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Psychological first aid (pfa) in disaster

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Weekly journal club topic presentatio of department of Psychiatry. Bangladesh is disaster prone country. Disaster psychiatry is very relevant here. Hope this ppt will provide mental health professional a little idea about PFA , disaster psychiatry and disaster management.

Published in: Health & Medicine

Psychological first aid (pfa) in disaster

  1. 1. Psychological First Aid (PFA) in disaster Dr Md Saleh Uddin Resident, Phase B Department of Psychiatry BSMMU, Dhaka 20.05.2014
  2. 2. Contents • Disaster • Disaster Psychiatry • Psychological First Aid (PFA) • Mental Health First Aid (MHFA) • Conclusion • References
  3. 3. Disaster
  4. 4. Disaster • is a severe destruction that greatly exceeds the coping capacity of the affected community Disaster Response RecoveryMitigation Preparedness
  5. 5. Local Scenario • Major Cyclones: 75 cyclones and floods/100 years
  6. 6. Natural disaster 1980-2010(CRED report 2012) • No of events:234 • No of people killed:191,836 • Average killed per year:6,188 • No of people affected:323,480,264 • Average affected per year:10,434,847 • Economic Damage (US$ X 1,000):17,072,500 • Economic Damage per year (US$ X 1,000):550,726
  7. 7. Natural disaster occurrence
  8. 8. Killed by disaster Affected by disaster
  9. 9. • A report published in 1996 states that 66% of the tornado affected people were psychologically traumatized in the costal area • Another study found 31.3% war injured freedom fighters suffering from post traumatic stress disorder even after 27 years of liberation war
  10. 10. • 2007 - Super cyclone ‘Sidr’ changed the views regarding post disaster mental health service • Technical and financial support came from World Psychiatric Association (WPA) • Multiple teams rushed to the affected area to provide mental health services
  11. 11. Training Manuals
  12. 12. Plan Act
  13. 13. • District Disaster Management Plan(DDMP)
  14. 14. Global scenario
  15. 15. • Damages (USD): 2012
  16. 16. Disaster Psychiatry
  17. 17. • Victim • Psychological responses • Psychosocial intervention
  18. 18. Psychological responses Psychological responses Within 24hrs Within days to weeks After 3 weeks
  19. 19. Psychological responses Don’t need intervention May need only minimal intervention Need help from mental health professional
  20. 20. Normal reactive process • Most recovers within 6 to 16 months • Common stress reactions Emotional , Cognitive, Physical, Interpersonal • Post traumatic growth/benefited response
  21. 21. Within 24 hrs • Tension, anxiety, panic • Stunned, dazed, shocked, disbelief • Restlessness, confusion • Agitation, crying and withdrawal • Survivor’s guilt
  22. 22. Within days to weeks • Being fearful , vigilant, hyper alert • Irritable, angry, unable to sleep • Worried, despondent • Flashback • Weeping, guilt feeling • Sadness • Positive thinking(hope for future, rescue work) • Acceptance of disaster as nature’s doing
  23. 23. After 3 weeks • Restlessness, panic feeling • Continued deep sadness, unrealistic, pessimistic thoughts • Outward inactivity, isolated and wihtdrawn behavior • Anxiety
  24. 24. Psychiatric response • Acute stress disorder • PTSD • MDD • Substance abuse • Psychological disorder • Organic • Adjustment disorder • Bereavement • Family violence • Child and spouse abuse
  25. 25. Psychosocial intervention • Psychosocial first aid (PFA) • Trauma counseling • Greif counseling • Anticipatory guidance • Crisis counseling • Problem solving counseling
  26. 26. Psychological First Aid (PFA)
  27. 27. • Understanding PFA • How to help responsibly • Providing PFA • Caring self and colleague
  28. 28. PFA “A human supportive response to a fellow human being who is suffering and who may need support” (Sphere2011, IASC WHO-2007)
  29. 29. PFA Elements • Care and support • Needs and concerns • Address basic needs • Listening to people, not pressuring • Comforting people and helping them to feel calm • Helping people connect to information, service and social support • Protecting from further harm
  30. 30. PFA What PFA is not • Not only professionals do • Not a professional counseling • Not “Psychological debriefing” or ”CISD” • Not asking, analyzing, put in order • Available to listen but not pressuring to talk
  31. 31. PFA Who need immediately • Serious life threatening injuries • So upset, cant care themselves and family • May hurt self/others
  32. 32. PFA When and where • Recently affected • Sometimes days or weeks after • Scene of accident/disaster • Health center, shelter/camps etc
  33. 33. PFA Providing PFA • Preparation • Good communication • PFA action principal • Ending help • Who likely need special attention
  34. 34. Providing PFA Preparation • Learn about crisis • Learn about available service and support • Learn about safety and security concern
  35. 35. Providing PFA Good communication • Basics of communication skill • Don’t pressure • Don’t think you must solve all problems • Don’t give false promise
  36. 36. Providing PFA Action principal
  37. 37. Providing PFA Ending help Depends on the context of crisis Individual’s role and situation Needs of the people
  38. 38. Providing PFA Special attention group • Child adolescent group • People with health conditions/disabilities • People at risk/discrimination/violence
  39. 39. Caring for self and colleague • Getting ready to help • Managing stress • Rest and reflection
  40. 40. • Safe effective feasible? • 58 citations • Insufficient evidence • Objective observation and expert opinion(Class iii, iv)
  41. 41. Mental Health First Aid (MHFA)
  42. 42. MHFA • Person developing a mental health problem or experiencing a mental health crisis • Until treatment /Support received • Not a substitute of counseling, medical care, peer support/ treatment.
  43. 43. MHFA People can learn • Overview of mental health problems • First aid for crisis situations • First aid for non crisis situations
  44. 44. MHFA Spectrum of mental health intervention
  45. 45. MHFA • Created in Australia (2001) • Currently in 18 countries • Piloted in USA (2008)
  46. 46. MHFA Why MHFA? • Problems are common • Stigma • Professional unavailability • Do not seek help • Awareness
  47. 47. Conclusion • Basics Disaster management Disaster Psychiatry Psychological first aid (LOOK LISTEN LINK) • Local research and system innovation
  48. 48. References • Disaster mental health response Handbook, The NSW institute of Psychiatry, Australia, 2000 • Role of psychiatry in disaster management: a brief review, H U Ahmed et al, NIMH, Dhaka. Journal of Psychiatry, Vol 20, December 2006 • Psychosocial care of Disaster affected population: Physicians manual, WHO, 2007 • NIMH Dhaka, Bangladesh, 2008 • Psychological first aid: guide for field worker, WHO, 2011 • Mental health service after disaster: Current scenario and future prospect of Bangladesh, H U Ahmed et al, WPA regional meeting, Indonesia, 2012 • National plan for disaster management 2010-2015, Disaster management and relief division, Govt republic of Bangladesh. • Annual disaster Statistical Review2012, Center for research on the Epidemiology of disasters (CRED), Belgium • www.google.com: Images
  49. 49. 1971 2013 2014
  50. 50. Disaster Vs Healthy Body & Mind “ SOCIAL WEAPON ”
  51. 51. Resilience
  52. 52. THANK YOU

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