Guidelines for APS members working with communities affected by floods

Many APS members live and work in communities that have experienced floods and want to find the best ways of working with their community . 

Others also want to help in whatever way they can, after a disaster, such as a flood. What can we do? How can we help? What are the most effective ways of doing this?

Current research evidence suggests that the real need for specific psychological support is likely to come into play some weeks after the disaster event. In the meantime, current best practice in mental health recommends the provision of psychological first aid, which is aptly provided by disaster relief workers who provide early assistance to people affected by disasters or emergencies. We outline the key elements in psychological first aid (PFA) below. 

Other useful information can be found on the Psychosocial Support in Disasters website, which the APS and other peak mental health organisations developed and launched last year.

Crisis interventions

Considerable controversy has arisen in recent years about the value of the widespread use of crisis interventions that include debriefing as a central feature. In the past, workers commonly used debriefing even in the early stages after the crisis. 

The APS Disaster Preparedness and Response Reference Group recommends instead the provision of psychological first aid (PFA) by people who are responding to the immediate psychological needs of children, adults and families who have recently experienced a disaster. 

PFA is an approach that is most consistently supported by current research and practice, and can be used in disaster settings, as well as by frontline relief workers. The key elements of PFA are:

  • promote safety and calm
  • promote connectedness
  • promote self-and community efficacy
  • promote empowerment
  • instil hope.

The way PFA works is that initial assistance offered to people dealing with a disaster or traumatic event is designed to reduce the initial distress caused by the traumatic event, and to foster shorter term and longer term adaptive functioning and coping. 

It is based on an understanding that people affected by disasters will experience a range of early reactions (physical, psychological, emotional, behavioural) that may interfere with adaptive coping needed during or soon after a disaster (Brymer et al., 2006). 

PFA is designed for children, adolescents, parents/caregivers, families and adults, as well as disaster relief workers. 

It is designed to be delivered by the first responders who may or may not have mental health skills but provide early assistance to people affected by disasters or emergencies. 

Initial responses expressed following a disaster or emergency are often labile, intense and highly reactive to ongoing circumstances Such reactions may be quite protective responses to a life threat, and tend to subside once people feel safe again (Silove et al., 2006). 

Therefore, the best responses are focused and flexible, and require the gathering of information to be responsive to the needs of individuals, and being sensitive to the experience of the person involved (Vernberg et al., 2008). 

In clarifying disaster-related traumatic experiences, people should avoid asking for an in-depth description of traumatic experiences as this may provoke unnecessary additional distress.  

Key elements in providing Psychological First Aid

(Adapted from Substance Abuse and Mental Health Services Administration (SAMHSA) (2007). Psychological first aid: A guide for emergency and disaster response workers. Washington, DC: U.S. Department of Health and Human Services)

1 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.

2 Promote calm

  • Listen to people who wish to share their stories and emotions, and remember that there is no right or wrong way to feel.
  • 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.

3 Promote connectedness

  • Help people contact friends and loved ones.
  • Keep families together, Keep children with parents or other close relatives whenever possible.

4 Promote self-efficacy

  • Engage people in meeting their own needs by helping them regain their confidence and ability to manage their current and future situations.

5 Promote help

  • Find out the types and locations of government and non-government services and direct people to the range of services that are available during and after the disaster. 
  • When they express fear or worry, remind people (if you know) that more help and services are on the way.

What not to do

It is not useful, and may even be harmful, to directly encourage a disaster survivor to ventilate their responses in the initial phase.  If a person has a desire to discuss their experiences, it is useful to provide them with support to do this but in a way that does not encourage disclosure beyond the level that they wish to discuss.

It is inappropriate to conduct a psychological assessment within the acute setting.  It is important to limit contact at this point to simple support, as outlined by Psychological First Aid.  People who display marked signs of risk (e.g., suicidality) should be referred for formal psychological and health services.

Subsequent psychological support

Specific psychological support provided by psychologists may be appropriate for facilitating psychological recovery later on, in the weeks and months following the disaster, for people affected more severely by the experience of the disaster or emergency. 

These might be people who are not starting to feel any better some weeks after safety has been restored, who may still be feeling highly anxious or distressed, and finding that their reactions to the traumatic event are interfering with home, work or relationships, and who are needing help to develop situation-specific adaptive coping.

References

Helping communities in times of crisis - APA Disaster Response Network (PDF, 1.24MB)

Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., Watson, P.  (2006).  Psychological first aid.  Field Operations Guide. Second Edition. National Child Traumatic Stress Network.  National Center for PTSD.

Jacobs, G.A. & Meyer, D.L. (2006) Psychological first aid: Clarifying the concept. In L. Barbanel & R.J. Sternberg (Eds) Psychological interventions in times of crisis (pp 57-71).  New York: Springer Publishing.

Munoz, M. Austin, B., Perez-Santos, E. (2007) Psychological first aid: ACERCARSE protocol 1. Psicologia Conductual, 15, 479-505.

Silove, D., & Steel, Z. Psychol, M. (2006).  Understanding community psychosocial needs after disasters: Implications for mental health services. Journal of Postgraduate Medicine, 52, 121-125.

Substance Abuse and Mental Health Services Administration (SAMHSA) (2007) Psychological first aid: A guide for emergency and disaster response workers. Washington, DC: U.S. Department of Health and Human Services  

Vernberg, E.M., Steinberg, A.M., Jacobs, A.K., Brymer, M.J., Watson, P.J., Osofsky, J.D., Layne, C.M., Pynoos, R.S. & Ruzeck, J.I. (2008) Innovations in disaster mental health: Psychological first aid. Professional Psychology: Research and Practice, 39, 381-388.

Young, B. (2006) The immediate response to disaster: Guidelines for adult psychological first aid. In E.C. Richie, P.J. Watson & M.J. Friedman (Eds) Interventions following mass violence and disasters: Strategies for mental health practices (pp 134-154). New York: Gilford Press.

Useful links and resources

Psychological First Aid: An Australian Guide 

This document was developed following roundtable discussions on 15 December 2009, co-hosted by Australian Red Cross and the Australian Psychological Society. The purpose of the guide is to provide an overview for people working in disaster preparedness, response and recovery about best-practice in psychological first aid following disasters and traumatic events.

Disaster Response Network (DRN)

The Disaster Response Network (DRN) is a national network of psychologists who have a special interest and expertise in working with individuals and communities affected by disasters and emergencies in Australia as well as those working to assist them. 

Psychosocial Support in Disasters web portal

This web portal provides health professionals working with disaster-affected individuals and communities with a step-by-step guide to disaster response and the psychological implications at each stage from preparation through to response and recovery.  

Psychological First Aid: Field Operations Guide

Developed by the National Center for PTSD, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning.

IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings

The Inter-Agency Standing Committee (IASC ) issues these guidelines to enable humanitarian actors to plan, establish and coordinate a set of minimum multi-sectoral responses to protect and improve people’s mental health and psychosocial wellbeing in the midst of an emergency.  

Best practice guidelines

APS Ethical Guidelines on co-ordinated disaster response, pro bono, or voluntary psychological services  

Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder

The Australian Centre for Posttraumatic Mental Health developed these guidelines in consultation with trauma experts from a range of disciplines, as well as people affected by trauma. These guidelines provide practical recommendations applicable in all healthcare settings.

APS tip sheets

APS tip sheets inform clients about a range of psychological issues and how psychologists can help. They are a useful resource for private practitioners and other health professionals, especially GPs.

InPsych special report: Response and recovery after the floods

The following special report appears in the February 2011 edition of InPsych.