Psychological First Aid | Sunday Observer

Psychological First Aid

12 May, 2019
We work closely with community leaders and religious leaders in the trauma affected context
We work closely with community leaders and religious leaders in the trauma affected context

The Easter bomb attacks a fortnight ago which saw the senseless loss of over 250 innocent lives have left our entire nation reeling with emotional shock. The impacts of emotional trauma, now being increasingly recognised as a serious health issue could be as deadly as the physical impacts. Health officials have revealed that recent studies have proved that anyone, whether child or adult who is directly or indirectly exposed to mass scenes of devastation and violence, was a likely candidate for experiencing significant psychological trauma and developing post traumatic symptoms .These deep mental wounds could be difficult to heal unless detected and addressed early.

Psychological First Aid is the answer, says the The Sri Lanka College of Psychiatrists (SLC) which issued a press release that it was ready to provide psychological first aid for those who suffered in the recent bomb attacks, as a frontline treatment to reduce such trauma. .

The Sunday Observer spoke to Clinical Psychologist Ms. Dimuthu Pasqual, Clinical Psychologist at Jinendhi Center for Psycholgical Services. Having worked at the National Council for Mental Health as a Psychotherapist , a Civil Clinical Counsellor at Military Hospital, Colombo and provided counselling and psychotherapy for youths and adults, she adopts an integrated approach to counselling persons in emotional shock.


Q. The Sri Lanka College of Psychiatrists ( SLC) has issued a press release that it was ready to provide psychological first aid for those who suffered in the recent bomb attacks. As a person who has specialised in this field, for the benefit of our readers, what is psychological first aid in laymen language?

A. After a traumatic event or a disaster which can be a natural one like Tsunami or a man-made one like a terrorist attack people may lose their homes or loved ones, be separated from family and community, or may witness violence, destruction or death. Psychological First Aid (PFA) helps to reduce this initial distress caused by traumatic events and to foster short- and long-term adaptive functioning and coping.

Q. The SLC also mentioned that this was the first line of emotional support for anyone affected by disaster. What exactly does this kind of support involve?

A. PFA support can be given as follows:

• Providing practical care and support, which does not intrude;

• Assessing needs and concerns;

• Helping to address basic needs (for example, food and water, information);

• Listening, but not pressuring them to talk;

• Comforting and helping them to feel calm;

• Helping people connect to information, services and social supports;

• Reduce the risk factors of mental illness as a result of the event, such as post traumatic stress disorder.

• Protecting people from further harm.

Q. How does it help a victim who has undergone the pain of losing a relative in a violent manner, suffered injury or faced the trauma of seeing their loved ones buried in mass graves?

A. It is very painful though this pain and losses are unique to every individual when a community is affected by a traumatic event. The positive part is that people help each other to share the pain and stand up through the change. It is a blessing from our rich culture and collectivistic communities.

Q. What are the early signs of emotional trauma following a personal tragedy?

A. Some of the signs are intrusive recollections of the trauma, a sense of reliving traumatic events, hypervigilance, exaggerated startled response, flashbacks, nightmares, night terrors, sleep disorders, irritability, or agitated behaviour. They may also describe difficulty concentrating, avoidance of people and triggers that are reminders of the trauma, a range of dissociative symptoms, numbing, distress following internal or external triggers, feelings of isolation, detachment, and lack of trust.

Q. Are all these symptoms visible or are there hidden symptoms that the victims do not want to discuss openly and which could lead to more serious fallouts?

A. Yes some symptoms are very subtle like numbness so that the individuals show avoidance. Also, these symptoms may not arise at once. So we might assume the individual has overcome the trauma but internally he or she may be reliving with it.

Q. What is the advice you would give such patients?

A. It is of course painful to remind the events, However reach for help and process the memory so that it will not add to the pain of mind the patient is already undergoing .

Q. Do you have some guidelines you follow when dealing with such persons? For example UNICEF and the WHO have issued a set of guidelines now followed by many countries around the world. Do you follow similar rules? Or have you changed them to suit our local environment and culture?

A. We follow the same guidelines given by WHO with a more culturally sensitive way. For example, we work closely with community leaders and religious leaders in the trauma affected context.

Q. Is your staff able to handle an emergency situation like this?

A. Yes, our staff comprises a registered clinical psychologist, child psychologist, counsellors and psychology interns.

Q. Have they undergone formal training? Where and for how long?

A. Two senior psychologists have undergone training with the NGO Save the Children where they have volunteered providing PFA during the Aranayake Landslide incident.

Q. What fields of study did the training course cover?

A. Our training courses cover the following fields of study:

  •  How to approach people who may need support
  •  How to communicate and ask about people’s needs and concerns
  •  Help people to feel calm, address basic needs and access services
  •  Help people cope with problems 
  •  How to give appropriate information
  •  How to work with children

Q. Is your staff mainly volunteers? Are they picked from community level so that they are readily accessible to the public at large?

A. They are mainly volunteers. Currently most of the volunteers are students. We hope to reach the public more and train them.

Q. What about the impact on doctors having to deal with victims of bomb blasts? Don’t they too undergo various mental disorders as a result? To cite some examples, after terrorist attacks in Paris in 2015, a study on its impact on the frontline resident medical response team revealed high degrees of symptoms of PTSD , and anxiety as well as depression. Did our own frontline physicians exposed directly to dealing with victims of the bomb blast in April suffer from similar mental health impacts?

A. Any professional could go through the impact of a trauma. Even bystanders and supporters might be affected by trauma. It is essential that everyone is aware of it and seeks help. Support groups and discussions among professionals are good mechanisms.

Q. How do you deal with them and help them cope in the event of a future attack?

A. Adequate information and support groups can help us to prevent and build coping skills and resilience in such times. This needs to be done at a national level addressing all facets of society.

Q. Injured children also need counselling. The Easter attack left several children orphaned and sent to foster homes till their relatives could be traced. Since most of these kids refuse to talk, what methods do you use to win their trust to confide their innermost fears in you?

A. Relating to children is different from relating to adults. How children react to the hardships of a crisis depends on their age and developmental stage.

It also depends on the ways their caregivers and other adults interact with them. For example, young children may not fully understand what is happening around them, and are especially in need of support from caregivers. We need to give them more of our time and attention, and help them to keep regular routines. Also expression therapies such as Art and play therapy can be used to communicate with children.

Q. Hot on the heels of the Easter attack, we experienced a cyclone islandwide resulting in landslides and many houses going under water. This has affected both adults and children living in such areas. How have your officers dealt with such children?

A. Working a trustworthy child protection agency or network, whenever possible is important. Keeping children and their caregivers together, and not letting them get separated is the next. Listening to children’s views on their situation, make them feel safe and keep them in their routine are some of the support care we gave.

Q. Your advice to the public on how to react to any future attack with the minimum risk of emotional trauma?

A. Facing unexpected trauma could happen to anyone anywhere in the world. So building resilience and preparedness for mental, emotional trauma and providing adequate information is the key to manage such risks.

It is alright to seek support for mental health issues, and needs to be given equal or more importance just like physical damages. Eradicating the stigma on mental health by making support services and professionals available to the public would help to minimize risks.