First, do no harm, part 3: Psychological first aid in disaster settings

Here, we look at some of the principles in delivering psychological first aid in disaster settings.

First, do no harm, Part 1
First, do no harm, Part 2: First aid for the mind
Part 4: Who needs help, of what sort, following a disaster?

 
In the last installment, I noted that first aid was never envisioned as something to be delivered by doctors and nurses. It was designed to be the province of baseball coaches and babysitters, in other words, of those who are most likely to be in first contact with the ill or injured.

Readers were reminded that the intent of first aid in severe cases is to provide sufficient skills (such as the ABCs of airway, breathing and circulation) to stabilize serious problems until definitive help can be secured. At the other end of the spectrum, first aid holds an equally important objective of enabling people to safely, effectively and confidently deal with cuts and bruises, sprains and strains, and other minor hazards that needn’t require specialized medical attention.

Psychological first aid in disaster settings works within very similar parameters to approach very similar objectives. It represents a marked change from approaches based on specific interventions (such as critical incident stress management) that permeated disaster mental health concepts of the 1990s.

Those strategies involved highly structured, wide-reaching, direct-intervention models which assumed that everyone exposed to disaster was at pronounced risk of developing pathological reactions. They asserted that rapid and structured intervention was necessary, even to the point of mandates, lest exposure result in lasting psychological impairment.

The principles of first aid, on the other hand, assume, in keeping with a growing body of empirical evidence, that victims of disaster are typically resilient, their concerns are principally instrumental and adaptive, and their reactions are generally transient and situational in nature, in short, that the victims will get better as their situation gets better. Accordingly, the best way to help a disaster victim deal with the stress of losing his or her home may well be to help them get a roof over their heads.

If that’s the case — and empirical evidence suggests that, for the vast majority of victims, it is — then the best way to provide emotional support is to do it in the context of activities and interactions taking place to address those practical issues.

That’s not to say that there aren’t times when the direct help of a counselor or social worker will prove needed and valuable. What it does suggest is that emotional support, especially in the beginning, is better received from first responders, disaster relief volunteers, shelter workers and their ilk in the context of their primary roles than through separate providers conducting separate interventions.

It also means that those who need more focused, specialized assistance need to be properly identified and given access to forms of treatment that have been solidly demonstrated as effective for the problems they present.

Organizations such as the American Red Cross have been systematically revamping their approaches to psychological support to reflect these changes in perspective. The principles are really quite straightforward:

• Contact and engagement: Make contact with those in need of assistance; provide practical, instrumental assistance with compassion and care.
  
• Safety and comfort: Take all needed steps to provide those affected with as safe and comfortable an environment as circumstances allow.
  
• Stabilization: Attenuate anxiety, provide a calming presence, help ground and orient the distraught, refer for emergency care in cases where clearly indicated.
  
• Information-gathering (current needs and concerns): Determine the pressing needs as seen by the person in need; tailor assistance efforts to address current needs while anticipating emerging situations.
  
• Practical assistance: Provide practical, instrumental help with identified needs; assist with problem-solving strategies and access to resources.
  
• Connection with social supports: Help those affected make contact with sources of social support important to them (e.g., friends, family, community and spiritual resources) and integrate their support into problem-solving and recovery.
  
• Information on coping: Simple, practical, proven tips on managing stress and coping with demands of disaster recovery, timed to match the situations and challenges at hand at any given juncture, can be useful and well received, especially when delivered in the context of practical assistance and social support.
  
• Links to collaborative services: Most disaster victims are unfamiliar with resources available to help with their various needs; assistance in navigating the resource network that evolves in a given community is particularly important to sustained recovery.

A complete manual for providing Psychological First Aid is available online. Specific versions tailored toward various front-line disaster recovery personnel (such as first responders, relief workers and spiritual care providers) are currently in progress.

There are, however, people who will need specific professional help to achieve their recovery. An effective approach to disaster mental health must be able to effectively identify those whose needs will not be met without specialized assistance and direct them toward resources and providers fully equipped to provide the care they need using efficacious, empirically validated treatments and techniques.

Our next installment will examine emerging best practices for integrating screening and treatment into the behavioral health aspects of community recovery.