NHS Education for Scotland

Psychological First Aid

Section 1:
Introduction to Psychological First
Aid (PFA)

Section 2:
The 7 Components of PFA

Section 3:
Taking Care of Yourself
NHS Education for Scotland

Section 1: Introduction to Psychological First Aid

This guidance is written to support those helping others in distress
during and after the COVID 19 Pandemic.
After reading this, you should :
• Understand what Psychological First Aid (PFA) is and is not
• Understand the ways that Pandemic like COVID 19 can affect us
• Understand the 7 key components of effective PFA
• Feel able to deliver PFA support to others
• Adapt PFA to the needs of particularly vulnerable groups of people
• Identify ways to take care of yourself while providing PFA
NHS Education for Scotland

What is Psychological First Aid?

• A humane, supportive and flexible response to a fellow human being
who is suffering during or after crises or emergencies, like the current
COVID 19 pandemic.
• It assumes most people will respond to events with great resilience.
• It is for use during and following situations of extreme stress.
• It involves:
• Providing practical care and support where necessary
• Helping people address basic needs and concerns
• Helping people connect to information, services and social supports
• Comforting people and helping them to feel calm
• Reducing distress and fostering adaptive coping.
• Protecting people from further harm.
NHS Education for Scotland

What Psychological First Aid is NOT

• It is not something that everybody affected by COVID 19 will need.
• It is not counselling.
• It is not “psychological debriefing” in that it does not involve a detailed
discussion of the events that are causing the distress.
• It is not asking a person to analyse their situation.
• It is not about pressurising a person to talk about their feelings.
• It is not something that only professionals can do.
NHS Education for Scotland

Psychological First Aid – Why?

Psychological First Aid involves offering humane, supportive and
practical help.
Evidence (according to various studies and the consensus of many
crisis helpers) tells us that people are more likely to be able to
psychologically cope with and recover from ongoing situations like
Covid 19 if they:

• feel safe, connected to others, calm and hopeful;

• have access to social, physical and emotional support; and
• feel able to help themselves, as individuals and communities.
NHS Education for Scotland

How do emergency events such as pandemics affect people?

Different kinds of crises affect people in different ways, and there’s
a wide range of responses that people can have.
Most often we respond with resilience, and in ways that are
designed to protect ourselves and our loved ones.
How we respond depends on a number of factors, including:
• How much support we have at the time
• Our previous experience of distressing events
• Our perceived capacity to cope with the situation
• The nature and severity of the situation itself
NHS Education for Scotland

Normal responses to pandemic situations

• There are a broad range of ways in which people react
during a pandemic.
• Distress may be common, but in most cases will not be
associated with lasting difficulties.
• Strong emotions can be seen as adaptive and normal
ways of responding to the characteristics of the pandemic
environment
• You’ll learn later about different kinds of normal human
reactions to these kinds of circumstances
NHS Education for Scotland

Section 2: The Seven Components of Psychological First Aid

NHS Education for Scotland

Before you start:

Before offering PFA , it is important that you have
accurate information & keep yourself updated - learn
about:
• The current details and facts about the pandemic
• The relevant current local and national advice, guidance
and instructions.
• What services are available for what kinds of support –
medical treatment, transport, medical, financial, childcare,
how and when they should be accessed
• The range of reliable and accurate resources for support
and sources of information that are available, particularly
online
• Know when, how, why and where to access additional
wellbeing supports for those who need it
• Who else is helping – what are the local community and
online supports?
• Are there any immediate or ongoing dangers or security
concerns?
NHS Education for Scotland

If you are offering PFA remotely ( for example via telephone or video link) ,
make sure that:
• The mode of communication you are using is safe secure and easy to
use.
• There is sufficient time for technical trouble shooting
• You speak slowly, clearly and calmly, communicating empathy and
warmth.
• You have your own private space to complete the call, ensuring that
you will not be overheard or interrupted
• The caller also has their own private space where possible, and that
they are able to speak to you without interruption
• Once you have established the callers needs, you are clear together
about how much time you expect the call to take
• You know your own limits, and you also know when and how to refer a
difficult call on to s supervisor.
NHS Education for Scotland

Key Component 1: Care for Immediate Needs for Safety

Although some immediate needs are obvious, always ask.

