Introduction

1. Community-Based Psychological First Aid Training: Mitigating Conflict Via Early Mental Health Interventions

2. Introduction • Sign-in sheet • Schedule • What is your name and background? • Course evaluation at the end

3. What You Will Learn Today • How the characteristics of crises and violence affect people • How stress can increase conflict • Why certain groups or individuals may need more help during and after stressful events • Psychological First Aid to support others and reduce conflict • How to help children, adolescents and those with vulnerabilities • How to recognize when someoneneeds more help • How to take care of yourself in stressful times

4. YOU CAN HELP! In difficult times, friends, family and neighbors can help each other. Understanding and practicing Psychological First Aid will allow you to be a more effective helper for people in your community.

5. The Importance of Community Support • Crises, disasters and violence lead to extreme stress for the people who experience them • The impact of stressful events can last for a very long time • BUT the stress can often be reduced if survivors get help during and right after the event. This can restore people’s trust: • In themselves • In the world • In others

6. Reactions to Crises/Disasters • Stress reactions are often related to an event’s: • Size • Cause • If it was expected or unexpected • Timing

7. Crisis/Disaster Size • How big was it? • Number of people and buildings affected • How bad was it? • Extent of damage, injuries and deaths • How long did it last? • Length of the actual event, or length of time people are strongly affected by an event. It’s very hard for people to start to recover when they’re not sure the danger is over.

8. Crisis/Disaster Cause • Natural • There’s no one to blame and no way to prevent it • People often feel helpless and frightened • Human-caused • People often feel angry as well as frightened and helpless • They may want to punish those they think are to blame – often blaming innocent people

9. Was It Expected or Not? • Expected events: • If people get a warning, there is a chance to prepare and to take action to avoid being injured • If people get a warning but they ignore it, they often feely guilty or ashamed • Unexpected events: • There is no chance to prepare, so people are more likely to be injured • They also may feel more stress because it was so surprising

10. Crisis/Disaster Timing • Time and day • Where were people when it happened? • Were families together or apart? • Was it light or dark? • Were people asleep? • Season/climate • Is it very hot or very cold out? • Do people have the right clothing or shelter?

11. Who Was Impacted? Some people or groups often have strong reactions to stressful events and may need more assistance. This can depend on: • Age (very young or very old) • Gender (women often feel more stress) • Family role (especially mothers trying to take care of their families) • Amount of exposure to the disaster (if the person was very close to it, or in danger for a long time) • Loss of family member, or injury to family member • Loss of home or possessions • Pre-disaster stress: If the person was already coping with other problems • Lack of resources: If the person did not have much social, financial, or personal support

12. Reactions can also depend on how people were treated after a crisis/disaster: Did they get help with practical needs like medical care or assistance rebuilding a damaged home? Did they get help with emotional needs (support from friends and family, Psychological First Aid, professional help for those with strong reactions)? Do they feel their needs were ignored or overlooked, or that people blamed them for their situation? What Help Did People Receive?

13. Reactions to Stress A person’s reaction will come from a combination of the characteristics of the crisis/disaster, the individual, and the response. Disaster characteristics Individual characteristics Response characteristics Survivor reaction

14. Common Reactions People can experience many different types of reactions when they are exposed to extreme stress. These are common reactions to difficult experiences: • Physical • Emotional • Thinking • Behavioral • Spiritual • Increased conflict

15. Reactions: Physical • Jumpiness, edginess • Appetite change (want to eat more or less than usual) • More desire for caffeine, nicotine, alcohol • Heart pounding, rapid and shallow breathing, light-headedness • Stomach distress • Trouble sleeping (fatigue, exhaustion, insomnia) • Muscle tension or pain • Headache • Worsening of other health conditions

16. Reactions: Emotional • Anger, hostility, rage • Resentment towards everyone, including those who are not to blame • Depression, sadness, tearfulness • Anxiety, fear, panic • Guilt, shame, self-doubt • Emotional numbing - not feeling anything at all • Feeling overwhelmed, hopeless, out of control • Irritability, impatience • Mood swings

17. Reactions: Thinking • Disbelief, sense of unreality • Worry • Can’t stop thinking about the situation • Problems with memory or concentration • Can’t focus, solve problems, or make decisions • Confusion • Errors in thinking (blaming self or other when it’s not fair, all-or-nothing thinking)

