Today is World Mental Health Day, when all stakeholders have the opportunity to raise awareness of mental health issues and stimulate appropriate action. This year’s theme is ‘Psychological first aid’, or PFA.
PFA is an on-site intervention intended to help people affected by a sudden traumatic occurrence, such as a mass-casualty event. It recognises that victims experience a variety of initial reactions after a traumatic event including psychological and behavioural reactions. It’s been proven that this technique decreases the chance of developing post-traumatic stress disorder, a debilitating condition that affects many people who experience a life-threatening event.
When PFA is applied in a timely and appropriate manner, most victims tend to recover well with the support of friends and relatives and only a few require further specialist support.
Although the World Risk Report (2015) ranked Malta as the second-safest place in the world to live in when it comes to natural disasters, our nation is not immune to mass casualty events. Last October’s Paqpaqli għall-Istrina accident is still fresh in our minds as are a number of fireworks-related accidents and industrial mishaps such as the 1995 Um El Faroud explosion.
The emergency and security services (the Civil Protection Department, the police and the Armed Forces of Malta) together with personnel and volunteers from the emergency health services and other organisations, such as the Red Cross, are usually the first on site to tend to the victims and, usually, priority is given to those who have been physically injured. While this approach may make sense from a resources point of view, we often overlook the fact that, although emotional distress is not always as visible as a physical injury, it may be equally painful and debilitating.
Psychological first aid should be provided as a key part of the emergency response and not as an afterthought
The national disaster contingency plan is said to have been undergoing a revamp recently and Malta’s preparedness to respond to mass-casualty events is regularly assessed during simulated drills conducted in different scenarios. However, little importance seems to be attached to having a coordinated PFA strategy. Such a national strategy should contain clear guidelines to emergency personnel and caregivers setting out the important elements, the dos and don’ts, the challenges presented by different settings and highlighting the importance of taking into account the age, vulnerability and cultural background of the victims.
The World Health Organisation mentions three important PFA principles which should be the backbone of any strategy: (i) the Look principle (assessing the safety of the area as well as identifying people in serious distress); (ii) the Listen principle (approaching people in need of support, asking them about their needs and listening to them while calming them down); and (iii) the Link principle (helping people to address their basic needs, access support services and cope with their problems by giving them accurate information and connecting them with their loved ones and other social support).
A good PFA strategy would advise caregivers of the importance of speaking slowly and concisely, maintaining a calm presence, giving encouragement and hope to survivors, avoiding speaking in terms of symptoms or diagnoses, avoiding patronising talk and, most importantly, avoiding any attempts to debrief the victims by asking them for details of what happened, which would force them to relive the traumatic experience.
Caregivers should also take into consideration the age, vulnerability and cultural background of the victim.
Children should be faced at eye level and special care must be taken to identify survivors having pre-existing disabilities and work with them in a quiet area.
For victims coming from a different cultural background, caregivers should be sensitive to particular customs including the choice of attire and the manner of greeting different family members.
A PFA strategy is essential because it’s been proven that successful provision of PFA depends on coordinated actions within a structured framework where roles and decision-making are clearly defined.
PFA should, therefore, be provided as a key part of the emergency response and not as an afterthought. This is why the Civil Protection Department and other authorities should seriously consider adopting such a strategy as part of the national disaster contingency plan.
Claire Axiak is a psychiatrist and a psychotherapist.