• First Identify if there are any immediate needs, like for medical
treatment, medication, food, communication or accommodation.
• Clear advice should be provided on what to do if someone is physically unwell
(either with a diagnosis or symptoms of Covid19)
• The practical and physical needs of health responders should be addressed e.g.
in terms of personal protective equipment (PPE)
• Clarify each need by talking it through, considering what assistance
might help.
• Develop an Action plan together based on what resources are
available, collaborating with people to enable them to make their own
decisions
• Finally, Support people to put this plan in to action, where possible
supporting them to experience success
NHS Education for Scotland

Key Component 2: Protect from Further Threat & Distress

• Ensure immediate physical safety, including medical care, supervision of children and those
unable to take care of themselves.
• Provide clear advice for family and carers of people who are physically unwell with Covid19- type symptoms
• This may be obvious (like the need to take precautions against infection, or whether / how to seek medical attention )
• It may be less obvious (like the risks of social isolation for those in domestically abusive relationships)
• Provide accurate situation information
• Be accurate and honest in the information you provide
• Avoid speculation, if you do not know the answer to a question, say so
• Attend to physical comfort and safety
• make sure people have access to a safe accommodation where they can socially distance and self isolate as necessary.
• Recognise the needs of vulnerable groups, such as
• Children and young people, and prioritise reuniting them with their family
• The elderly
• Those with pre-existing mental health conditions,
• People with limited resources for example who are homeless or seeking asylum
• People who may be cognitively impaired, through intellectual disability, dementia, or
• Those with physical impairments such as hearing or sight loss or mobility problems
• Protect people from additional trauma and reminders
• Encourage people to only access reputable sources of information,
• Advise against excessive exposure to information, limit their checking of these to once or twice per day
NHS Education for Scotland

Key Component 3: Comfort and Consolation for people in distress

Providing emotional comfort to people. The main elements are:
• Be respectful
• Introduce yourself, giving your name, organisation, and role.
• Ask people’s permission to speak to them; ask for their names.
• Address adults using their last name, unless given permission otherwise.
• If speaking with a child, ask the permission of their parent if present

• Listen in order to help people feel calm

• Speak calmly and with compassion.
• Allow plenty time, try not to look around or seem distracted.
• If you are physically present with someone, be on the same eye level, either by sitting or squatting if necessary
• Do not pressure them to talk
• Listen if they want to talk
• If they are very distressed, help them to feel calm, and try to ensure they are not alone

• Offer support to people who are distressed or grieving

• Provide a safe environment for people to deal with their grief.
• Listen carefully, with empathy.
• Let people tell you what they need.
• Stay calm and take time with people.
• If they need it, help them to plan how they will arrange a funeral
NHS Education for Scotland

Key Component 3: Comfort and Consolation for people in distress

Managing the impact of PPE and social distancing on empathy

• If you are offering comfort to a person face to face, and you are wearing
Personal Protective Equipment that prevents a person from seeing your
face, try to make sure they can see a friendly photo of you, with your name
and role beside it, so that they can see beyond the mask.
• Keeping a 2m distance and wearing PPE may limit the extent to which you
can use non-verbal signals of empathy (like facial expression or touch) that
you would normally when comforting someone in distress. This means
that you may need to use more explicit verbal expressions of empathy than
you usually would
NHS Education for Scotland

From WHO ( 2011) Psychological First Aid: A

guide for field workers.
Accessed:
https://apps.who.int/iris/bitstream/handle/1
0665/44615/9789241548205_eng.pdf;jsessi
onid=E437A8B252C3B3FA9945A4CB819C73
B8?sequence=1
NHS Education for Scotland

Key Component 4: Provide Information and Support for Practical Tasks

This may involve supporting people with their medical needs, financial needs,
childcare, or with funeral arrangements.

Make sure people are informed where and how to access services, especially
vulnerable people
• Say only what you know – do not make up information
• Keep messages simple and accurate, repeat often
• Explain the source and reliability of information you give

Support people’s resilience and sense of control when possible, to

generate their own solutions:
• Clarify options and describe what may happen.
• Ask which option they think is best for them.
• Help make an appointment if necessary
NHS Education for Scotland

Consider a broad range of services

People may need assistance with access to:

• Medical treatment • Social services

• Food • Childcare
• Transport • Faith-based services
• Health • Funeral planning
• Housing • Support groups
• Finance
NHS Education for Scotland

Key Component 5: Provide Information on Coping

Providing people with information and strategies that will reduce their distress and
promote coping.
• Ongoing emergency situations can be disorientating, confusing and overwhelming.
• They can compromise a person's ability to cope with problems.
• Helping to promote effective coping is an important step in helping people adjust to
what has happened and plan for the future.
• You can help people:
• Access information online about normal reactions to extreme stress, positive coping & self care
• Think about different coping options.
• Identify successful coping mechanisms they’ve used in the past
• Creatively adapt their normal coping strategies to social isolation conditions.
• Understand possible negative consequences of some coping strategies.
• Make conscious choices about how they cope.
• Increase their sense of control
NHS Education for Scotland

