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Aus Red Cross (2013) - Psychological 1st Aid For Disaster PDF
Aus Red Cross (2013) - Psychological 1st Aid For Disaster PDF
First Aid
An Australian guide to
supporting people
affected by disaster
Psychological First Aid
An Australian guide to supporting people affected by disaster
Contents
Foreword 2
Understanding psychological first aid 4
What is psychological first aid? 5
What psychological first aid isn’t 6
Who benefits from psychological first aid? 7
The aim of psychological first aid 9
Five elements of psychological first aid 10
Who delivers psychological first aid? 12
Where is psychological first aid delivered? 13
Using psychological first aid in the field 14
© Copyright Preparing to provide psychological first aid in the field 15
Second edition published by: Important questions to ask before entering an emergency site 16
Australian Red Cross 2013
155 Pelham St, Carlton, Victoria 3053 Psychological first aid action principles 18
and
Australian Psychological Society Important questions and messages to consider when using
Level 11, 257 Collins St, Melbourne, Victoria 3000
psychological first aid 19
National Library of Australia
Cataloguing-in-publication data:
ISBN: 978-0-909896-00-3 Adapting psychological first aid 22
Photography copyright: All images are referenced For culture 23
within and remain the property of the Australian
Red Cross, stated photographer, or other parties For children and young people 24
as noted.
For people with health conditions or physical or mental disabilities 26
Within this resource, the term ‘emergency’ is
used and can apply to any form of emergency
incident or disaster. Where the term ‘disaster’ is Self care for people working in the field 28
used, this is interchangeable to ‘emergency’ and
connotations of one term over the other should Self care 29
©Australian Red Cross/Allan Reinikka
Foreword overview of the field (see reference list). activities focused more on the responding to and recovering from
The guide is also used in conjunction rebuilding of towns damaged by floods, an emergency.
This psychological first aid guide with psychological first aid training fire or storms and healing the physical
is for people working in disaster This guide is also in line with resources
delivered by Australian Red Cross. wounds of those injured.
preparedness, response and recovery. It detailed in the Psychosocial Support in
provides an overview of best practice in Emergency is the generic term used in Disaster mental health and the Disasters portal (www.psid.org.au) and
psychological first aid following disasters Australia to describe disruptive and/ or identification of post-traumatic stress the World Health Organization, War
and traumatic events. destructive events that cause loss of disorder led to a shift in approaches to Trauma Foundation and World Vision
life, property and livelihoods, injury and emergency management. Responses International (2011) Psychological
Each state and territory has plans damage to communities. during this period focused on first aid: Guide for field workers.
to deal with the health impacts of applying clinical mental health skills in WHO: Geneva.
disasters. Included in these plans are For the individual this may mean the
emergency settings, for which they were
arrangements that cover the mental loss of:
never intended.
health impacts of emergencies. • near or significant loved ones
It was then recognised that most
There are many types of psychological • control over one’s own life and future people did not develop serious mental
first aid and it is increasingly being • hope and initiative health issues after emergencies. Most
used in the post disaster field. There people recover well with some basic
• dignity
is an urgent need for this technique support. This led to the development of
to be given an Australian context. • social infrastructure and institutions
psychological first aid as a primary tool
Psychological first aid needs to be • access to services
after an emergency.
packaged in a way that clearly outlines • property and belongings
its aims, components, when it is used, It has been recognised both in Australia
• livelihoods
where it can be applied, and who and internationally that psychosocial
• place. support in emergencies is best delivered
benefits from its use, who can deliver it.
After an emergency, people often lose as a community-based activity, rather
This guide sets out to achieve this confidence in the norms, networks, and than within a medical health system2.
aim in a simple form. It complements trust in the society that is supposed to Providing coordinated psychosocial
work done by the Disaster Response protect them1. Until the late 1970s, the support in emergencies has now
and Resilience Research Group at psychosocial aspect of emergencies was become a critical part of preparing for,
the University of Western Sydney. Dr often ignored. Emergency management
Sally Wooding and Professor Beverley
Raphael have written a chapter on 2 For more information see Inter-Agency Standing Committee
1 For more information see International Federation of Red 2007; International Federation of Red Cross and Red Crescent
psychological first aid that provides an Cross and Red Crescent Societies 2009. Societies 2009; van Ommeran, Saxena & Saraceno 2005.
