Sunday, 16 October 2016

Reflecting on the need for psychological first aid in 2016

Last Monday, (10th October) was World Mental Health Day (WMHD) 2016. Established 24 years ago by the World Federation for Mental Health, every year a different theme is used to both raise awareness, generate ideas for change and to share experiences. This years theme focused on the need for psychological first aid (PFA) and the support that should be provided to those in distress. We live in a world that at times feels characterised by unprecedented levels of conflict, natural and man-made disasters and personal trauma (such as abuse, neglect and sexual exploitation). Recognising what we can do to 'be with' and 'help' people experiencing trauma and crisis is important and critical to their mental health and well-being.

However, I think the risk of not recognising the trauma being experienced by others is very real. We are bombarded by 24 hour news stories from around the world and as a consequence, its easy to see why we might become inured to the impact on the mental health and well-being of others that such crisis's can bring. For example, on Wednesday evening when I returned from work, the main news item on the 10 o'clock news was the fact that Marmite was disappearing from our supermarket shelves as a consequence of a pricing dispute between one of the UKs biggest supermarkets and its main supplier. Sadly, the humanitarian crisis in Syria was way down the list of news items presented, and even then the story was framed in a dispute between the motives of both Russia and the US involvement in the dispute. Not good.

Of course recognising a mental health and or well-being problem is not always easy. Most mental health struggles do not occur in isolation to other experiences in our lives. I know from my research into the relationship between childhood sexual abuse experiences and adult mental health problems that experiencing trauma or some other crisis and its impact on one's mental health and well-being can be immediate and for some people also happen over a long period of time. I was reminded of this 'impact gap' last Tuesday during my journey back from London to Manchester.

I had left plenty of time to make the journey on the London underground, to get to the mainline station, buy a sandwich and small bottle of wine, and wait 10 minutes for the train to start boarding. It wasn't to be. I could see that the underground platform was already crowded as I approached it, but as there was a tube train already there I assumed that people would get on and the platform would become less congested. The train doors didn't open, and an announcement was made that there was a problem further up the line, and we would be delayed. After 15 minutes the numbers of people on the platform continued to grow, and my anxiety levels started to rise to such an extent that I started experiencing physical distress. I had to leave the station and get a taxi in rush hour traffic resulting in my missing my train back to Manchester.

It wasn't just the anxiety of missing my train that I was experiencing. On reflection I think it was also a memory of what happened on the same tube line way back in 1975. Then a train didn't stop at Moorgate station and crashed into the tunnel wall killing 43 people and injuring many, many more. I was living in London at the time, and I had travelled to work on the train before the one that crashed. I moved to Wales later that year, but for the 7 months between the crash and the move I never travelled on a tube train again. It was many years later that I finally started to travel on them once more. Coincidentally, I started my mental health nurse education and training in the October of 1975.

Thankfully my state of anxiety was short lived, and it wasn't really a crisis that required PFA. Unfortunately that is not always the case for many people caught up in a distressing traumatic situation. Critically, PFA is not something that only professionals are able to do. If you want to know more, about PFA, the WHO have produced a wonderful guide. However, in use, PFA does not necessarily involve a detailed re-telling of the event that caused the distress, but it will involve listening to people; its about providing practical care and support, which does not intrude; it might be about assessing concerns; and helping people address their basic and immediate needs. Absolutely it will involve comforting people and helping them feel calm; and protecting them from further harm. 

Some people will need PFA immediately or very soon after their crisis experience, others may find it useful slightly further down their road of recovery. It will very much depend upon an individual's experience, resilience store, and their emotional and physical resources. PFA appears to be most beneficial when the actions and responses help others to feel safe, calm and hopeful; able to access social, emotional and physical support; being connected to others, but also feeling able to help themselves as individuals and communities. Thankfully most of us won't find ourselves in a position of needing PFA, or of a need to provide it. But WMHD 2016, more so than in other years, helped me, to quietly reflect on all those whose lives will have been changed through such lived experiences.