Ways of coping: Some examples

Helpful Unhelpful
• Use coping mechanisms that have worked well in the past. These behaviours can be seen as
• Think creatively about how you can adapt them to conditions of understandable responses to
social isolation / distancing traumatic or overwhelming events,
but they may lead to other problems.
• Talk to friends and family for support by phone or online. • Spending large amounts of time
• Make a plan for coping with social isolation that will help you feel watching news broadcasts about
useful – jobs to be completed, skills to develop the pandemic
• Get enough rest, nutrition and exercise. • Loss of structure to the day
• Set and maintain as normal a schedule as possible. • Ruminating on what has happened
or what might happen – instead try
• Relax: schedule time to do what normally helps you to relax to stay in the present moment
• Take part in an online support or community group. • Alcohol and substance misuse.
• Use humour. • Withdrawing from friends and
• Focus on something practical that will help right now. family.
• –Understand and tolerate the different ways people cope with • Over-eating or under-eating.
stress: they may be more short tempered or distractible • Blaming self or others.
• Pay special attention to reactions & behaviours of children. • Doing risky things.
• Help young people understand why adults may be behaving • Getting violently angry
differently
NHS Education for Scotland

Key Component 6: Connect with Social Support

• People recover more quickly when they are connected to family and friends. It supports:
• A sense of self-worth, well-being, confidence and hope.
• The sharing of experiences and concerns.
• Making sense of what has happened.
• A degree of normality.
• Participation in problem-solving and supporting of others.
• The sharing of information.

• It is especially important in the context of social distancing to support people to connect with
their natural support networks, including their loved ones, friends and communities.
• Encourage creative ways to maintain meaningful social contact despite isolation measures
• People may need help or encouragement to connect through internet by phone or by other means.
• Make sure people know how to access means of communication adapted to their needs, especially
vulnerable people
• Support access to community and religious support
• Be aware of and able to link people with local and national online resources and supports

• Community online resources can also be important.

NHS Education for Scotland

Key Component 7: Educate and Normalise Responses

People can experience a wide range of reactions and responses during and after an
emergency situation. We can sometimes interpret these responses as meaning there
is something wrong with us. In fact they are most often often perfectly normal and
common human reactions to abnormal events .
It is important to understand the most common responses and reactions to
emergencies so that you can help people understand and normalise their reactions.
Key messages:
• It's normal for people to have strong emotions in an emergency situation
• Psychological reactions to an emergency can be best understood as the reactions
of normal human beings to sudden, unexpected and unpredictable threats.
• Intense emotions will come and go.
• People will have a range of reactions, and need to know that there is no ‘right’ or
‘wrong’ way to think, feel and respond. These can include:
NHS Education for Scotland

Normal Emotional ResponsesNormal

Features of Pandemic Environment to Pandemic
emotional responses Normal cognitive
responses
Uncertainty of the situation and about the future, Distress – Anxiety Distraction,
Ongoing frequent and significant changes to our lives, Euphoria Loss of focus
Perceived threat

Sense of unfairness Distress – Anger Irritability

Uncertainty of the situation, Dark Humour
Ongoing changes to our lives ,
Perceived threat
Loss – of previous lifestyle, of relationships and Sadness Feeling slow
contacts, of employment, sometimes of loved ones Guilt Confusion
Grief
Shame
Loss of sense of control over own world and life Shock, numbing, Shut down, zoning
Physical reactions like pain out
Quest for meaning Lack of responses
NHS Education for Scotland

Consider the needs of people who may need additional

or adapted information or support:
• Children and adolescents, especially if caregivers are unwell
• People who:
• Are neuro-diverse - for example with Autistic Spectrum Disorders or ADHD
• Have cognitive impairment or dementia
• Have hearing / visual loss or impairment
• Have chronic illnesses
• Have pre-existing mental health conditions
• Have an intellectual disability
• People with limited access to supports and resources/ affected by:
• Homelessness
• Domestic abuse
• Asylum seeking
• Substance Misuse
• English not a first language
NHS Education for Scotland

Section 3: Taking Care of Yourself

• The emotional labour involved in successfully managing our own emotions whilst
attending to the needs and distress of others can be very demanding ( both at work
and at home) during a pandemic.