4 Psychological First Aid An Australian guide to supporting people affected by disaster 5
Psychological first aid has a long history1. Post-emergency settings are not clinical Who benefits from There will also be some situations
It has become more popular since environments and it is inappropriate psychological first aid? where people have an immediate need
the emergence of research showing to conduct a clinical or psychological for more care than can be provided
the dangers of critical incident stress assessment within the setting. The sudden, disruptive nature of by psychological first aid. These
debriefing2. Since 2002, psychological emergencies means that people will people need to be promptly referred
It is important to limit contact be exposed to uncertainty and stress.
first aid has been recommended as a to specialised support. This includes
at this point to simple support, People will experience different degrees
key part of the provision of psychosocial people who are:
like psychological first aid. People of distress. Any person in distress
support following disasters. • seriously injured and needing
who display marked signs of risk should have access to psychological
(e.g. suicidal tendencies) first aid, where possible. This includes emergency medical care
What psychological first should be referred to formal adults, adolescents and children, as • so distressed that they are unable
aid isn’t mental health services. well as disaster relief workers and first to perform the basic activities of
It is important to clarify what responders. daily life
psychological first aid is NOT to How people respond and cope depends • threatening harm to themselves
differentiate it from earlier forms of Psychological first aid is: on a variety of factors, including their or others.
post-disaster support, most notably experience of the emergency, their
• NOT debriefing It is important to remember that not
critical-incident stress debriefing. health, their personal history and their
• NOT obtaining details of everyone who experiences an emergency
It is not useful – and may be harmful – available supports. will have emotional distress or problems
traumatic experiences and losses
to directly encourage disaster survivors Some people may be at more risk of during or after the crisis. Not everyone
to talk about what happened to them • NOT treating
negative consequences. These may who experiences a crisis will need
if they do not want to. If a person • NOT labelling or diagnosing psychological first aid. Some protecting
include those people who:
wants to discuss their experiences, • NOT counselling factors include1:
it is useful to provide them with • have had previous traumatic experiences
• NOT something that only • good level of functioning
support. But this should only be in professionals can do • have underlying mental illnesses
a way that does not push them to • social support
• NOT something that everybody • were exposed to events where the
discuss more than they want3. horror element was high • ability to cope
who has been affected by an
emergency will need. • thought they were going to die • strong moral belief systems
1 For more information see Drayer, Cameron, Woodward &
• experienced traumatic bereavement • returning to normal life
Glass 1954; Raphael 1977a&b and 1986.
2 For more information see National Institute of Mental Health (i.e. reducing disruption).
2002; Rose, Bisson & Wessley 2003; Bisson, Brayne, Ochberg • have had serious losses of property,
& Everly 2007; Bisson & Lewis 2009. livelihoods, or disruption to 1 For more information see Johns Hopkins School of Public
3 For more information see Watson et al. 2002; Health & International Federation of Red Cross and Red
Ruzek et al. 2007; McNally, Bryant, & Ehlers 2003. communities and networks. Crescent Societies 2008.
8 Psychological First Aid An Australian guide to supporting people affected by disaster 9
Five elements of psychological first aid 3. Promote connectedness 4. Promote self efficacy
There are five basic elements to • Provide repeated, simple and • Help people contact friends and • Engage people in meeting their
psychological first aid that have accurate information, in a range of loved ones. own needs.
been drawn from research on risk methods, on
how to get these basic • Keep families together. • Assist with decision making, help
and resilience, field experience and needs met. • Keep children with parents or other them to prioritise problems and
expert agreement1. close relatives whenever possible. solve them.
2. Promote calm • Help establish contacts with support
The elements of psychological first aid 5. Promote hope
are to promote:
• Stabilise people who are people
(friends, family or community
overwhelmed or disoriented. • Convey expectancy that people
helping resources).
• safety will recover.
• Provide an environment, as far as • Respect cultural norms regarding
• calm practical, removed from stressful
• Be there/be willing to help.
gender, age and family structures.
• connectedness
situations or exposure to sights, • Offer practical help to people to • Reassure people that their feelings
• self-efficacy and group efficacy sounds and smells of the emergency. address immediate needs and are normal.
• hope. • Listen to people who wish to share concerns.
their stories and emotions, without • Provide information and direct people
1. Promote safety forcing
them to talk. to those services that are available.
