developing mental health. edition 2 - psychological first aid
DESCRIPTION
An electronic publication for mental health in developing countries - promoting fresh ideas to reduce suffering worldwide.TRANSCRIPT
Edition 2
An electronic publication for mental health in developing
countries - promoting fresh ideas to reduce suffering worldwide.
Psychological First Aid I. An Introduction
Psychological First Aid: Guide for field workers
This selec<on of headlines from the last 12 months hardly touches the scale of disaster affec<ng communi<es and people groups across the world. The mere use of the terms “headlines”, “communi<es” and “people groups” can distance us from the reality of each individual’s experience. It is their reality that we consider with psychological first aid.
Disastrous events are occurring all the 1me in the world. These include war, natural disasters, accidents, fires. People may experience loss of property or loved ones, be separated from family and community or may witness or be subject to violence and destruc1on.
Psychological First Aid (PFA), according to humanitarian organisa1ons Sphere and the Interagency Standing CommiGee (IASC), is defined as “involving humane, suppor1ve and prac1cal help to fellow human beings suffering serious crisis events” and has been recommended by many interna1onal and na1onal expert groups.
‘Pakistan School Massacre 141 dead in Peshawar’ ‘Thousands of Yezidis escape to Mount Sinjar’ ‘Flash flooding kills 170, displaces 200,000 in Malawi’ ‘Ebola kills more than 10,000 in Sierra Leone, Liberia and Guinea’
The World Health Organisa1on’s (WHO) mhGAP Guidelines Development Group evaluated the evidence for Psychological First Aid and for psychological debriefing (one-‐to-‐one semi-‐structured interview with someone about the trauma1c experience). They concluded that psychological first aid, rather than psychological debriefing, should be offered to people in distress aQer being recently exposed to a trauma1c event.
WHO in 2011 published Psychological First Aid: Guide for field workers. The guide reflects the emerging evidence and interna1onal consensus on how to support people in the immediate aQermath of extremely stressful events.
UNHCR es1mated in Africa and the Middle East in the first six months of 2014 5.5 million people were displaced by war alone. Any provision for mental heath care that might exist in resource-‐poor countries is likely to be both disrupted and quickly overwhelmed by disasters of any scale. The approach in this guide acknowledges the place of non-‐healthcare professionals as being central to providing PFA.
The PFA approach aims to support people who may have a range of needs including psychosocial, spiritual and physical.
In summary the guide includes:
1. Understanding PFA • Humane, suppor1ve and prac1cal help to fellow human beings suffering serious crisis
events 2. Providing PFA responsibly means
• Respec1ng safety, dignity and rights • Adapt what you do to take account of the person’s culture • Be aware of other emergency response measures • Look aQer yourself
3. Providing PFA • Prepare • Look • Listen • Link
4. Caring for yourself and colleagues It is possible that those providing PFA may be affected themselves by the disaster or easily overwhelmed by the helping role. Some prac1cal advice is given here regarding self-‐care for the helpers.
5. Case scenarios
6. Psychological First Aid – Pocket Guide See DMH Bite Size at end of this DMH edi<on
The WHO Psychological first aid: Guide for field workers
Whilst Psychological First Aid: Guide for field workers provides an excellent summary and resource, by its own admission it is not context-‐specific.
In 2014 the Ebola virus outbreak in West Africa had significant impact on the wellbeing of those affected, their families, communi1es, and also relief and health workers. WHO published an
update to Psychological First Aid: Guide for field workers called Psychological First Aid during Ebola virus disease outbreaks.
This context-‐specific guide acknowledges the ongoing risk posed by the Ebola virus to both those affected, their communi1es and healthcare workers. The guide suggests useful ways of extending the psychological aspect of PFA to the wider social and public health domains which are very relevant in this situa1on. Specific public health advice is a strong element of this update.
From the field Dr Peter Hughes a UK-‐based psychiatrist and Chairperson of RCPsych VIPSIG (Volunteering and Interna1onal Psychiatry Special Interest Group) visited Sierra Leone in the Autumn of 2014 on
behalf of WHO, a post-‐visit interview can be listened to at hCp://youtu.be/oHzoOrxEUbk (with thanks to WHO for permieng ongoing access to this recording).
In this interview Dr Hughes thoughfully recounts his experience and observa1ons during this trip.
The emerging goal during the visit was to help a small group of professionals to be able to train
and provide support to community workers to deliver the kind of help outlined in Psychological first aid during Ebola virus disease outbreaks.