• It is important that we are all able to talk openly and honestly about our mental
health and wellbeing – Looking after our mental health is just as important as our
physical health.

• Using the ABC of self care in a crisis situation can really help us to maintain our own
personal resilience and strength in the face of increasing stress and emotional
labour, and is especially important during a long period of crisis.
NHS Education for Scotland

The A B Cs of Self Care:

Awareness Balance Connection

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A: Awareness and normalisation of your own responses to

stress
A: Awareness and normalisation of your own
responses to stress

Be aware of your own personal signs of stress. Be

compassionate to yourself – remind yourself that:
• These are normal reactions to an extraordinary
situation
• Your reaction is not an indication that you are not
capable, but that you need to pay attention to
taking care of yourself
• You can acknowledge and seek to tackle risks and
sources of stress where possible, in collaboration
with colleagues
NHS Education for Scotland

B: Balance between your life and the demands of your work

Although the demands may be extreme, do not have extreme
expectations of yourself:
• A balance of roles at work, rotating between more and less stressful
roles
• Know your limits, and maintain yourself within them – saying no or
delegating when you can
• Take regular breaks when you can, even for short periods.
• Try to keep reasonable working hours and manage the size of your
workload.
• Planning time away from work for relaxation and recreation, to
balance work stress.
• Practise stress management.
• Minimise your intake of alcohol, caffeine or nicotine and avoid non-
prescription drugs.
• Eat healthily and stay hydrated.
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C: Connection with your people and social supports, and to your

own values

• Access supervision and peer consultation

routinely
• Try to pair up with a colleague especially if
you are new to this work.
• Seek out telephone or online contact with
friends, loved ones or other people you trust
for support.
• Attend to your connections with loved ones
when you are at home – and pay attention to
numbing or shutting off mentally.
• Take time to connect to your values ,and why
the work you are doing is important and
meaningful to you
NHS Education for Scotland

Responding to psychological risks if you are working directly or

indirectly with those affected by COVID 19
This work involves includes risk of exposure to infection, but the demands of the situation also include risks to your
physical, mental and social wellbeing.
Just as physical protection from infection is critical to your ability to stay safe and continue to do your job -
Psychological protection from the impact of chronic stress associated with working in a pandemic environment is
also important in supporting you to do your job safely and well.
All of us will have individual vulnerabilities and strengths in the face of physical and psychological stress.
The good news is that most of us will be relatively resilient in the face of theses risks, if we take the right steps to
protect our resilience:
1. Be aware of your own personal signs that your risk from chronic stress is increasing:
• Think about what your own personal signs of increasing stress are.
• The next slide can help you to create your own personal traffic light system that warns you when you are at
risk. What are your amber warning signs of stress?
2. Identify and use your own tried and tested strategies for managing stress think of these as your Psychological
Protection. There are some example on the next-but-one slide. What are yours?
3. If you think it would be useful in these new and more extreme circumstances, you might want to learn and use
some new protective coping strategies, like mindfulness, grounding, or relaxation. There are many helpful apps and
websites that can help you do this.
NHS Education for Scotland

Creating a wellbeing plan:

On the next slide is a table of some of the
common warning signs that your physical,
psychological or social wellbeing is at risk
from stress.

Use this table to reflect on what your own

warning signs are. What are the signs that you
need to pay attention to, and that mean you
need to invoke your wellbeing plan?
NHS Education for Scotland
Type of wellbeing Physical wellbeing Psychological Wellbeing Social Wellbeing

At risk warning: Examples: Examples: Examples:

Green - none Physically fit and strong, Exercising Enjoying leisure activities Feeling connected to colleagues,
as normal regular opportunity for check ins
Feeling mentally well, focussed
Sleeping well, rested Regular meaningful restorative contact
Being interested and curious about the with loved ones
Eating and drinking as normal world

Amber- possible More tired/ weak than normal Feeling angry or anxious, low or sad at Limited sense of connection with work
risk – time to do work much of the time colleagues / team
something Reducing activities that bring sense
of enjoyment / meaning Difficult to focus: At the edge of your Reduced social contact
personal “stretch” zone
Infrequent or unhealthy eating and Withdrawing mentally from loved ones
drinking Can’t stop thinking about difficult
events from the work shift
Red – stop, take Disrupted / no sleep Feeling unable to cope or afraid nearly Isolated from or avoiding connections
action all the time with colleagues
Exhausted or lethargic
Becoming angry at work and at home Cut off from family and friends
Drinking alcohol / abusing
substances to cope Totally absorbed in thoughts about Avoiding and/or dreading any social
No physical or leisure activity difficult or terrifying work events activity, social isolation
NHS Education for Scotland

