“First aid for the mind is just as important as first aid for the body”
Life in general, most of us have directly observed our friend, family member, coworker in psychological distress. Psychological first aid can be used before, during, or after a crisis event. An important aim of psychological first aid is to build people’s capacity to recover.PFA is a supportive and compassionate presence designed to do primarily three things:
1. stabilize (prevent the stress from worsening)
2. Mitigate (de-escalate acute distress
3. facilitate supportive care, if necessary PFA primarily does not include diagnosis or treatment.
Psychological first aid supports recovery by helping people to identify their immediate needs and their strengths and abilities to meet these needs. One of the well-known research findings is that a person’s belief in their ability to cope can predict their outcome. Typically, people who do better after trauma are those who are optimistic, positive, and feel confident that life and self are predictable.
Three Ways that Psychological First Aid (PFA) might begin
- Sometimes a person in distress may approach you and ask for help. For example, your one friend calls you and says, “ Hey, I’m feeling quite stressed out, do you have some time to talk?” A simple response like, “ Sure, what’s going on can relieve person a little. In many instances, the person simply wants to vent. They simply want to be heard. They don’t approach with the expectation that you will resolve the issue at hand. In these situations, it’s important to listen. Better not rush to solve the problem, unless that is the expectation. Once you've heard what they have to say, you can simply reply like, “ I’m sorry you are going through that, how can I help? If the person declines assistance then you might just say, “ Well let me know if something I can do, even if it’s just listening.” Follow up with that person in a day or two to see how they are doing.
- A second way PFA might begin is when someone approaches you on someone else’s behalf. They will suggest that you speak with the third party because something seems wrong. Be sure to ascertain from that person specifically what makes them believe something is wrong with the third party. For example, your daughter’s teacher may contact you and say she seems to be having a difficult time at school. Your response might be, “ What specifically is concerning you?” It might be grades, conflict with other students, or just a significant change in her behavior. With that information, you could talk to your daughter, “ Your teacher spoke with me yesterday. She said you seem to be distressed. What’s going on?” you can say, “ I’m sorry you are going through that, how can I help?” If there is really nothing you can do to assist directly at that point, then just say, “ Well let me know if there is something I can do, even if it’s just listening.” Again, periodic follow up is important.
- An especially challenging way PFA might begin is when you see someone who looks or sounds distressed. For that person’s well-being you can approach them, but what do you say? “ I couldn’t help but notice you seem distressed.” If they respond, ask, “ How can I help?” Then help them develop a plan to address the problem, or help them develop a plan for coping, or both. If they do not respond, or say there is nothing you can do, simply say “ I’m a good listener.” Again, if possible, follow up with that person at an appropriate time to see how the person is doing.
The three scenarios above are merely examples of how Psychological First Aid (PFA) might begin. PFA is no panacea, nor is it a substitute for mental healthcare, but years of research and experience has shown it can be a useful tool to assist people in acute distress when applied by those with proper training in PFA. Anyone can get training in PFA; it’s for everyone, from workplaces to professional responders, to the general public.
Dos and Don’ts in Psychological First Aid (PFA)
- Do remain calm when speaking to a person in distress. Show concern but be a confident reassuring presence. The other person will gain confidence from your confidence.
- Don't get caught up in the situation. Remember the antidote for stress is calm and confident.
- Do listen. Encourage the person to talk about what happened and their reactions to those events. If the person does not want to speak at that time, ask if you can check back with them later.
- Don't interrupt, unless the disclosure seems to be escalating the distress.
- Do try to identify “the worst part” of the situation, if possible. Do this carefully, and it can help you identify the core issues at hand if they are not otherwise obvious.
- Don't rush. If the person is medically stable and safe, the passage of time alone begins to de-escalate situations.
- Don't be dismissive. Don't minimize their concerns or say, “Well at least…” as an attempt to distract, or help the person feel better.
- Don't act on some preconceived notion of what you think the person needs. Ask what they need. Perspective-taking such as this will foster trust.
- Don't hesitate to ask specific questions about the person’s ability to competently attend to others (significant relationships, childcare, eldercare) or perform the duties of their job.
- Don't hesitate to ask about the intention to harm themselves or others. Seldom will this be an issue, but sometimes you may sense feelings of profound hopelessness, depression anger vindictiveness. In such cases, it’s important to inquire and follow up. In the most rare and extreme cases, you may have to help the person get immediate professional care.
- Don't make promises you can't keep.
- To determine what else if anything is needed after your initial conversation. Don’t hesitate to ask for guidance or assistance from a healthcare professional if you are worried about the person’s well-being.
- Do serve as a liaison to connect the person with continued assistance, if necessary.
- To advocate for this person in seeking further assistance, if necessary.
- Do follow up a day or so later to see how the person is doing.