Psychological First Aid (PFA)

Greater Kashmir

If Psychological First Aid (PFA) and follow up is good, only a small number of cases will need further assistance.

As the floods hit, the hospitals and other health centres got submerged, pharmacies & drugs got washed away, patients lost their prescriptions & medicines, and when managed to come out of the waters they took support from medical relief camps. Initially the camps helped with whatever was at hand. The following weeks witnessed inflow of drugs in such huge quantities that medicine literally got distributed not dispensed among direct and indirect victims both and we could see people shopping for medicine. And soon after many people were heard saying, “Please, no more medicines, we have been stuffed with medicines…need some food”. Someone also asked, “do all the medicines have to be taken empty stomach?
Tirelessly and fearlessly people did for each other whatever needed to be done and the floods are itself a witness to the effort.
Over a period of nearing two months now, the priority has shifted from relief to rehabilitation. With magnitude of destruction so huge, coming months so harsh, our darbar moving to brighter lands, and the rehab work so slow, many feel genuinely hopeless.
We can see the devastation and destruction of material but we cannot see the sadness, anger, irritability, fear, anxiety, numbness and disconnect of many; so the disruption may not be just of the dwellings but of the community psychosocial health as well. The former can be reconstructed with time but the latter may gain chronicity n burden our society for many many years.

Psychological first aid (PFA)
Psychological first aid is like any other first aid which is sometimes enough to take care of the patient or at least lesson the morbidity by timely referral. It can be given by family, friends, neighbours, colleagues and members of the general population
So be the volunteer who knows the job.

Recognise stressful traumatic reactions.

• Anger and irritability
• Numbness, withdrawal, or disconnect.
• Feeling a lack of involvement or enjoyment in favorite activities.
• Feeling a sense of emptiness or hopelessness about the future.
• Regression to earlier developmental phase.

• Sleep difficulties n Gastrointestinal problems (Diarrhea, cramps)
• Stomach upset, nausea
• Elevated heart rate n Elevated blood pressure
• Elevated blood sugar
• Fatigue or Hyper arousal

• Difficulty concentrating
• Difficulty with memory
• Intrusive Memories
• Confusion
• Recurring dreams or nightmares
• Questioning spiritual or religious beliefs.

• Family difficulties —physical, emotional abuse
• Substance abuse
• Being overprotective of family
• Keeping excessively busy
• Isolating oneself from others
• Being very alert at times, easily startled
• Problems getting to/staying asleep

• Avoidance – places, activities, people that bring back memories
• Person feels back in the moment of the trauma
• May see, hear, feel, smell, taste the sensations that happened in the event
• Ordinary response – It is NOT psychosis
• Generally only lasts about 30 seconds
• Become less frequent with time

Recognize psychological n emotional needs of people…
Most often, people especially need someone to talk to about their experience….
Someone to care
Someone to really listen to them…..
Someone to lean on or cry with…..
Someone to be present to them  ……

As a psychosocial volunteer
• Be an effective listener
• Encourage to talk about present state of feelings and thoughts rather than memorizing the traumatic episode  again  n again
• Try not to interrupt until story is ended and ask questions to clarify.
• Occasionally re-state a part of the story in your own words to make sure you understand.
• A proper body language, eyecontact, facial expressions, encouraging prompts, nods and soft tone of voice is critical.
• Establish sequence…   
• Avoid “Why and “Why not?”
• Do not give sermons…Assure these are expected ordinary reactions to an extraordinary event.
• Educate that one need not fight with oneself or feel guilty about such reactions and they will pass with time.
• Encourage to maintain the basic life structure or routine schedule.
• Respect the privacy n dignity of the sufferer
• Be non-judgmental, impartial n give equal care for all irrespective of gender, age, ethnicity, religion ,political  perspective
• Avoid “I know how you feel.”…in fact say I am trying to understand how you feel.
• Empathize not sympathize.
• Be flexible, soothing, supportive and advocate their issues where needed.
• Last but not least the volunteer has to be neat n tidy, well kempt n well dressed to gain the trust of the sufferer that yes…he or she looks in a position to help.
Remember, no matter how you personally see an event, if an individual sees it as traumatic, it is.

This can only be provided by mental health professional like psychiatrists, physician specialists with experience in psychiatry, clinical psychologists.
If Psychological First Aid (PFA) and follow up is good, small number of cases will need further assistance.
Refer if unpleasant symptoms last more than four to six weeks despite good PFA support.
It continues to be difficult for the person to function effectively on the job, or at home, or at school despite good PFA support.
An individual feels concerned about his/her behaviors or emotions.
Evidence of potential for violence to self or others, or psychotic processes
Excessive use of substances
Child abuseor Spouse abuse
Significant withdrawal (as change in behavior)

When volunteers are frequently exposed to the pain and stress of others, they can sometimes take that stress and pain on themselves.
And feel no time or energy for oneself, disconnection from loved ones, social withdrawal, increased sensitivity to violence,generalized despair and hopelessness, nightmares and over time personality can even change.
So, take care of self: rest, relax, eat well, and maintain daily routine, regular physical exercises n incorporate activities of interest’s n take personal and family time advisors…

So the way we joined hands to save each other in the first place …..We have to understand our responsibility in saving each other from the psychosocial aftermath of this disaster…
“If you are not the part of the solution you are the part of the problem.’