Creating a wellbeing plan:

• On the next slide are some examples of ways to protect your physical
psychological and social wellbeing during and after work.
• Use this table to reflect on what helps you to maintain your wellbeing. Can
you take some time to create and commit to your own wellbeing plan?
NHS Education for Scotland
Type of Risk Physical Demands Psychological stress Isolation/loss of connection

Type of Behaviours Thoughts Social connections

Protection
During work Permission from self and others to take Focus attention on what you can control Opportunities for regular check in with
breaks in a safe environment Notice and limit rumination colleagues

Eat and drink well Understand normal responses to stress Work with a buddy where possible
Notice your own stress response, acknowledge it is OK
Pace yourself & normal to feel stress Maintain connection with outside
supports in breaks
Take mental “breathing space” breaks when physical
ones may be impossible
Leaving work Do a physical 'check in’ - “Am I ok?” Take a moment to say to yourself “Todays shift is over. I Connect and share with colleagues.
have done what I can.”
What steps do I need to take to be OK? Check on your colleagues before you
Reflect on your day and acknowledge your feelings. leave. Are they ok?
Who can I speak to / what do I need ? What went well?

Intentionally switch your attention to home, restore,

recharge, replenish & rest
At home Balance – try to plan activities that you Awareness – notice the days impact on your Body, Connection – create and sustain mental
know help you relax and that provide Emotions, Relationships and Activity and physical connections to people and
light to the shade of the day’s work. activities that are important.
Plan a wind down routine to mentally and physically
disconnect from work
Prioritise rest, exercise & eating. Connect also to your values – why is this
Take time to consciously switch off mentally from work work important you and your
Plan a wind-down routine to sleep community?
NHS Education for Scotland

For managers of health and social care staff:

Keep all staff protected from psychological as well as physical risks. Psychological protection from chronic stress and poor mental
health can be as important as physical protection from infection in supporting staff capacity to fulfil their roles safely.

1. Prevent Moral Injury ( MI)

1. Be aware of risks for exposure to potentially morally injurious experiences ( PMIE)
2. Take proactive steps to mitigate PMIEs and prevent moral injury
2. Awareness of and care for staff stress
1. Be clear that stress and the feelings associated with it are quite normal reactions in the current situation, and that managing your mental
health and psychosocial wellbeing during this time is as important as managing your physical health.
2. It is important that ABC self care provisions and strategies are in place for both workers and managers, and that managers can be a role-
model of self-care strategies to mitigate stress.
3. Facilitate access to, and ensure staff are aware of where they can access mental health and psychosocial support services.
3. Balance of workload
1. Rotate workers from higher-stress to lower-stress functions.
2. Initiate, encourage and monitor work breaks.
3. Implement flexible schedules for workers who are directly impacted or have a family member impacted by a stressful event.

4. Connection and support

1. Ensure good quality communication and accurate information updates are provided to all staff.
2. Partner inexperienced workers with their more experienced colleagues. The buddy system helps to provide support, monitor stress and
reinforce safety procedures.
3. Ensure you build in time for colleagues to provide social support to each other.
4. Make sure there is time at the end of a shift for reflection so that work can be left at work. Consider an end of shift checklist
NHS Education for Scotland

Key PFA messages:

1. To look after others effectively – you first have to look after yourself. Apply these PFA principles
to yourself.
2. Be aware of the facts and resources available, so that you can offer clear and accurate
information and support for practical tasks, and connect people to the services and resources
that they need.
3. Although you may not be able to help someone to solve all the things they are currently facing,
by listening more than talking, by offering comfort and consolation, you can help them to
become and stay calm, which will support them to use their normal coping mechanisms.
4. Responding a person in distress, first make sure that any immediate and ongoing needs or
risks are clarified and attended to.
5. Distress and strong emotions are normal human responses to a pandemic situation
6. All the evidence suggests that people who are connected to their family , friends and
community are likely to cope better and to recover – think creatively with a person about how
they might overcome the barriers of social isolation to make sure they are connected to those
that matter to them
NHS Education for Scotland

Congratulations - You’ve reached the end of this unit.

If you can, now take a moment to:

• Reflect on how you will use the

seven key components of
Psychological First Aid in your
work

• Create a traffic light warning

system and a psychological
protection plan for your own self
care.