Psychological first aid is increasingly known after COVID-19 pandemic in India. People are gradually realising the importance of mental health in the Indian context. Mental health existed even before the pandemic. The Mental Health concerns and issues erupted like a volcano during and post emergency after years of dormancy. We are much more aware of medical first aid through school textbooks or red cross activities. We have not heard, let alone read about mental health aid and psychological first aid in schools.
So, what is Psychological First Aid? According to Public Health England, Psychological First Aid is a straightforward way of delivering psychosocial care in the immediate aftermath of emergencies, including infectious disease outbreaks. Be it the police, NGO, home officer, pharmacist, or teacher, any individual or group could deliver this aid by assessing the situation.
How do most people commonly respond to an emergency? I understand that socio-cultural differences affect the way people respond. People may respond rationally and selflessly, panic, freeze and tend to themselves. In my observation, collectivistic communities tend to respond selflessly/rationally. Whereas individualistic communities may respond selfishly. Indian communities are generally collectivistic in nature, but urban cities of India need not prove the same.
How do emergencies impact mental health? The trauma inflicted on individuals can vary in intensity and nature depending on the nature of emergency. The state of illness, isolation, bereavement, panic, helplessness, and entrapment were commonly felt during the pandemic. There are signs of distress seen immediately or after some time. Diagnoses are not made until symptoms have persisted for at least a month. Post-Traumatic Stress Disorder, Depression, Media and Substance abuse and Anxiety are more likely to develop after emergencies. PFA can reduce the risk of people developing those mental health illnesses.
Uncertainty, loss of control and disruption to normal supports were key features of the pandemic that lead to signs of distress. The first step in PFA is to prepare and look out or notice the signs of distress. The second step is to listen to understand their specific needs. The third is to link to provide further support. Reactions to stress may help us establish if someone is showing signs of distress.
The four major types of reactions to stress are emotional, cognitive, social, and physical. Emotional reactions involve how the individual perceives and copes with the stressor. They can vary from fear and anxiousness, helplessness, hopelessness/ demotivation, guilt, anger or frustration, sadness, loneliness to fear of the infection/calamity. Cognitive reactions are connected to thoughts and ability to manage them. These reactions include impaired concentration, confusion/disorientation, intrusive thoughts, dissociation/denial, hypervigilance, and impaired memory. Social reactions involve how a person interacts on a social level and looks after their basic personal needs. These reactions include reduced confidence/self-esteem, withdrawal, irritability, interpersonal conflict, avoidance, lack of self-care and obsessive/ compulsive behaviours. Physical reactions are somatic complaints. Any bodily system can be affected. Typical symptoms include breathing difficulties, increased heart rate and blood pressure, sweating, palpitations, muscle tension, gastrointestinal symptoms, and somatic symptoms: hyper-arousal, headaches, change in eating habits, reduced energy, and insomnia. People with cognitive differences show reactions that are different from how they usually react in day-to-day challenges. Caregivers/ close knit community members could help identify them.
Eighty percent of people experience distress in the first two weeks after the disaster or emergency. Professional help is a should if their distress lasts for more than two weeks. People who are developing disorders may have symptoms like people who are distressed. The difference is in the persistence, severity, and effects of these symptoms on peoples’ lives. The effects are disproportionate to the severity of the stress or mental health disorders develop new symptoms two weeks after the event. Secondary stressors can be socio-economic problems that can have long term effects. The long-term effects of secondary stressors can lead to persistent distress opening avenues to newer mental health concerns or worsening of existing mental disorders.
With that said resilience is a psychological trait that we can develop over our lifespan. Resilience and coping are adapting to, bouncing back or even bouncing forward after experiencing adverse events. The positive outcome is likely to depend on the amount of support we have at that time, our previous experience of distressing events, our perceived capacity to cope, the nature and severity of the situation itself, being able to accept and use psychosocial support, being able to deal with circumstances realistically, having strong self-belief and value. It is important to train children, adolescents, and adults in the grassroot levels of positive coping and psychological aid. We all are born with the innate capacity to cope adverse situations. Our body can heal from trauma and our nervous system is neuroplastic in nature. So, there is hope!
Written By - Maria Rose (Therapist at The Mood Space)
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