PSYCHOLOGICAL FIRST AID FOR TEENAGE YEARS –AN ESSAY BY DR.JAYAMOHAN M.B.,B.S.,

SYNOPSIS

·       Why PSYCHOLOGICAL FIRST AID ?

·       Why The Theme For 2016  ?

·       Burden Of Psychiatric Illness In India- Statistical Data

·       Stigma Related To Mental Illness

·       What Is PSYCHOLOGICAL FIRST AID ? What Not Is PFA ?

·       What Illnesses Psychological First Aid Covers For ?

·       Who Can Participate ?

·       Who Are The TARGET GROUPS ?

·       Where Can PFA Be Provided?

·       Why TEENAGERS ?

·       Why Provide PSYCHOLOGICAL FIRST AID  in SCHOOLS?

·       Why TEACHERS To Provide Psychological First Aid  ?

·       The ACTION PRINCIPLES of PSYCHOLOGICAL FIRST AID

·       ALGEE Action Plan

·       COPING UP

·       Helping Responsibly: Ethical Guidelines

·       PSYCHOLOGICAL FIRST AID IN INDIA-SUNDHAR APPROACH BY SANGATH-NGO

·       Specific Entities

o  Depressive Disorders

o  Eating Disorders

o  Alcohol Abuse &  Drug/Substance Use

o  Suicidal Thoughts & Deliberate Self Harm

o  Bullying

o  Sexual Abuse

·      Conclusion

WHY PSYCHOLOGICAL FIRST AID ?

World Mental Health Day is celebrated on 10^th of October annually across the world to create awareness on mental health issues. The theme of this year’s World Mental Health Day is

“PSYCHOLOGICAL FIRST AID”.

Contrary to the name suggests, psychological first aid covers both psychological & social support.

 Mental health crises & distress are viewed differently because of ignorance, poor knowledge, stigma & discrimination. This cannot continue to be allowed to happen, especially as we know that

There Can Be No Health Without Mental Health.

Psychological & mental health first aid should available to all, & not just a few. This is the reason why the World Federation for Mental Health (WFMH) has chosen psychological & mental health first as its theme for World Mental Health Day 2016.

 Mental health disorder is one of the common disorders across the globe. According to World Health Organization, there are approximately 450 million people who suffer from mental disorders. In India, around 1.5 million people are affected from severe mental health problems, including children & adolescents. Many are reluctant to seek help or might not even know where to turn for care. As a society, we remain largely ignorant about the signs & symptoms of mental illness, & we ignore our role as responsible community members to help people experiencing these illnesses.

BURDEN OF PSYCHIATRIC ILLNESS IN INDIA- STATISTICAL DATA UNVEILS THE HIDDEN TRUTH

Six percent of Kerala’s population have mental disorders & 1 in  5 have emotional & behavioral problems & needs mental health counselling, reveals govt statistics.

In fact, depression, the commonest form of mental illness, is prevalent in 30.7 out of 1,000 people in urban areas like Mumbai. WHO statistics say the average suicide rate in India is 10.9 for every lakh people. Interestingly, doctors observe that suicide rate was higher among the southern States compared to those in the north. It is the second leading cause of death among those in the age group of 18-29, & most suicides in India are by those below 44 years.

O.3 PSYCHIATRISTS PER ONE LAKH POPULATION IN INDIA. WHO statistical data 2014.

The Government of India had started the National Mental Health Program (NMHP) in 1982, considering the heavy burden of mental illness in the country.

Stigma Related To Mental Illness

There is a  misconception that the people suffering from mental disorders are violent & dangerous to public. Such negative attitude & misbelief results in social distance,particularly for those experiencing psychotic disorders. This results in  social stigma.

The inability to communicate effectively to the general public has a damaging effect on the mentally affected individuals, as well as the society as a whole. That's why, the public awareness & social support to mentally sick individuals play a key role to combat this stigma.

What is Psychological First Aid ?

Its an education training program that introduces participants to risk factors & warning signs of mental health problems , builds underst&ing of their impact & overviews common treatments. It uses

·        role playing,

·        group work activities &

·        simulations

 to demonstrate how to assess mental health crisis , select interventions & provide initial help & connects persons to Psychiatrists, & social supports as well as self help resources.

Few questions that psychological first aid answers us are :

·        What can I do as a participant ?

·        Where can someone find psychiatric help ?

·        How can I promote or protect the well being of someone ?

What is not psychological first aid ?