18. Reactions: Behavioral • Avoiding reminders of the crisis • Sleeping a lot more or less than usual • Can’t relax • Withdrawing, isolating oneself from family and community • Increased conflict with family or co-workers • Working too much to avoid thinking about the event • Crying easily • Bullying other people • Change in sex drive

19. Reactions: Spiritual • Change in relationship with G_d or higher power (increase in faith, or questioning of faith) • Change in religious practices (increase or decrease in prayer or attending services) • Questioning of belief that the world is fair • Struggle with questions about meaning, justice, fairness

20. Reactions: Increased Conflict When we are stressed we cannot: • Be fully aware of our own feelings • Really know what we need • Communicate our own needs clearly • Accurately read another person's nonverbal communication • Hear what someone is really saying These factors all increase conflict!

21. Reactions to Loss When a loved person dies because of crisis or violence, survivors can feel strong emotions: • If it was human-caused: anger, blame • If a warning was ignored: self-blame, guilt • If the survivor feels they should have done more: shame • If a death was sudden and unexpected: no chance to say goodbye or resolve issues with the person, or to prepare for the loss

22. Psychological First Aid:Helping People in Need

23. Helpful Helping • Describe a difficult time in your life and a person who helped you through it. • What were the qualities of that person? • What did he or she say or do that helped you the most?

24. Principles of Helpful Helping We should do all that we can to: • Promote a sense of safety • Promote calm • Promote sense of confidence and competence in self and community • Promote connection • Instill hope and faith (Hobfoll et al., 2007)

25. Defining Psychological First Aid Psychological First Aid (PFA) describes a humane, supportive response to a fellow human being who is suffering from a serious crisis event and who may need support. (World Health Organization, 2011)

26. Purpose of PFA Psychological First Aid actions are designed to address all of the connected needs of the survivors: • Practical • Physical • Emotional and social

27. Elements of Psychological First Aid PFA is not a process, but a toolkit to be used as needed, in any order appropriate • Model calm • Provide warmth and acknowledgement • Listen • Be honest and trustworthy • Help survivors help themselves • Attend to safety needs • Attend to physical needs • Provide information and direction to services • Provide psychoeducation • Help survivors connect • Help survivors avoid negative connections • Assist with traumatic grief • Assist with conflict resolution

28. Model Calm Just being calm when you are in contact with someone in great distress can be helpful. Disasters and violence increase physical and emotional arousal or excitement. One aim of PFA is to reduce this high arousal level by “modeling calm” - if you show people your own calm attitude and behavior, they often become less upset. By being steady you can help survivors control their own strong feelings.

29. Provide Warmth and Recognition • Be respectful and show caring and concern for the survivor by being attentive and speaking in a soothing tone of voice. • Do not judge the survivor’s thoughts and feelings. • Do not minimize the disaster or distress: • Survivors need people to see that they have experienced a stressful event and that their reactions are understandable. • If their distress is not recognized and validated, survivors may not take the necessary time to rest and recover.

30. Listen If survivors want to describe what happened to them, be prepared to listen. Do not pressure people to talk if they do not want to. Listen to both thoughts and feelings. Be ready to listen to a survivor’s feelings of pain or loss or rage or shock without getting overwhelmed yourself or changing the subject. Do not leave survivors alone if their feelings are very strong. Make sure they are with a family member, spiritual leader, or other supportive person.

31. Things to Say to Show You Are Listening • “So you feel…” • “I hear you saying…” • “I sense you are feeling…” • “You appear…” • “It seems to you…” • “So tell me if I am getting this right? You seem to be feeling that…”

32. Be Honest and Trustworthy Only honest and genuine caring and listening is helpful for survivors. Being truthful does not mean being blunt or rude. Know your own limits so you can take a rest or break when you need to. Do not try to care for others when you are exhausted. Do not repeat or gossip about what you hear.

33. Help Survivors to Help Themselves Support survivors’ strength, courage and power so they can begin to regain a sense of control. If they are able, survivors can be encouraged to participate in helping others. Ask: “How have you gotten through tough times before?” or “What skills do you have that will allow you to get through this?” Allow survivors to determine the kind of assistance they receive and how much they want to talk about the event.

34. Attend to Safety Needs • Try to protect survivors from threats from the ongoing disaster or violence, especially those who may be so upset or disoriented that they are not able to care for themselves. • Help people to find shelters or places to say that maximize safety. • Support safety and stability by encouraging families to maintain their routines as best they can.