• Remove from, or reduce exposure to, • Remember that there is no right or • Link people with available services.
threat of harm. wrong way to feel.
• Respect cultural norms regarding
• Help people meet basic needs for • Be friendly and compassionate even if gender, age, family structures and
food, water, shelter, financial and people are being difficult. religion.
material assistance. • Offer accurate information about
• Help people obtain emergency the disaster or trauma and the relief Self efficacy is the belief
medical attention. efforts
underway to help survivors that one’s actions are
understand the situation.
• Provide physical and likely to lead to positive
emotional comfort. • Provide information on stress
and coping. outcomes, and feeling
• When they express fear or worry, able to help oneself.
remind people (if you know) that more
1 For more information see Hobfoll et al. 2007, IFRC 2009,
help
and services are on the way.
SAMHSA 2010, Queensland Health (2008).
12 Psychological First Aid An Australian guide to supporting people affected by disaster 13
Preparing to provide
psychological first aid in
the field1
Many emergency situations can be
stressful and often require urgent
action. The more that is known about
the situation, and the better prepared
a person is psychologically, the more
effective the support will be.
Prior to using psychological first aid in the
field people should:
• Learn about the crisis event.
• Learn about available services and
supports.
• Learn about safety, access and
security concerns.
• Consider their physical and mental
preparedness.
Using
psychological
first aid in
the field
©Australian Red Cross/Dilini Perera
Psychological first aid action principles1 Important questions and messages to consider when using
The World Health Organization (WHO) has developed a framework consisting of psychological first aid
three action principles to assist in the delivery of psychological first aid.
These principles provide guidance for how to view and safely enter an emergency Look
situation (LOOK) in order to understand the needs of affected people (LISTEN) and Check for safety
link them with the information and practical support they need (LINK). • What dangers can you observe, e.g. damaged road, unstable buildings, fire,
flooding etc?
Principles Actions • Ask if you can be there safely without harming yourself or others
Look • Check for safety. • If you are not certain that the area is safe, then DO NOT GO!
• Check for people with obvious urgent basic needs. Check for people with obvious urgent basic needs
• Check for people with serious distress reactions. • Does anyone need emergency first aid?
• Do people need urgent protection (e.g. clothing)?
Listen • Approach people who may need support.
• Are there any people who might need special attention?
• Ask about people’s needs and concerns.
• Know your role and try to obtain help for people who need special
• Listen to people and help them to feel calm.
assistance or who have obvious urgent basic needs
Link • Help people address basic needs and access services. Check for people with serious distress reactions
• Help people cope with problems. • Are there people who are extremely upset, immobile, not responding to
• Give information. others, disturbing others, or in shock?
• Connect people with loved ones and social support. • Where and who are the most distressed people?
• Consider who may benefit from psychological first aid and how
you can best help.
1 World Health Organization, War Trauma Foundation and World Vision International (2011). Psychological first aid:
Guide for field workers. WHO: Geneva.
20 Psychological First Aid An Australian guide to supporting people affected by disaster 21
Listen Link
Approach people who may need support Help people address basic needs and access services
• Approach people respectfully and according to cultural norms • For example, food, water, shelter, material needs
• Introduce yourself by name and organisation • Learn what specific needs people have and try to link them to
• Ask if you can provide help available assistance
• If possible, find a quiet and safe place to talk • Do not make promises you cannot keep
• Help the person feel comfortable Help people cope with problems
Ask about the people’s needs and concerns • Help identify their most urgent practical needs and assist with prioritising
• Address any obvious needs. For example, if a person’s clothing is torn or • Help the person identify support people
they need a blanket • Give practical suggestions for people to meet their own needs (e.g. how to
• Always ask for people’s needs and concerns register with Centrelink etc)
• Do not assume you know Give information
• Find out what is most important to them at this moment • Find out where to get information and updates
• Help them work out what their priorities are • Try to get as much information as you can before approaching people
with support
Listen to people and help them to feel calm
• Keep updated
• Stay close to the person
• Only say what you know
• Do not pressure the person to talk
• Listen in case they want to talk about what happened Connect people with loved ones and social support
• If they are very distressed help them to feel calm and try to • Keep families together and children with their parents
make sure they are not alone • Help people to contact friends or relatives.
