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