His reflec1on “you don’t hug each other, you don’t shake hands, if a child comes near you, you turn away, washing hands … burial … is a maGer of life and death” illustrates powerfully the need for PFA to incorporate the public health message: “public health is really, really important, some simple messages like washing your hands properly … saves a life, not touching people … saves a life, having a safe funeral … saves your life”.
II. Psychological First Aid In Practice, In Context
Psychological First Aid during Ebola virus disease outbreaks
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The challenge going forward in responding well to disastrous events in the world is considerable. These two guidelines and accounts from the field such as that by Dr Peter Hughes are welcome as we look to respond to peoples needs psychologically in distressing and disabling situa1ons.
Links Psychological First Aid: Guide for field workers. Currently available in 15 languages at www.who.int/mental_health/publica1ons/guide_field_workers/en/
Psychological First Aid during Ebola virus disease outbreaks. Available in English and French at www.who.int/mental_health/emergencies/psychological_first_aid_ebola/en/
WHO Webinar interview with Dr Peter Hughes following visit to Sierra Leone. Available at hGps://www.youtube.com/watch?v=oHzoOrxEUbk&feature=youtu.be
DMH bite-size
Given the tragic events in Nepal in April, we remember colleagues struggling to bring physical, mental and spiritual support to the many people who have been affected by the earthquake. We are highligh1ng this helpful special ar1cle on community-‐based mental healthcare and psychosocial support within a disaster context. AQer a disaster gaps between needs and services widen as some 30 to 50 percent develop moderate or severe psychological distress. Global consensus is that the effects of disaster on mental health are best addressed by exis1ng services rather than by trying to establish parallel systems, and that non-‐specialist health prac11oners and community led workers can be effec1ve.
Access to community-‐based mental healthcare and psychosocial support within a disaster context by Katherine P O’Hanlon and Boris Budosan BJPSYCH
INTERNATIONAL VOLUME 12 NUMBER 2 MAY 2015
www.rcpsych.ac.uk/pdf/PUBNS_InterV12n2.pdf (p44)
Get the PFA app…
PFA Mobile was designed to assist responders who provide psychological first aid (PFA) to adults, families, and children as part of an organised response effort. This app provides responders with summaries of PFA fundamentals, PFA interventions matched to specific concerns and needs of survivors, mentor tips for applying PFA in the field, a self-assessment tool for readiness to conduct PFA, and a survivors' needs form for simplified data collection and easy referral.
Click here for iPhoneClick here for Android
Earthquakes and Dreaming Dr Dhana Ratna Shakya
We Nepalese are reeling under one or other stressors, natural such as recent mega-‐quake, frequent floods, land-‐slides and man-‐made, such as unemployment, armed conflict, bandhas etc.1 The recent series of earthquakes, of 7.9 and 7.3 magnitude in April -‐ May 2015, have taken the lives of nearly 9000 people (at 1me of wri1ng and many more might be missing from available data), and have affected almost half of the country area wide, many injured and crippled. Uncertainty and the consequences of the mega-‐shake have led to disturbed mental and psychological state of many Nepalese. In such current Nepalese context, mental health problems are an1cipated to be higher than usual (community data is yet to be
generated for this country), though sadly mental health is a low priority. Though there a is gradually increasing number of teaching hospitals in different parts of the country, mental health service is less available than required, and mental health research is a low priority. Mental health is low on the agenda in health policy, priority and resource alloca1on so far in Nepal.
Earthquakes and Dreaming Dr Dhana Ratna Shakya
We Nepalese are reeling under one or other stressors, natural such as recent mega-‐quake, frequent floods, land-‐slides and man-‐made, such as unemployment, armed conflict, bandhas etc.1 The recent series of earthquakes, of 7.9 and 7.3 magnitude in April -‐ May 2015, have taken the lives of nearly 9000 people (at 1me of wri1ng and many more might be missing from available data), and have affected almost half of the country area wide, many injured and crippled. Uncertainty and the consequences of the mega-‐shake have led to disturbed mental and psychological state of many Nepalese. In such current Nepalese context, mental health
problems are an1cipated to be higher than usual (community data is yet to be generated for this country), though sadly mental health is a low priority. Though there a is gradually increasing number of teaching hospitals in different parts of the country, mental health service is less available than required, and mental health research is a low priority. Mental health is low on the agenda in health policy, priority and resource alloca1on so far in Nepal.
