psychological first aid (pfa) in disaster

Psychological First Aid (PFA) in disaster

Dr Md Saleh UddinResident, Phase BDepartment of Psychiatry BSMMU, Dhaka20.05.2014

Contents

• Disaster • Disaster Psychiatry• Psychological First Aid (PFA)• Mental Health First Aid (MHFA)• Conclusion • References

Disaster

Disaster

• is a severe destruction that greatly exceeds the coping capacity of the affected community

Disaster

Response

RecoveryMitigation

Preparedness

Local Scenario• Major Cyclones: 75 cyclones and floods/100 years

Natural disaster 1980-2010(CRED report 2012)

• No of events:234• No of people killed:191,836• Average killed per year:6,188• No of people affected:323,480,264• Average affected per year:10,434,847• Economic Damage (US$ X 1,000):17,072,500• Economic Damage per year (US$ X 1,000):550,726

Natural disaster occurrence

Killed by disaster Affected by disaster

• A report published in 1996 states that 66% of the

tornado affected people were psychologically

traumatized in the costal area

• Another study found 31.3% war injured freedom

fighters suffering from post traumatic stress disorder

even after 27 years of liberation war

• 2007 - Super cyclone ‘Sidr’ changed the views

regarding post disaster mental health service

• Technical and financial support came from World

Psychiatric Association (WPA)

• Multiple teams rushed to the affected area to

provide mental health services

Training Manuals

Plan Act

• District Disaster Management Plan(DDMP)

Global scenario

• Damages (USD):

2012

Disaster Psychiatry

• Victim

• Psychological responses

• Psychosocial intervention

Psychological responses

Psychological responses

Within 24hrs

Within days to weeks

After 3 weeks

Psychological responses

Don’t need intervention

May need only minimal

intervention

Need help from mental health professional

Normal reactive process

• Most recovers within 6 to 16 months

• Common stress reactionsEmotional , Cognitive, Physical, Interpersonal

• Post traumatic growth/benefited response

Within 24 hrs

• Tension, anxiety, panic• Stunned, dazed, shocked, disbelief• Restlessness, confusion• Agitation, crying and withdrawal• Survivor’s guilt

Within days to weeks

• Being fearful , vigilant, hyper alert• Irritable, angry, unable to sleep• Worried, despondent• Flashback• Weeping, guilt feeling• Sadness• Positive thinking(hope for future, rescue work)• Acceptance of disaster as nature’s doing

After 3 weeks • Restlessness, panic feeling• Continued deep sadness, unrealistic,

pessimistic thoughts• Outward inactivity, isolated and wihtdrawn

behavior• Anxiety

Psychiatric response

• Acute stress disorder• PTSD• MDD• Substance abuse• Psychological disorder • Organic • Adjustment disorder• Bereavement • Family violence• Child and spouse abuse

Psychosocial intervention

• Psychosocial first aid (PFA)• Trauma counseling • Greif counseling• Anticipatory guidance• Crisis counseling• Problem solving counseling

Psychological First Aid (PFA)

• Understanding PFA• How to help responsibly• Providing PFA• Caring self and colleague

PFA

“A human supportive response to a fellow human being who is suffering and who may need support” (Sphere2011, IASC WHO-2007)

PFA

Elements

• Care and support• Needs and concerns• Address basic needs• Listening to people, not pressuring • Comforting people and helping them to feel calm• Helping people connect to information, service and social

support• Protecting from further harm

PFA

What PFA is not

• Not only professionals do• Not a professional counseling• Not “Psychological debriefing” or ”CISD”• Not asking, analyzing, put in order • Available to listen but not pressuring to talk

PFA

Who need immediately

• Serious life threatening injuries• So upset, cant care themselves and family• May hurt self/others

PFA

When and where

• Recently affected• Sometimes days or weeks after

• Scene of accident/disaster• Health center, shelter/camps etc

PFA

Providing PFA

• Preparation• Good communication • PFA action principal• Ending help• Who likely need special attention

Providing PFA

Preparation

• Learn about crisis• Learn about available service and support• Learn about safety and security concern

Providing PFA

Good communication

• Basics of communication skill• Don’t pressure• Don’t think you must solve all problems• Don’t give false promise

Providing PFA

Action principal

Providing PFA

Ending help

Depends on the context of crisisIndividual’s role and situationNeeds of the people

Providing PFA

Special attention group

• Child adolescent group• People with health conditions/disabilities• People at risk/discrimination/violence

Caring for self and colleague

• Getting ready to help• Managing stress• Rest and reflection

• Safe effective feasible?• 58 citations• Insufficient evidence• Objective observation and expert

opinion(Class iii, iv)

Mental Health First Aid (MHFA)

MHFA

• Person developing a mental health problem or experiencing a mental health crisis

• Until treatment /Support received

• Not a substitute of counseling, medical care, peer support/ treatment.

MHFA

People can learn

• Overview of mental health problems• First aid for crisis situations• First aid for non crisis situations

MHFA

Spectrum of mental health intervention

MHFA

• Created in Australia (2001)• Currently in 18 countries• Piloted in USA (2008)

MHFA

Why MHFA?• Problems are common• Stigma • Professional unavailability• Do not seek help• Awareness

Conclusion

• BasicsDisaster managementDisaster Psychiatry Psychological first aid (LOOK LISTEN LINK)

• Local research and system innovation

References• Disaster mental health response Handbook, The NSW institute of Psychiatry, Australia,

2000• Role of psychiatry in disaster management: a brief review, H U Ahmed et al, NIMH, Dhaka.

Journal of Psychiatry, Vol 20, December 2006

• Psychosocial care of Disaster affected population: Physicians manual, WHO, 2007

• দূ�র্যো���গ পরবর্তী� মর্যো��সা�ম�জি�ক পজিরচ���, ম�ঠ প���র্যো�র কম�র্যোদূর ��� জি�র্যোদূ� জি�ক�,NIMH Dhaka, Bangladesh, 2008

• Psychological first aid: guide for field worker, WHO, 2011

• Mental health service after disaster: Current scenario and future prospect of Bangladesh, H U Ahmed et al, WPA regional meeting, Indonesia, 2012

• National plan for disaster management 2010-2015, Disaster management and relief division, Govt republic of Bangladesh.

• Annual disaster Statistical Review2012, Center for research on the Epidemiology of disasters (CRED), Belgium

• www.google.com: Images

1971 2013 2014

Disaster Vs Healthy Body & Mind

“ SOCIAL WEAPON ”

Resilience

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