·         It is not professional counselling.

·         It is not “psychological debriefing” in that PFA does not necessarily involve a detailed discussion of the event that caused the distress.

·         It is not asking someone to analyze what happened to them or to put time & events in order.

·         Although PFA involves being available to listen to people’s stories, it is not about pressuring people to tell you their feelings & reactions to an event.

What illnesses Psychological first aid covers for ?

Non crisis situations	Crisis/critical situations
·       Anxiety disorders ·       Depressive disorders ·       Eating disorders ·       Bulimia ·       Anorexia nervosa ·       Alcohol abuse ·       Drug/substance use ·       Psychosis ·       Attention deficit hyperactivity disorder	·       Suicidal thoughts/ideations/ behaviors/tendencies ·       Non suicidal self injury ·       Deliberate self harm ·       Acute alcohol intoxication ·       Problem cannabis use ·       Bullying ·       Sexual abuse/violence ·       Cyber abuse ·       Natural disaster-fire accident, ·       hurricane, floods ·       building collapse, ·       bombing, ·       firearm ,gun shooting
Who can participate ?		Who are the target groups ?
·       Social workers ·       Employers ·       Faith community leaders ·       School teachers ·        School counselors ·       College/university faculty & staff ·       Police, veterans ·       Firemen ·       Parents/Family Members of person suffering from psychiatric illnesses ·       NGO ·       Ebola burial team		·       Children ·       Teens, adolescents ·       Adults ·       Person with Family history ·       Alcoholics ·       Drug abusers ·       LGBTQ persons ·       Obese teens, lean teens ·       people with serious, life-threatening injuries who need emergency medical care ·       people who may hurt themselves or hurt others

Where is PFA provided?

PFA is provided wherever it is safe enough to do so. Eg, at the scene of an accident, or places where distressed people are served, such as health centres, shelters or camps, schools & distribution sites for food. For people who have been sexual violated, privacy is essential for confidentiality & to respect the person’s dignity

Approximate Age	Psychosocial crisis	Virtues	Related forms of psychopathology
Infancy 0-2 years	Basic trust vs. mistrust	Hope	Psychosis, addiction,depression
Early childhood 2–4 years	Autonomy vs. shame & doubt	Will	Paranoia,obssession,compulsion,impulsivity
Preschool age 4–5 years	Initiative vs. guilt	Purpose	Conversion disorder., phobia , psychosomatic disorder, inhibition
School age 5–12 years	Industry vs. inferiority	Competence	Creative inhibition, inertia
Adolescence 13–19 years	Identity vs. role confusion	Fidelity	Delinquent behavior, gender related identity disorders, borderline psychotic episodes
Early adulthood 20–39 years	Intimacy vs. isolation	Love	Schizoid personality disorder, distantiation
Adulthood 40–64 years	Generativity vs. stagnation	Care	Mid life crisis, premature invalidism
Maturity 65-death	Ego integrity vs. despair	Wisdom	Extreme alienation, despair

ERIKSON'S STAGES OF PSYCHOSOCIAL DEVELOPMENT

WHY TEENAGERS ?

Teenagers include 13 to 19 years age old boys & girls.

Teenagers get easily affected & can react with varied emotions as in case of

·       Loss of a family member, school mate or friend

·       Observing serious injury or death of another person

·       Family members missing after an event

·       Getting hurt after an event

·       Home loss, family moves, change in neighborhood, school or loss of belonging

·       Past traumatic experience, injury

·       Pet loss

•  Had a close personal relationship with any victim(s)

•  Have a history of depression or suicidal thoughts or attempts

•  Have a history of anxiety, shyness, or low self-confidence

•  Have a history of risk-taking behavior

–– Those exposed to community violence or domestic violence

–– Those with a history of abuse &/or neglect

–– War or other refugees or political asylums

–– Members of economically disadvantaged groups

–– Medically vulnerable individuals

·       autistic children                

·       speech impairment            

·       emotional disturbance       

·       hearing visual impairment

·       cognitive impairment

·       learning disabilities

POST TRAUMATIC STRESS/ POST DISASTER PSYCHOLOGICAL AID- A PICTURE

Why Provide Psychological First Aid in Schools?

1. Schools are typically the first service agencies to resume operations after a disaster/emergency & can become a primary source of community support during & after the incident.

