the Merchant Marine, and the first scientific study of “the trajectory of the grief process” came out the same year, in the wake of the devastating 1942 fire at Boston’s Cocoanut Grove nightclub. In less than 15 minutes, 492 people were dead and another 166 injured, making the blaze the deadliest nightclub fire in U.S. history. This and later studies showed that mental health “casualties” far exceeded those who suffered physical harm during such cataclysms. Hence, the field of disaster mental health developed gradually over the decades, finally entering the modern era after the 9/11 attacks.
People suffer from a wide range of mental health problems during and long after emergencies and will be more likely to recover if they feel safe, connected, calm and hopeful; have access to social, physical and emotional support; and find ways to help themselves.
Recent reports note that in 2018, the United States experienced some of its most devastating weather conditions ever. From raging wildfires to damaging street flooding and record-breaking hurricanes, extreme weather ravaged neighborhoods and cities nationwide. With climate change predicted to be increasingly significant, such extreme weather conditions are expected to continue for years to come. Such extreme weather conditions bring about mass destruction and chaos, but also overwhelming expenses. According to a recent Christian Aid report, 2018’s top three most expensive climate-driven events worldwide all occurred in the United States.
With this kind of forecast, it is time to recalibrate our plans for post disaster mental health. But, we don’t have to recalibrate from scratch. Turns out, there has been success in broadening the base of people who can provide psychological first aid. For the most part, disaster mental health in the form of psychological first aid has been provided by mental health professionals, physicians, nurses and the clergy. However, given the pace of natural and man-made disasters, I think it is time to expand our — “sphere of influence,” to include non-professional providers of PFA.
Learning from Others in Chronic Disasters
Andrea Ucini, who writes for the Economist tells the following story. “At Jabal Amman mental-health clinic, perched atop a hill in the old town of Jordan’s capital, Walaa Etawi, the manager, and her colleagues list the countries from where they see refugees — and what ails them. There are Iraqis, many with post-traumatic stress, Syrians with depression, Sudanese with anxiety, and at least ten other nationalities. By local estimates, 1.4 million people have poured into Jordan from Syria’s civil war alone. Disaster-relief groups like the International Medical Corps (IMC), which run the Jabal Amman clinic, came to help. In the past two decades care for mental distress in such emergencies, whether wrought by conflict or natural calamity, has become an immediate priority — on a par with shelter and food. And what has been learned from disasters has inspired new, pared-down mental-health care models that can be deployed quickly to help lots of people. In parts of Indonesia, Sri Lanka, the Philippines and elsewhere these models became part of rebuilt health-care systems.”
People suffering chronic disasters have figured out that the scale of mental health problems and the shortage of specialists to treat them is a complex problem.
As disaster-relief experts wondered how quickly to train local people to provide mental-health care, they realized that, for the most part, non-specialists might be able to do the job.
“We used to assume that people need professional counseling,” says Julian Eaton of the London School of Hygiene and Tropical Medicine, a veteran in post-disaster care. But it turned out this was not so. Rates of mental-health problems usually doubled after a calamity. But few people needed a psychiatrist. Most got better with simple, appropriate help that anyone could provide. Known as “psychological first aid”, it is something that can be taught in a matter of hours.
This training is now standard fare in the first days after a disaster. Teachers, pastors, barbers and taxi-drivers are taught to notice people in distress, to provide the right kind of emotional support, and to avoid common mistakes such as pressing sufferers to recount stressful events.
Seeking unprofessional help
Disaster relief has taught that non-specialists can be trained to treat mild-to-moderate depression and anxiety, which affect 15–20% of people in any given year. The idea, known in the jargon as “task-shifting”, was “born out of necessity”, says Peter Ventevogel of UNHCR, the United Nations refugee agency.
The United States should examine the feasibility of broadening the sphere of influence to include non-professionals that have been trained and/or certified in psychological first aid to barbers, hair dressers, bar tenders, taxi drivers, teachers, barista’s, pharmacists, veterinarians, charity organizations, child facilities, volunteer first responder organizations and others who provide daily services to citizens on an ongoing basis.
Resource materials have already been generated. In addition to the John’s Hopkins Guide to Psychological First Aid, the World Health Organization has its own handbook.
What is is and isn’t
PFA is not psychotherapy, nor is it a substitute for psychotherapy. It does not entail diagnosis or treatment. PFA can be an effective public health intervention especially well-suited for areas wherein health care resources are scarce, situations where access to emergent care is limited, or as a means of significantly increasing surge capacity in the wake of organizational or community adversity, such disasters and workplace or community violence.
Psychological First Aid is not meant to take the place of licensed mental health professionals. Beneficial to those with little or no previous mental health training, psychological first aid can fill a wide shortage of disaster mental health professionals until the crisis has subsided.
Evidence and experience show that people who feel safe, connected, calm and hopeful; have access to social, physical and emotional support; and find ways to help themselves after a disaster will be better able to recover long-term from mental health effects. Crisis intervention should not be considered treatment but, rather, as a means of fostering resilience, that is, helping people to rebound from adversity.
City, state and local governments could provide training with local incentives to attend and state universities could use its resources for curriculum development applicable to a wide variety of learning styles.
As the complexity of challenges continues to grow so must the capacity to widen the sphere of influence to include others in the community willing to lend a hand at lessening the traumatic mental health effects of disasters.
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Angi English is the Chief of Staff for the New Mexico Department of Homeland Security & Emergency Management. She writes on issues related to emergency management and homeland security. She has a Master’s of Arts in Security Studies from the Naval Postgraduate School’s Center for Homeland Security and Defense and a Master’s in Educational Psychology. She is a HSx Founding Scholar for Innovation at the Naval Postgraduate School Center for Homeland Defense and Security. Angi is a certified Part 107 drone pilot, Licensed Professional Counselor (LPC) and Licensed Marriage and Family Therapist (LMFT). She lives in Santa Fe, New Mexico.
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