• If prayer or religious practice is important people may
benefit from being linked with their spiritual base
22 Psychological First Aid An Australian guide to supporting people affected by disaster 23
Useful organisations Inter-Agency Standing Committee (IASC) References and resources Drayer, CS, Cameron, DC, Woodward,
www.humanitarianinfo.org/iasc WD & Glass, AJ 1954, ‘Psychological first
Australian Child & Adolescent Trauma, ACPMH 2009, Community Recovery aid in community disaster’. Journal of
Loss & Grief Network (ACATLGN) International Committee of the Following Disaster: Training for American Medical Association, vol. 156,
www.earlytraumagrief.anu.edu.au Red Cross (ICRC) Community Support People – Workshop 1, pp. 36–41.
www.icrc.org Guide and Resource, Australian Centre
Australian Centre for Posttraumatic Hobfoll, SE, Watson, P, Bell, CC, Bryant,
International Federation of Red Cross for Posttraumatic Mental Health &
Mental Health (ACPMH) RA, Brymer, MJ, Friedman, MJ et al.
and Red Crescent Societies (IFRC), beyondblue, Melbourne, Australia.
www.acpmh.unimelb.edu.au 2007, ‘Five essential elements of
Psyho-social Support Reference Centre Australian Emergency Management
Australian Psychological Society (APS) immediate and mid-term mass trauma
http://psp.drk.dk Institute, 2011. Community Recovery
www.psychology.org.au intervention: Empirical evidence’,
National Center for PTSD Handbook 2. Psychiatry, vol. 70, pp. 283–315.
Australian Red Cross www.ncptsd.va.gov Bisson, JI, Brayne, M, Ochberg, FM & International Federation of Red Cross
www.redcross.org.au
National Child Traumatic Stress Everly, GS 2007, ‘Early psychological and Red Crescent Societies (IFRC) 2009,
beyondblue Network (NCTSN) intervention following traumatic events’, Psychosocial Handbook, International
www.beyondblue.org.au www.nctsn.org American Journal of Psychiatry, vol. 164, Reference Centre for Psychosocial
Department of Human Services (DHS), pp. 1016–19. Support, Copenhagen, Denmark.
National Institute of Mental Health
State Government of Victoria (NIMH) Bisson, JI & Lewis, C 2009, Systematic Inter-Agency Standing Committee (IASC)
www.dhs.vic.gov.au/emergency www.nimh.nih.gov Review of Psychological First Aid, 2007, IASC Guidelines on Mental Health
Department of Health (Queensland) commissioned by the World Health and Psychosocial Support in Emergency
Psychosocial Support in Disasters Portal Organization.
www.health.qld.gov.au/mentalhealth/ www.psid.org.au Settings, IASC, Geneva, Switzerland.
useful_links/disaster.asp Brymer, M, Jacobs, A, Layne, C, Pynoos,
Sphere Project for Minimum Standards Ironson, G, Wynings, C, Schneiderman,
Disaster Response and R, Ruzek, J, Steinberg, A, Vernberg, E N, Baum, A, Rodriguez, M, Greenwood,
in Humanitarian Response & Watson, P 2006, Psychological First
Resilience Research Group, www.sphereproject.org D et al. 1997, ‘Post-traumatic stress
University of Western Sydney Aid – Field Operations Guide, 2nd edn, symptoms, intrusive, thoughts, loss,
www.uws.edu.au/disaster_response_ Substance Abuse and Mental Health National Child Traumatic Stress Network and immune function after Hurricane
resilience/disaster_response_and_ Services Administration (SAMHSA) & National Center for PTSD, USA. Andrew’, Psychosomatic Medicine, vol.
resilience www.samhsa.gov Carver, C 1999, ‘Resilience and thriving: 59, pp. 128–41.
Emergency Management In Australia World Health Organization (WHO) Issues, models and linkages’, Journal of
www.ema.gov.au www.who.int Social Issues, vol. 54, pp. 245–66.