Editor’s Note Whilst comple1ng the ar1cles for this edi1on of DMH with its focus on psychological first aid I tuned in to the news to hear of another disaster, this 1me of an earthquake in Nepal. In March I met Dr Dhana Ratna Shakya a Nepalese Psychiatrist at a PRIME1 conference and quickly gained both affec1on and enormous respect for him and his work in Nepal. Hearing of the earthquake my thoughts turned to him so I was relieved to hear that he and his immediate family were well, although he too lost extended family and his home was destroyed. Days aQer the quake he had an ar1cle published in the Kan1pur Na1onal Daily 1tled “LET'S NOT FORGET MENTAL HEALTH' in this Mega-‐Earthquake 1me”.2 Our contact since then has shown him to be someone of vision and how that vision might be achieved -‐ envisioning a beGer future for his country and
championing the cause of those with mental health concerns, despite the brokenness around him. This DMH edi1on references WHO Guidelines on Psychological first aid in disaster situa1ons, a clearly ar1culated document which presents a methodology rooted in available evidence and best prac1ce. We need this type of guidance, but we also need champions and dreamers. So I’ve included Dr Dhana’s report from Nepal -‐ a country which needs him and many more like him every bit as much as interna1onal aid to rebuild and heal.
1. PRIME (Partnership in Interna1onal Medical Educa1on) Network. www.prime-‐interna1onal.org
2. Kan1pur Na1onal Daily (2/5/2015 Saturday) epaper.ekan1pur.com/kan1pur
Dhana (centre) greets John Geater, PRIME Interna<onal Director, and Jo Clark PRIME
Opera<ons Manager
In such a context, Nepalese mental health will have to learn a lot from others and to make con1nuous aGempt in service extension, academic progress and research coverage. A Nepalese psychiatrist like me working in an academic ins1tute3,4 of a developing na1on aspires to collaborate with professional colleagues and organisa1ons interna1onally such as PRIME2. In the current state of stress and crisis, Nepalese mental health professionals require generous support and assistance from their colleagues and associated organisa1ons, like PRIME for appropriate disaster response, management and thereaQer rehabilita1on, not only in visible physical but also in psychological dimensions. Now, I am dreaming for recupera1ng and rehabilita1ng Nepalese society, both visible physically outside and psychologically inside through appropriate disaster response (provision of shelter, safety, basic needs), management (problem solving, coping, health care, needful assistance, early diagnosis and treatment) and rehabilita1on (earth-‐quake resistant residence and safety conscious structures, capacity based employment and fair facilita1on of people in development ac1vi1es etc.). I hope and pray my dream come true!
1. Shakya DR. Psychiatric emergencies in Nepal. Developing Mental Health, Interna1onal Journal for Mental health care. UK. 2008; 6(8): 5-‐7. 2. PRIME (Partnership in Interna1onal medical educa1on) Network. hGp.www.prime-‐interna1onal.org 3. Shakya DR. Department of Psychiatry, BPKIHS And It’s Contribu1on To Mental Health Literature of Nepal. J Psychiatrists’ Associa1on of Nepal. 2014;3(1).
4. BP Koirala Ins1tute of Health Sciences (BPKIHS). bpkihs.edu/introduc<on
I have, am engaged and seeking to: 1. Pursue Mental health awareness acNviNes (I have run an orientaNon workshop for major teacher force of Bhaktapur (principals, vice-‐principals, in charges of about 40 schools) with aCendance of about 100. Similar programs will be there for other groups. Also, will be busy in Panga KirNpur, another very hard hit place. There are many similar requests and proposals. I am afraid I may not be able to help all of them. 2. DistribuNng print mental health materials in tented placements and other needful places. 3. WriCen many arNcles for naNonal and regional papers (including KanNpur, my arNcle happened to be the first in whole country raising voice for mental health during this mega-‐quake and happy to be joined by many others). 4. Media coverage by interviews in FM, TV. 5. Health state assessment for the vicNms coming into my contact (so far about 400 vicNms covered from my locality, also through the volunteers I oriented). 6. Seeking a way/fund for organising mental health camps for needy vicNms. With all these, hope I will be able to do something for mental recuperaNon of my traumaNsed sisters and brothers and I will be joined/supported some way.
A recent email from Dr Dhana to Dr John Geater, PRIME’s International Director, demonstrates how much of an extraordinary impact one person can make…
Psychological First Aid: Pocket guide (Screenshot)
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Registered Office: Innovation Centre, Highfield Drive, Churchfields, St.Leonards, East Sussex, TN38 9UH www.prime-international.org
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