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What is PFA?

Rather than implementing debriefing sessions, PFA can be used to support people experiencing disasters or other crisis events.
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I recently returned from Sierra Leone after 18 months of working out there with King’s Sierra Leone partnership as their mental health coordinator. On August 14, there was a big mudslide and widespread flooding in Freetown. Nearly 1,000 people died, but many, many internally displaced people. So at that time, just as a pure coincidence, we were due to be running a national teaching week. And for the mental health nurses, they’d all been called to Freetown and were there as a training session. The mudslide happened in the early hours of Monday morning. I think quite quickly after it happened, the Ministry of Health responded and said actually we need a mental health response to this.
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So by the very next day, we were all out on site, spread at various different sites across the different areas that were affected by the mudslide. The nurses were delivering psychological first aid at three of the affected sites initially. That was, I think, very, very challenging in the first couple of days. You know, people were still acutely distressed. It was noisy. It was hectic. There wasn’t any space to see anybody. But there were people, like I said, very, very distressed at the time. And I remember a lot of the nurses would talk to the patients and it took a big toll on them as nurses, as well.
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And sometimes, you would see them crying at the end of the day just because the stress of what they were hearing from other people. But I think it was good that the Ministry of Health recognised there was a need and supported the nurses through this. And actually, the nurses were only due to be in Freetown for a week for the training week. I think they stayed for three weeks in total, all of them. And then, as the response progressed, the Freetown-based nurses spent some of their time based at what became the camps for the internally displaced people and set up mental health bases at those sites. And they were there for about three months until the camps closed down.
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Initially, it was psychological first aid. But as the response progressed, it became clear that the nurses were there, and they were accepting referrals in from the other providers and looking at the people that were more severely affected by the mudslide. Well, what was good was that at the time people were openly talking about kind of mental health. I think Sierra Leoneans could understand mental health in the concept of disaster. They could understand that something bad happened, and that meant that people were prone to being quite upset about it and developing mental health problems. So it meant that was openly talked about. You heard it on the radio, talking about it.
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So it much more kind of recognition of it, as opposed to someone who becomes acutely psychotic, perhaps for no reason at all. This was kind of much more understood that your relative, your neighbour might have a reason to develop mental health problems coming out of the disaster. So it was much more widely recognised and talked about. And there were lots of advocacy campaigns, as well, afterwards of radio broadcasts. And actually, it got a lot more people phoning in, talking about mental health than perhaps happened before the mudslide when we did broadcasts there. The phones wouldn’t really ring before, but afterwards, people called in a bit more.

Rather than implementing debriefing sessions, psychological or mental health first aid (PFA) can be used to support people experiencing disasters or other crisis events. PFA is recommended by the World Health Organisation (WHO, 2011), and takes a humanitarian approach. It gives a framework for supporting individuals and ensures that dignity and culture are respected.

PFA has been endorsed by many international agencies and aims to reflect the current evidence and international consensus on how best to support individuals after disasters or other crisis events. PFA involves:

  • Providing practical and unintrusive care and support
  • Assessing needs and concerns
  • Helping people to address basic needs, for example, food and water, information
  • Listening to people, but not pressuring them to talk
  • Comforting people and helping them to feel calm;
  • Helping people connect to information, services and social supports
  • Protecting people from further harm

PFA is NOT:

  • Something that only professionals can do
  • Professional counselling
  • ‘Psychological debriefing’ in that PFA does not necessarily involve a detailed discussion of the event that caused the distress
  • Asking someone to analyse what happened to them or to put time and events in order
  • Although PFA involves being available to listen to people’s stories, it is not about pressuring people to share their feelings and reactions to an event

References

WHO. (2011). WHO | Psychological first aid: Guide for field workers. Retrieved from https://www.who.int/mental_health/publications/guide_field_workers/en/.

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