34 Psychological First Aid An Australian guide to supporting people affected by disaster 35
Jacobs, G 2010, Roundtable discussion Raphael, B 1977b, ‘The Granville train Solomon, Z 2003, Coping with War-Induced Watson, PJ, Friedman, MJ, Ruzek JI &
between Professor Jerry Jacobs disaster: Psychological needs and their Stress – The Gulf War and the Israeli Norris, FH 2002, ‘Managing acute stress
and various Australian emergency management’, Medical Journal of Response, Plenum, New York, USA. response to major trauma’, Current
management experts, 19 July 2010, Australia, vol. 1, pp. 303–5. Psychiatry Reports, vol. 4, pp. 247–53.
Stevens, G & Raphael, B 2008a,
Australian Psychological Society,
Raphael, B 1986, When Disaster Strikes CBRN SAFE: Psychosocial Guidance World Health Organization, War
Melbourne, Australia.
– How Individuals and Communities for Emergency Workers – Chemical, Trauma Foundation and World Vision
Johns Hopkins Bloomberg School of Public Cope with Catastrophe, Basic Books, Biological, Radiological & Nuclear International (2011). Psychological
Health & International Federation New York, USA. Incidents, University of Western first aid: Guide for field workers.
of Red Cross and Red Crescent Societies Sydney, Australia. WHO: Geneva.
Raphael, B, Stevens, G & Taylor, M
2008, Public Health Guide in Emergencies,
2009, Disaster Response and Resilience Stevens, G & Raphael, B 2008b, CBRN World Health Organization (WHO)
2nd edn, Geneva, Switzerland.
Research Group, University of Western SAFE – Incident Pocket Guide, University 2010, Helping in Crisis Situations in Low
‘Does early psychological intervention Sydney, Australia. of Western Sydney, Australia. and Middle Income Countries Guide to
promote recovery from posttraumatic Psychological First Aid – currently in draft.
Rose, S, Bisson, J & Wessley, S 2003, Substance Abuse and Mental Health
stress?’, Psychological Science in the
‘A systematic review of single Services Administration (SAMHSA) Wooding, S & Raphael, B 2010.
Public Interest, vol. 4, pp. 45–79.
psychological interventions (‘debriefing’) 2007, Psychological First Aid – A Guide Psychological First Aid – Level 1
National Institute of Mental Health following trauma – Updating the for Emergency and Disaster Response Intervention Following Mass Disaster,
2002, Mental Health and Mass Violence Cochrane review and implications for Workers, US Department of Health and University of Western Sydney, Australia.
– Evidence-based early Psychological good practice’, in RJ Orner & U Schnyder Human Services, Washington, DC, USA.
Young, B 2006, ‘The immediate
Intervention for Victims/Survivors of (eds) Reconstructing Early Intervention
Substance Abuse and Mental Health response to disaster – Guidelines for
Mass Violence, NIMH publication No. after Trauma Innovations in the Care of
Services Administration (SAMHSA) adult psychological first aid’, in EC
02-5138, US Government Printing Office, Survivors, pp. 24–9, Oxford University
2010, Psychological First Aid for First Richie, PJ Watson & MJ Friedman (eds)
Washington DC, USA. Press, Oxford, UK.
Responders – Tips for Emergency and Interventions Following Mass Violence
Queensland Health (2008) Psychological Ruzek, JI, Brymer, MJ, Jacobs, AK, Disaster Response Workers and Disasters – Strategies for Mental
First Aid Core Actions Emergency Layne, CM, Vernberg, EM & Watson, PJ (http://store.samhsa.gov/home). Health Practices, pp. 134–54, Gilford
Management Unit Fact Sheet. 2007, ‘Psychological first aid’, Journal Press, New York, USA.
van Ommeran, M, Saxena, S & Saraceno,
of Mental Health Counseling, vol. 29,
Raphael, B 1977a, ‘Preventive B 2005, ‘Mental and social health during
pp. 17–49.
intervention with the recently bereaved’ and after acute emergencies – Emerging
Archives of General Psychiatry, vol. 34, consensus?’, Bulletin of the World
pp. 1450–4. Health Organization, vol. 83, pp. 71–6.
36 Psychological First Aid An Australian guide to supporting people affected by disaster 37
40 Psychological First Aid
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Red Cross Red Crescent Movement
In all activities our volunteers, members and staff are guided by the Fundamental
Principles of the Red Cross and Red Crescent Movement.
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not take sides in hostilities or engage at Societies have equal status and share
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racial, religious or ideological nature. helping each other, is worldwide.
NOVEMBER 2013
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