2. Preparing for emergencies is critical for all school staff. While school personnel should be prepared to respond to high impact/low frequency events such as fire accidents, school shootings, large-scale natural disasters ,& public health emergencies, they must also be prepared to address smaller scale events that schools face each day. Emergency events that do not typically garner national headlines, but do disrupt the learning environment, include suicides, transportation accidents, peer victimization, community violence, staff or student deaths, injuries on the playground, & infectious diseases

3. Emergencies affect students’ academic & social achievement.

4. Trauma-related distress can have a long-term impact if left untreated. Unaddressed mental health needs, including those from exposure to violence & other potentially traumatic events, increase dropout rates, lower academic achievement, disrupt peer relationships, & impact overall well-being.

5. Brief interventions can produce positive results that last

Why teachers are the best to provide psychological first aid to teenagers ?

Most of the teenagers go to school. As a teacher , they are in an excellent position to help their students after a disaster, school crisis or an emergency. Teachers are the one who get the direct experience/first h& experience of the event. After the event, changes can happen in students’ thoughts, feelings & behaviors. Common reactions to disasters, include trouble sleeping, problem at school & with friends, trouble concentrating, not finishing work/assignments. The student may become more irritable, sad, angry or worried.

As a Teacher ,

Listen-

·       behavior of the teenager

·       School performance

·       Interactions with school mates & teachers

·       Participation in school activities

·       Behavior at home as discussed with parents

Protect

·       Speak to them honestly

·       Adjust the assignments

·       Encourage the student to take a break from activities

Connect

·       Check in with the student

·       Find resources that can offer support to them

Teach

·       Coping strategies

·       Help them at every step

Synopsis of Core actions

1. Contact & Engagement

2. Safety & Comfort

3. Stabilization

4. Information Gathering

5. Practical Assistance

6. Connection with Social Supports

7. Information on Coping

8. Linkage with Collaborative Services

THE ACTION PRINCIPLES OF PSYCHOLOGICAL FIRST AID

Look

·       Check for safety

·       Check for adolescent with obvious urgent basic needs

·       Check for teenager with serious distress reactions

Listen

·       Approach people who may need support

·       Ask about people’s needs & concerns

·       Listen to people & help them to feel calm

Link

·       Help people address basic needs & access services

·       Help people cope with problems

·       Give information

·       Connect people with loved ones & social support

ACTION PLAN  FOR MENTAL HEALTH FIRST AID

ALGEE ACTION PLAN

A-APPROACH

L-LISTEN

G-GIVE SUPPORT

E-ENCOURAGE PROFESSIONAL HELP

E-ENCOURAGE OTHER SUPPORTS

·       Approach someone whom you recognize the warning signs & symptoms , assess for the signs & assist with any crisis

·       Listen non-judgmentally

·       Give support , be it emotional or practical & give information like fact sheets or web sites

·       Encourage appropriate professional help , like medical & psychological therapies , encourage the person to speak to their doctor,psychiatrist

·       Encourage other supports like self help strategies , cope up with alcohol abuse , seek attention from family members, beloved ones & friends.

COPING

Everyone has natural ways of coping. Encourage people to use their own positive coping strategies, while avoiding negative strategies. This will help them feel stronger & regain a sense of control

Encourage positive coping strategies	Discourage negative coping strategies
·       Get enough rest. ·       Eat as regularly as possible &   drink water. ·       Talk & spend time with family & friends. ·       Discuss problems with someone you trust. ·       Do activities that help you relax (walk, sing, pray,play with children). ·       Do physical exercise. ·       Find safe ways to help others in the crisis & get involved in community activities.	·       Don’t take drugs, smoke or drink alcohol. ·       Don’t sleep all day. ·       Don’t work all the time without any rest or relaxation. ·       Don’t isolate yourself from friends & loved ones. ·       Don’t neglect basic personal hygiene. ·       Don’t be violent.

Helping Responsibly: Ethical Guidelines

·        Do’s  

·        Before you approach an individual, first observe politely.

·        Offer practical assistance (food, water). This is often the best way to make contact.

·        Ask simple, respectful questions to determine how you may help.

·        Remain flexible & adjust to people & their situations as needed. Do not enter the site with any agenda other than providing PFA.

·        Be prepared for those impacted by the event to either avoid you or flood you with contact.

·        Speak calmly. Be patient, responsive, & sensitive.

·        Speak slowly, in simple concrete terms; do not use acronyms or jargon.

·        Listen carefully when students want to talk. Focus on understanding (“getting”) what they want to tell you, & hearing how you can be of help. Children who are too young to speak, or who may not speak clearly, often express their feelings & show what they want through their behaviors, such as play.

