Psychological First Aid
Psychological First Aid (PFA) is an evidence based approach to help people in the short, medium and longer term after major incidents, disasters and other, smaller scale, traumatic incidents. It is also appropriate for supporting people during prolonged or continuing situations such as the COVID-19 Pandemic. It is intended to minimise the distress that typically occurs during or after such incidents or situations and to help people develop ways of managing and coping.
This model is based on recommendations from an NHS Guidance document entitled ‘Planning for the Psychosocial and Mental Health Care of People Affected by Major Incidents and Disasters’. These recommendations have recently been endorsed by the International Red Cross and Red Crescent (ICRC), the World Health Organisation (WHO) and Public Health England (PHE) as the ‘approach of choice’ in supporting people during the COVID-19 Pandemic.
Psychological First Aid
Details of the Approach
The Psychological First Aid model makes no assumption that all those involved will require professional mental health care, but rather that the majority of people will experience a wide range of reactions, some of which may interfere with their lives, and that empathic support from responders early on may help the recovery process.
It is a flexible and practical approach capable of being delivered:
- During the initial rescue response following a major incident
- In hospitals following deaths and other traumatic events or during the response to a major influx of injured people
- In hospitals and elsewhere during prolonged events or situations such as Pandemics
- In the people Centres that are set up, such as the Survivor Reception Centre, Family and Friends Reception Centre and the Humanitarian Assistance Centre
- During medium and longer term support after major incidents
- Immediately following smaller scale traumatic incidents
- A few days after smaller scale incidents
- During medium and longer term support after smaller scale incidents
- By union representatives whilst they are supporting members who have been made redundant or who may be vulnerable to being made redundant
The goal of Psychological First Aid is to reduce people’s emotional distress, help them with whatever they need, and encourage behaviours that will assist them to return to normal functioning. It is not about making people relate details of distressing experiences.
The overall objectives are:
- Providing comfort and consolation
- Protecting people from further threat and distress
- Providing immediate physical care
- Offering practical assistance and information to help people address their immediate needs and concerns
- Encouraging goal orientated and purposeful behaviour
- Helping people to reunite with loved ones
- Enabling voluntary sharing of experiences
- Enabling voluntary sharing of experiences
- Ensuring that medical staff are provided with appropriate support
- Facilitating a sense of being in control
- Identifying people who need further help (e.g. through Psychosocial Triage)
- Providing information about typical reactions to trauma and some coping techniques
- Ensuring that they know how to contact sources of support
The PFA Model of Peer Support
Organisations should consider developing a system or protocol designed specifically to provide support for staff following incidents that are experienced by staff as being traumatic or unusually stressful. This would usually be part of the Policy and Procedures documents maintained by the organisation.
Staff are often expected to carry on as normal in the wake of events that should have triggered a supportive response from managers. They are likely to recover better and return more quickly to normal functioning if they are given an opportunity to talk through the events, how they have reacted to them and to receive advice and education on dealing with reactions. That opportunity may be delivered by trained and supervised Responders from within the organisations’ own resources or by a ‘paid for’ response from an external Employee Assistance Programme provider or other external professional counselling organisation.
This support should be in addition to any ‘operational debriefing’ process where the sole objective is to identify and learn any lessons from the event. It is suggested that the system be flexible and delivered as required. This support after traumatic events should become part of the organisational culture or ‘this what we usually do around here.’
On the day
On the day the event happens staff should be seen before they go home and be given the opportunity for a short informal chat called a Defusing.
Three to Five days
At the time of the Defusing or within the next day or so, consideration should be given as to whether a longer opportunity to discuss the events should be provided. This should be delivered between 3 and 5 days after the event and is called a Psychological First Aid Session. (PFA Session)
Follow Up
If staff are managing reasonably well at the time of the PFA session, they should be informally monitored and supported over the following days and weeks. Managers should also keep an informal eye on staff involved in a traumatic incident.
If staff are experiencing a lot of reactions, not managing well or it was a very serious event, further, more formal support should be offered. This would probably take the form of a second PFA Session.
Approximately 4 weeks after the event staff should be contacted and their present level of reactions checked. If there are still a lot of reactions around, they should be referred to a mental health professional for assessment and treatment if necessary.
Feedback from our clients
“Zoom approach worked surprisingly well. Small group work made possible –excellent. Good slides and content. Good pre-course reading and information for future reference. Knowledge and experience of Gerry”
- Facilitation via Zoom and breakout rooms worked really well given current limitations.
- Anecdotal stories based on Gerry’s previous experience were interesting and relevant and helped illustrate the points he was making.
- Humorous style and relaxed delivery welcomed.
- Good balance of facilitator input, case studies and group discussion.
- Calm and well-paced delivery and good humoured.
- Clear and good at keeping everyone involved.
- Excellent content and facilitation in difficult/different circumstance –well done and thanks Gerry.
- The break halfway through each session was really helpful. Working online requires a different level of concentration so a break is important.
Feedback from Consultant Doctors following recent training for Health Education England