Should We All Be Trained In “Psychological First Aid”?

A couple of weeks ago, it was revealed that young women in England are becoming increasingly likely to self-harm, suffer from chronic mental illness and experience post-traumatic stress disorder (PTSD). According to a survey conducted by the NHS, one in eight young women (12.6%) aged between 16-24 have experienced PTSD, three times as many as when the last study was conducted in 2007. The rising levels of anxiety and depression in young Britons has been well documented and panic attacks are becoming common occurrences – of those diagnosed with a common mental disorder, 44.6% reported panic attacks, and women are twice as likely as men to have a panic disorder.

It seems fitting therefore, that the theme of this year’s World Mental Health Day, which is being marked today, is psychological first aid. Perhaps this term will not immediately mean anything to you – it certainly didn’t to me when I began researching this piece. But now, having spoken to psychologists, specialists and aid workers, not only has the meaning of psychological first aid become apparent, the importance of its principals has too. And while its main application is in critical and traumatic situations, the more we practise the basics in everyday life, the more beneficial it could be for all of us. Gerry Jackson, a former Metropolitan police officer, has been running traumatic incident training for the last 25 years. In this time he has both administered psychological first aid himself and also taught nurses, doctors, aid workers, airline staff, business managers and a variety of other professionals how best to provide it to those in need. Gerry’s reason for going into the field is deeply personal – he was part of a small team sent to Lockerbie in 1988 to deal with the aftermath of the bombing and plane crash. “We spent an awful three days recovering bodies and going to the mortuary,” he says. “In the end, I had to go for some counselling, which is when I decided to get trained myself." Gerry explains that much of what he teaches people is based on guidance first issued by the NHS in 2009. “It’s about comfort and consolation, protecting people from threat, immediate physical and emotional care, reuniting people with loved ones and also simply talking about it if they want to. To be honest, this is not rocket science, it’s common humanity. But when things have gone horribly wrong, people don’t know what to do, or they’re doing their best but not getting it right.”

“There are always going to be people around who will need help and to be listened to,” says Dr. Debbie Hawker, a chartered member of the British Psychological Society who has written a journal paper on the importance of psychological first aid for NGO workers. “These situations come up every day, so the more of us who know and understand psychological first aid, the better.” She explains that if you reduce what are known as the arousal reactions after an event i.e. rapid heartbeat and frantic thoughts, this can reduce the likelihood of people developing PTSD or other anxiety disorders later on. “A lot of people are naturally able to administer psychological first aid,” Hawker points out, “But if you have even basic training it can give you the confidence to go and ask someone if they’re OK and to be calm, and this in turn helps people to feel that someone’s there and that they’re not alone.”

The World Health Organisation's guide to psychological first aid is an online resource to get acquainted with the practice. Their basic tips include: "try to find a quiet place to talk, and minimise outside distractions", "respect privacy and keeping the person’s story confidential if this is appropriate", "stay near the person but keep an appropriate distance depending on their age, gender and culture", "let them know you are listening" and "be patient and calm."

It might seem that much of what psychological first aid incorporates could be seen as common sense or at least common decency, something Hawker agrees with. One example she gives her students is an incident when she saw an elderly woman who had fallen over in the road. “People just came out and helped. They put a coat over her legs, made sure she was warm enough, reassured her. Afterwards I thought ‘That’s what psychological first aid is’ – they gave her safety, warmth, water. And none of those people would be trained in it, they were doing it naturally.” Dr. Sarah Davidson, head of psychosocial support at the British Red Cross, helped to create the CALMER framework that the charity uses, based on six sequential stages: consider, acknowledge, listen, manage, enable and resource. “In the Red Cross we train all of our staff and volunteers in CALMER,” says Davidson. “It’s important to practise these interpersonal skills and strategies during normal days so that when big events do happen, our team are already accustomed to using them and so are more resilient.”

She points out that while first aid courses are readily available to the public, this is not the case for psychological first aid but that it would be “really helpful” if more people understood it or if training were made widely available. “People say that psychological first aid is common sense, but often things are only common sense once you know about them. People can end up doing things in these situations that they think are helpful, but it actually turns out that they’re not at all.” If you've ever witnessed a friend have a mental breakdown and been unsure what to do, or seen a visibly upset stranger but not stopped to check if they were OK, this is where psychological first aid would help. Psychological first aid is about giving yourself, and other people, the resilience and the resources to cope with difficult situations. It’s about remaining calm and it’s about having the confidence to approach someone. If we know that more and more young women in Britain are becoming highly anxious and at risk of having panic attacks or suffering from PTSD, then the least we can do is teach ourselves the tools to help them. As Davidson puts it, “I think that psychological first aid would be really useful in a much wider set of events, rather than just being administered after a traumatic event. It’s about how we support one another and how we facilitate coping with normal, everyday events, ahead of the extremes.”