·        Support & reinforce the person’s individual strengths & coping strategies, including the positive things he/she has done to stay safe.

·        Give information that directly addresses the person’s immediate goals, & clarify answers repeatedly as needed.

·        Give information that is accurate & age-appropriate.

·        Reassure young children that the adults are there to protect them & keep them safe.

·        Remember that the goal of PFA is to reduce distress, assist with current needs, & promote adaptive functioning.

Don’ts

·      Do not assume that everyone who has been through the emergency will be traumatized.

·        Do not pathologize

·         Do not focus on the individual’s helplessness, weaknesses, mistakes, or disability. Focus instead on what he/she has done that is effective or has contributed to helping themselves or others, both during the emergency & in the present setting. Let the student know that continuing to attend school & performing academically shows his/her strength & resilience.

·        Do not assume that all students & staff members want or need to talk to you. Being physically present in a supportive & calm way in itself often helps affected people feel safer.

·        Do not “debrief” by asking for details of what happened.

·        Do not give inaccurate information.

Psychological First Aid In India-SUNDHAR Approach By Sangath

Sangath is a non-governmental, not-for-profit organisation committed to improving health by empowering existing community resources to provide appropriate physical, psychological & social therapies. Its primary focus areas include child development, adolescent & youth health, & mental health & chronic disease.
    Started in 1996, it began as Goa’s first multi-disciplinary child development clinic based in Porvorim through the voluntary contributions of its seven founder-members. Sangath has now stretched its reach to become one of the state’s most influential health NGOs garnering local, national & international recognition.
    Over the years, we have shifted to a public health model to increase the coverage of basic interventions for child development, adolescent health & mental health. We empower low-cost human resources with knowledge & supervision to improve access to healthcare for children with developmental disabilities, adolescents & young people, or people with any form of mental disorder.
    Training & supervising low-cost human resources is one of our most inventive strategies, & examples of our work using this method include:

·        Training lay people, whom we refer to as health counsellors, to deliver psychosocial treatments for depression in adults attending primary healthcare centres or for schizophrenia in community settings

·        Training lay people or teachers, whom we refer to as school health counsellors, to deliver a package of interventions to promote the health & educational outcomes of adolescents in schools

·        Integrating learning resource rooms & remedial education in mainstream schools to promote inclusive education for children with learning disabilities (such as LEL & Prayas)

·        Training community outreach workers to promote the mental health of people living with HIV & their caregivers

Our work is driven by a few guiding principles:

·        Multi-disciplinary interventions:.

·        Linking services with

·        Inter-sectoral collaboration: Our work today involves a collaborative framework involving key partnerships with government health services, department of education, schools, other NGOs & the Goa Medical College.

·        Scaling up

Six projects following the SUNDAR approach are currently in progress, for:

1)  the treatment of alcohol use disorders in primary care;

2)  the treatment of severe depression in primary care;

3)  the treatment of maternal depression in community settings by peers (i.e. other mothers);

4)  parent-mediated interventions for autism;

5)  school mental health promotion for young people; &

6)  the prevention of depression in late life.

  

Newspaper Headlines – Reveals The Intensity & The Need For The Psychiatric First Aid

The Effects of Media Coverage of Disasters on Children & Adolescents :

Because the news media often focus on the most frightening aspects of disasters,viewing disaster media coverage can be emotionally upsetting for children &  adolescents.

                                                                                 Youth who view media coverage may be afraid, worried, or anxious. They may not be able to sleep because of these reactions or may not be able to stop thinking about what they have seen or heard.

                                        Students may be distracted while in class because they are thinking about the event or they may not be able to pay attention to their class work because they are tired from not sleeping well. Reactions such as fear & worry result from youth thinking that what they see on TV or the Internet could happen to them, their family, or their friends.

Disasters covered in the media do not have to occur close to home to be upsetting for children & adolescents. Media coverage of major disasters like

·       COIMBATORE BOMBING 1998

·       BANGALORE TRAIN BOMBING 2013

·       CHENNAI TRAIN BOMBING 2014

·       URI ATTACK,

·       PATHANKOT ATTACK 2016

·       2015 CHENNAI , PONDICHERRY FLOODS

·       2016 ASSAM FLOODS

·       2015 GUJARATH CYCLONE

Create panic among teens & general population can upset youth residing far from those events. Older youth may be able to distinguish between disasters that are closer to, or farther from home, but younger children may not be able to make that distinction. Teachers & school staff should be aware that any disaster depicted in the media has the potential to affect a student & that youth may not be able to accurately estimate their

vulnerability to a natural or human-caused event.

