Psychological first aid and health care professionals
In the same way that you respond to medical emergencies through the ethical principles of doing no harm and doing good http://www.aaem.org/aboutaaem/codeofethics.php, there are some principles of mental health first aid that will help you respond helpfully and ethically. Here are some suggestions, adapted and modified from the Substance Abuse and Mental Health Services Administration (SAMHSA) website (PDF).
When you first meet people who have experienced disaster, they will often have intense and appropriate emotions that include intense fear, uncertainty, and apprehension. You can help them manage the stress associated with their initial disaster response through the following “Dos” and “Don’ts”:
DO:
Promote Safety:
- Help people meet basic needs for food and shelter, and obtain emergency medical attention.
- Provide repeated, simple, and accurate information on how to get these basic needs.
Promote Calm:
- Listen (PDF) to people who wish to share their stories and emotions and remember that there is no right or wrong way to feel.
- Smile, use a soft tone and open and welcoming gestures, while allowing the person you are talking with to dictate the distance between you.
- Be friendly and compassionate -- even if people are being difficult.
- Offer accurate information about the disaster or trauma and the relief efforts underway to help victims understand the situation.
Promote Relationships:
- Introduce yourself if they do not know you.
- Ask the person what they would like to be called, and do not use nicknames or first names without permission. With some cultures it is important to always address the person as Mr. or Mrs.
- Use words like “please” and “thank you”.
- Do not make global statements about the person’s character.
- Lavish praise is not believable.
Promote Connectedness:
- Help people contact friends and loved ones.
- Keep families together. Keep children with parents or other close relatives whenever possible, and understand that the way of responding to trauma will vary with levels of development.
Promote Self-Efficacy (PDF):
- Give practical suggestions that will steer people toward helping themselves. This is a time for “tranquilization by the trivial.”
- Engage people in meeting their own needs.
Promote Help:
- Find out the types and locations of government and non-government services and direct people to those services that are available.
DO NOT:
- Force people to share their stories with you, especially very personal details.
- Give simple reassurances like “everything will be okay” or “at least you survived.”
- Tell people what you think they should be feeling, thinking, or how they should have acted earlier.
- Tell people why you think they have suffered by alluding to personal behaviors or beliefs of victims.
- Make promises that may not be kept.
- Criticize existing services or relief activities in front of people in need of these services.
These and other ways of being can interfere with the working alliance (PDF) you might otherwise establish with people you are trying to help.
Look for signs of agitation and increased stress. People in such phases of response to disaster may:
- Challenge or question your authority, in which case you might:
- answer the question calmly.
- repeat your statement calmly.
- Refuse to follow directions, which may be best responded to by:
- not asserting control. Rather, let the person gain control of him- or herself.
- remaining professional.
- restructuring your request in another way.
- giving the person time to consider your request and perhaps pose alternatives.
- Lose control and become verbally agitated, to which you might:
- reply calmly.
- state that you may need assistance to help them.
- Become threatening or intimidating, not responding to your attempts to calm, in which case you should:
- seek immediate assistance
Adapted from “Nebraska Disaster Behavioral Health Psychological First Aid Curriculum” at this site (PDF).
Summary: People in the midst of disasters, or immediately following, will often have strong feelings of confusion, fear, hopelessness, sleeplessness, anxiety, grief, shock, guilt, shame, and loss of confidence in themselves and others. Your early contacts with them can help alleviate their painful emotions and promote hope and healing. Your goal in providing psychological first aid is to promote an environment of safety, calm, connectedness, self-efficacy, empowerment, and hope.
Web Links
http://mentalhealth.samhsa.gov (PDF)
Treatment Locators
Mental Health Services Locator
(800) 789-2647 (English and Español)
(866) 889-2647 (TDD)
Substance Abuse Treatment Facility Locator
(800) 662-HELP (4357) (Toll-Free, 24-Hour English and Español
Treatment Referral Service)
(800) 487-4889 (TDD)
Hotlines
National Suicide Prevention Lifeline
(800) 273-TALK (8255)
(800) 799-4889 (TDD)
SAMHSA National Helpline
(800) 662-HELP (4357) (English and Español)
(800) 487-4889 (TDD)
Workplace Helpline
(800) WORKPLACE (967-5752)