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Decentralized and Networked Psychological First Aid for Social Resilience by Angi English

Last year, I enjoyed watching the documentary of Apollo 11 at my local movie theater and was really taken with the dynamics of the lunar “sphere of influence,” or gravitational pull of the moon.

When Apollo 11 was a certain distance from the moon, the lunar sphere of influence changed the dynamics of its flight.
The concept piqued my curiosity of how a “social sphere of influence” or social pull could help effect change in the number of people in a community willing to have a positive impact during disasters. How could all of us, pulling together socially influence each other for good? And, how could a bottom-up strategy of goodwill for each other make us all more resilient? So, I wondered could our social influence for good include the idea of non-professionals providing much-needed immediate psychological first aid in environments of significant trauma?

What is Psychological First Aid?
Psychological First Aid (PFA) may be simply defined as a supportive and compassionate presence designed to stabilize and mitigate acute distress, as well as facilitate access to continued care.
George Everly and Jeffrey Lating wrote the most frequently cited text regarding PFA entitled “The Johns Hopkins Guide to Psychological First Aid.” At its core, PFA is designed to reduce the initial distress caused by traumatic events. Since a large-scale emergency will initially overwhelm existing mental health response resources, psychological first aid — the provision of basic psychological care in the short-term aftermath of a traumatic event — is an invaluable resource and skill set to possess.
The term “psychological first aid” first appeared, of all places, in a 1944 curriculum developed by the Merchant Marine, and the first scientific study of “the trajectory of the grief process” came out that same year in the wake of the devastating 1942 fire at Boston’s Cocoanut Grove nightclub. In less than 15 minutes, 492 people perished and another 166 were injured, making the blaze the deadliest nightclub fire in U.S. history. This study and subsequent studies identified that mental health “casualties” far exceeded those who suffered physical harm during such catastrophic incidents.
The studies found that individuals experience a wide range of mental health problems during and long after emergencies and will be more likely to recover if they feel safe, connected, calm and hopeful; have access to social, physical and emotional support; and find ways to help themselves. Since then, the field of disaster mental health has developed gradually over the decades, and finally entered into the national dialogue in the aftermath of the 9/11 attacks.
PFA is not psychotherapy, nor is it a substitute for psychotherapy. It does not entail diagnosis or treatment. PFA can be an effective public health intervention especially well-suited for areas wherein health care resources are scarce, situations where access to emergent care is limited, or as a means of significantly increasing surge capacity in the wake of organizational or community adversity including disasters and/or workplace community violence. Psychological First Aid is also not meant to replace licensed mental health professionals. It is beneficial to those with little or no previous mental health training, and can fill a wide shortage of available disaster mental health professionals until the crisis has subsided.
Crisis intervention should not be considered treatment but, rather, as a means of fostering resilience, that is, helping people to rebound from adversity. Options to mainstream the training could include collaboration by city, state and local governments with local universities as part of a curriculum development tailored to a wide variety of learning styles. As the complexity of challenges continues to grow so must the capacity to widen the sphere of influence to include others in the community willing to lend a hand at lessening the traumatic mental health effects of disasters.
Recent reports note that in 2018, the United States experienced some of its most devastating weather conditions in history. From raging wildfires to damaging street flooding and record-breaking hurricanes, extreme weather ravaged neighborhoods and cities nationwide. With climate change predicted to be increasingly significant, such extreme weather conditions are expected to continue for the foreseeable future. These conditions bring not only mass destruction and chaos but also overwhelming societal and economic costs. According to a recent Christian Aid report, 2018’s top three most expensive climate-driven events worldwide all occurred in the United States. Most recently, COVID 19 is proving to be a long term, slow-moving trauma, producing anxiety and depression globally. The implications of quarantine, uncertainty about timing for access to a vaccine protocol and the lack of consistent access to even basic services for some will have cascading negative impacts on levels of society.
A recalibration of our plans for post-disaster mental health is now required, and the really great news is we do not have to recalibrate from scratch. Traditionally, disaster mental health in the form of psychological first aid has been provided by mental health professionals, physicians, nurses, and the clergy. However, given the pace of natural and man-made disasters, I think it is time to expand our — “sphere of influence,” to include non-professional providers of PFA.

Learning from Others in Chronic Disasters
Andrea Ucini, writing for the economist, tells the following story. At Jabal Amman mental health clinic, perched atop a hill in the old town of Jordan’s capital, Walaa Etawi, the manager, and her colleagues list the countries from where they see refugees — and what ails them. The ethnic mix includes Iraqis, many with post-traumatic stress, Syrians with depression, Sudanese with anxiety, and at least ten other nationalities. By local estimates, 1.4 million people have poured into Jordan from Syria’s civil war alone.
Disaster-relief groups such as the International Medical Corps (IMC), which run the Jabal Amman clinic, came to help. In the past two decades, care for mental distress in such emergencies, whether wrought by conflict or natural calamity, has become an immediate priority — on a par with shelter and food. What has been learned from this type of disaster has inspired new, pared-down mentalhealth care models that can be deployed quickly to help lots of people. In parts of Indonesia, Sri Lanka, the Philippines and elsewhere these models have become part of rebuilt health-care systems.” Communities suffering chronic disasters know that the scale of mental health problems and the shortage of specialists to treat people post-disaster is a complex problem.
As disaster-relief experts wondered how to quickly train local people to provide mental health care, they realized that, for the most part, non-specialists might be able to do the job. The answer was literally hidden in plain sight.
“We used to assume that people need professional counseling,” says Julian Eaton of the London School of Hygiene and Tropical Medicine, a veteran in post-disaster care. But it turned out this was not so. Rates of mental health problems usually doubled after a calamity. But few people needed a psychiatrist. Most got better with simple, appropriate help that anyone could provide. Known as “psychological first aid”, it is something that can be taught in a matter of hours. This training is now standard fare in the first days after a disaster. Teachers, pastors, barbers and taxi-drivers are taught to notice people in distress, to provide the right kind of emotional support, and to avoid common mistakes such as pressing sufferers to recount stressful events.

