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How should you talk to a person in crisis?

Source: Thomson Reuters Foundation - Wed, 17 Aug 2011 03:46 PM
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LONDON (AlertNet) - When people are in the midst of a crisis, it's not just shelter, food, water and medical care that they need. They are worried, stressed, even traumatised.

As an aid worker, coming across disaster-hit men, women and children on a regular basis, how do you talk to them in a way that eases the mental anxiety they're going through?

You might think that most humanitarian staff would already know how best to interact with people in an emergency. But that's not necessarily so, says Dr Leslie Snider, senior programme advisor at the War Trauma Foundation in the Netherlands.

"In the chaos of the moment, it isn't always so easy and clear what are the good things to say, and what you should not say," she tells AlertNet.

In response to repeated requests, the World Health Organization (WHO) has partnered with the War Trauma Foundation and World Vision International to put together a simple manual that provides pointers for all those who help people in crisis.

Launched ahead of World Humanitarian Day on Aug. 19, "Psychological First Aid: Guide for Fieldworkers" is aimed at enabling humanitarian and emergency workers all over the world to provide basic but vital psychosocial support to people in acute distress, including helping relief workers themselves.

"In the last five years the psychological damage left in the wake of tsunamis, earthquakes, droughts and conflicts has proven as devastating as the physical damage," Dr Bruce Aylward, WHO assistant director-general for polio, emergencies and country collaboration, said in a statement.

"Recognising that we can do more and do better for the mental health of disaster-affected populations, WHO and partners have developed this guide to ensure that standards and best practices are consistently applied in humanitarian settings."

Snider said guides on psychological first aid already exist, but this is the first that has been widely agreed on by the international aid community and backed by the WHO. It has the support of 24 large agencies, including CARE, the International Committee of the Red Cross (ICRC), Action Contre la Faim, International Medical Corps and a range of U.N. bodies, including UNICEF.

NON-INTRUSIVE, PRACTICAL APPROACH

According to the guide, psychological first aid describes "a humane, supportive response to a fellow human being who is suffering and who may need support". It does not amount to professional counselling and does not have to be practised by experts.

The manual also emphasises its difference from a form of mental health assistance known as "psychological debriefing," which involves asking a person to systematically recount their perceptions, thoughts and emotional reactions experienced during a recent stressful event.

In 2009, the WHO concluded that psychological first aid, rather than psychological debriefing, should be offered to people in severe distress after recent exposure to trauma. Debriefing is no longer recommended because studies have shown it to be ineffective or even harmful, Snider says.

Psychological first aid, in contrast, takes a softer approach.

It involves providing non-intrusive practical care and support; assessing and helping people address their basic needs and concerns (for example, food or water); listening to people but not pressuring them to talk; comforting them and helping them feel calm; linking people with information, services and social support; and protecting them from further harm.

The guide notes that those in particular need of psychological help in a crisis include children and adolescents, people with health conditions or disabilities, and people at risk of discrimination or violence. Some may need more advanced urgent support, such as people who are seriously injured or those who could hurt themselves or others.

The manual says aid workers should respect cultural contexts and norms, and ask questions like whether it is appropriate for a man to offer psychological first aid to a woman.

Towards the end, there are some effective examples of model conversations an aid worker might have with someone who has just run out of a building that has collapsed in an earthquake, or an unaccompanied boy who has arrived at a refugee camp after fleeing conflict.

For now, the guide is available only in English, but there are plans to translate it into five to 10 other languages for use in low- and middle-income countries, including Pakistan and Sri Lanka. 

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