                                   The more disaster media coverage students see, the more afraid or upset they may become. Media coverage of a disaster may cause youth to worry about what is happening, which in turn causes them to want to watch more of the disaster coverage to get more information, which can then cause them to worry even more.

                                   Younger children may be even more frightened by disaster media coverage than older youth. Video & images of injury, death, & destruction may be particularly upsetting for younger students. 

               Given the potential of media coverage of disasters to frighten or upset young people, what can you as a teacher or school staff member do? The next section describes strategies you can use to prevent or reduce the distress students experience in reaction to disaster media coverage.

Strategies for Helping Students Cope with Disaster

          When a major disaster is covered in the news, one way teachers & school staff can help students is by explaining the event.

Explaining media coverage of disaster includes:

Helping students understand  what has happened & what is happening.

 This may include discussing where the disaster happened (e.g., how close the disaster was to where your students live) & why it occurred.

This may also include clarifying any misconceptions students have about the disaster.

 Connecting the disaster to lesson plans. Explaining what happened in a recent disaster can be explored through history, geography, social studies, & science lesson plans.

                   Informing students about the nature of the media & news coverage. Discuss with students how the news typically shows the scariest parts of any situation & repeats those parts over & over. This may help students understand that repeated images or video of death & destruction are not the only thing happening.

                Reminding students that there are plenty of good things going on in the world. Talk with students about the good things that are occurring in your community.

Discuss with students how positive events do not make the news, but happen all the time. It may also help to discuss with students that there are lots of good people helping during a disaster (such as emergency responders, medical personnel, the government, & volunteers).  

Assuring students that they are safe. Explain to students that they are safe & that their family & all the adults at school will always do everything they can to keep them safe.

 Following a disaster, teachers & school staff often have an opportunity to help students cope with a disaster by talking about the event.

Specific entities

Areas of concern	Questions to ask	Psychological first aid
Death of loved one	Did someone close to you got hurt or die as a result of an event ? Who got hurt ?	Provide emotional comfort Acute grief assistance Call the parents Offer a follow up meeting
Prior alcohol or drug use	Have you been using alcohol or drugs to stop thinking about the event ?	Provide positive coping up strategies. Seek a medical referral for those who present with acute alcohol withdrawal
Thoughts about causing harm to self or others	Sometimes situations like these can be overwhelming . have you ever thought of harming yourself ? Have you had thoughts about harming someone else ?	Stay with the teen until the appropriate personnel arrive & assume their management of his/her care
Sexual abuse	Have you been placed under a situation where you were left helpless, vulnerable &   possibly  your privacy violated by someone ?	Informing parents Providing reassurance & rehabilitation Legal steps
bullying	Has someone hurt you by gesture or by words or by actions ?	Informing his/her parents, school authorities
Eating less or more	Have you felt like you were out of your body shape ? & felt pressurized to get a perfect body shape ?	Seek medical & psychiatric  therapy
Attention deficit hyperactive disorder	Have you been able to concentrate during the classes ?  able to underst& what our teacher teaches us ?	Seek for psychiatric care

Conclusion :

As is the screening test for medical diseases, which is commonly employed among the healthy population to identify the individuals at risk, psychological first aid , in a similar way, is not a therapeutically interventional method.

Its rather an initial management , where the participant makes use of the time & space wisely,  till the appropriate psychiatric assistance arrives to the spot, the participant makes use of it & helps the persons vulnerable from going low, help them recover, only to be treated later in a proper way.

As the awareness about the psychiatric ilnesses increases , the stigma will disappear, we can identify the symptoms early & can intervene at the earliest & can provide a better quality of life for the individual.

Psychological first aid has been successfully practiced in various countries in a mass approach :

Europe: psychosocial support staff of local agencies

Iraq: UNHCR protection officers

West Bank/Gaza: family members, humanitarian aid staff

Sudan: psychiatrists, psychologists, emergency staff

Sri Lanka: NGO & government staff, local villagers

UN/NGO managers of humanitarian aid agencies to support their own staff

Japan: national defense force, police, embassy staff

West Africa: medical personnel, Ebola burial teams, families

USA : Haiti earthquake, September 11 terrorist attacks , hurricane .

Thank You