Seeking Unprofessional Help
Disaster relief has taught that non-specialists can be trained to treat mild-to-moderate depression and anxiety, which affect 15–20% of people in any given year. The idea, known in the jargon as “task-shifting”, was “born out of necessity”, says Peter Ventevogel of UNHCR, the United Nations refugee agency. The United States should examine the feasibility of broadening the sphere of influence to include non-professionals that have been trained and/or certified in psychological first aid to barbers, hairdressers, bartenders, taxi drivers, teachers, barista’s, pharmacists, veterinarians, charity organizations, childcare facilities, volunteer first responder organizations and others who provide daily services to citizens on an ongoing basis.
Resource materials have already been generated and could be tailored to the environment. In addition to the John’s Hopkins Guide to Psychological First Aid, the World Health Organization has produced its own readily accessible handbook.

Talking with Children
As adults, and as parents, we have the experience to understand and think critically about the interconnectedness of issues in a way that children have not. Having conversations about all types of emergencies in a developmentally appropriate way which engages kids and reduces their natural fear of the unknown will contribute to both a family and community sense of resilience.
Children often learn how to react to the unknown by watching trusted adults around them and listening to adult conversations, even when they do not appear to be interested. In this context, adults have an opportunity to model the behavior and have informed conversations that will empower our children. ◙

About Angi English

English has an impressive career as a strategic thought leader, leading strategic initiatives in homeland security and emergency management including various risk management projects for and with state and federal task forces. In 2010, appointed by Secretary Janet Napolitano, English worked with 35 other task force members representing local, State, Tribal and Territorial governments to collaboratively take stock of national preparedness and provide recommendations to Congress. The task force worked collaboratively with all stakeholders over a full year to produce a report for Congress, “Perspectives on Preparedness: Taking Stock Since 9/11.” Additionally, English provided advisory services in the development of the Presidential Policy Directive 8, the directive aimed at strengthening the security and resilience of the United States through systematic preparation for the threats that pose the greatest risk to the security of the Nation, including acts of terrorism, cyber-attacks, pandemics, and catastrophic natural disasters. Additionally, the taskforce facilitated the overhaul of the Threat and Hazard Identification Risk Assessment (THIRA) and the National Disaster Response Framework.
In her 30 years working in homeland security, emergency management, mental health, risk management and disability advocacy communities, she is a recognized award-winning leader. In 2012, she graduated from the Executive Leadership Program at the Naval Postgraduate School and in 2014, graduated “With Distinction,” with a Master’s Degree in Security Studies from the Naval Postgraduate School. She was named the Naval Postgraduate School Center for Homeland Defense and Security Curtis H. Butch Straub Achievement Award winner for exemplary leadership and vision. In addition to this honor, she became a Founding Scholar for Innovation at the 18-month think tank called HSx, “Advanced Thinking in Homeland Security” through the Naval Postgraduate School where she created an award-winning grand challenge project, “One Health Alert System: Complexity Oriented Model for Rapid Detection for Disease Outbreaks.”
As Chief of Staff at the New Mexico Department of Homeland Security and Emergency Management, English is a strategic thought leader providing oversight of all agency strategic initiatives and successful execution with the collaboration of senior leadership and is a key advisor to the Secretary and Deputy Secretary.
She is a featured writer for Homeland Security: A Platform by the Center for Homeland Defense and Security For Radical Homeland Security Experimentation with over 30 publications, many focused on navigating “sensemaking in conditions of uncertainty,” and a featured authored in the Wiley Publishers text “Foundations of Homeland Security: Law and Policy, 2nd Edition with a chapter on “Metacognition and Errors in Judgement Related to Decision-Making in Homeland Security.” The chapter explores how the brain and its subsequent thinking processes are influenced by the organic mechanisms of the brain, the social dynamics of groups, and the social construction of reality by people in general.
When she’s not solving tough problems, she is out flying her drones as a FAA Certified Part 107 Drone Pilot or behind the lens of her camera, photographing landscapes in remote areas of the world. Combining her interests for drones and public safety, she was an instrumental advisor in the creation of New Mexico’s Fusion Center’s drone program, a half-million-dollar effort.
She volunteers her time with various hunger initiatives such as the Austin Empty Bowl Project or with Austin Wildlife Rescue where at times she has served as a “possum anesthesiologist,” and as a volunteer drone pilot for local search and rescue efforts. Hopelessly in love with her wiener dog, “Harper Lee,” she and her veterinarian spouse care and rehab various kinds of animals in the ecosystem.

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