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
THANK YOU