35. Attend to Physical Needs When people are very distressed, they can ignore their own injuries. Be sure that those who are hurt receive medical attention. Survivors could be offered water, hot drinks, or blankets, which provide comfort as well as helping with physical needs. If someone’s home is damaged, you may need to assist them with finding a shelter, or locating a friend or relative to stay with.

36. Provide Information and Direction to Services Survivors want and need different kinds of information (what happened, who was affected, where can I get help). If possible, provide lists of available resources. When people are very upset they may have a hard time understanding or remembering information. Speak clearly and slowly using simple language, and repeat yourself if needed. Provide only information you know is true. Rumors are very common in stressful times – encourage people to not accept or share false information.

37. Psychoeducation • Help people understand their reaction to the experience is natural and understandable: • “a common reaction to an uncommon event” • Share materials on stress and stress management: • Teach effective ways of coping (actions that help people feel better and function better) • Help people recognize when coping skills are not working. For example, smoking or using drugs or alcohol may make people feel better for a while, but do not help them function better

38. Help Survivors Connect • Social support can lower stress even if the support comes from one reliable person. • Survivors should be reunited with people who can provide emotional support and security: • Friends, neighbors, and family can offer practical support (money, a place to stay), emotional support, and advice. • Clergy, spiritual leaders, or family leaders can offer guidance and comfort.

39. Help Survivors Avoid Negative Connections Not all relationships or family members are supportive; some relationships can be sources of stress and misery. Contact with people who blame or punish the survivors, increase their anxiety, or make demands on them will not help recovery. Encourage survivors to connect with family and friends they trust.

40. Assisting Survivors after a Death There may be practical problems you can help with such as contacting family members, identifying remains or arranging funerals. However, when there are no problems to solve, you can help simply by being a calm and supportive presence. Link survivors to spiritual and family leaders. Be kind.

41. Help Survivors to Manage Conflict Conflict is decreased when survivors can: • Manage their stress and stay calm. • Pay attention to the feeling of others. Try to recognize and respond to the things that matter to the other person. • Control their emotions and behavior. • Try not to hold onto resentments and anger. • Be aware of and respectful of differences.

42. Pay Special Attention to or Try to Get More Help for Those Who: Threaten to harm themselves or others Are not thinking clearly, or seem confused Repeat the same behavior over and over Are hysterical or panicking Do not seem connected to reality Had someone close to them killed or injured or missing Have a home that is unlivable Have a preexisting psychiatric disorder Are physically injured Had a long or intense exposure to the event

43. Helping Those with Vulnerabilities • These individuals may have issues related to mobility, cognition, sensory, and/or overall health. • Be aware of their need for medications, assistive devices (like a wheelchair or hearing aid), meals, structure, other social supports. • Recognize these individuals are unique even if they have similar conditions. • Be clear when you communicate with them. • Be aware of your own responses to working with these individuals. • It may be helpful to keep a list of where these individuals live so someone can check on them.

44. HelpingChildren and Adolescents • They need special attention and care, and are not as resilient as you might think • Their needs will vary based on developmental age and they may regress to earlier stages in the face of disaster or violence, acting younger than they are or losing skills like toilet training. • Do provide basic information to young people, but don’t add unnecessary details that may scare them. • Allow children to talk about the experience if they want to, and provide supportive listening. • As much as possible, allow them to interact with other children. • Try to establish routines as quickly as possible, such as regular meal times and school activities.

45. Take Care of Yourself Everyone who responds to a crisis or helps others in times of conflict is impacted. You need to be alert for signs of stress and distress in yourself and in others who are trying to help survivors. It is important to learn good self-care habits now so you can continue to use them during a crisis, and especially afterwards See the brochure, Help for the Helpers, for specific ways to practice healthy self-care

46. Practicing Psychological First Aid In groups of 3-5 (depending on size of class) read the scenario and discuss how you would apply the principles of Psychological First Aid. Someone in the group should write down your responses to share with the rest of the class at the end of the exercise.

47. Some Final Thoughts on Helping Others Be kind Be calm Be informed Be tolerant Be patient Be flexible Ask for help when you need it Take care of yourself

48. THANK YOU Questions and comments Be sure to fill out course evaluations