The terms 'first aid' and 'crisis response' bring to mind images of ambulances, flashing red lights, dire emergencies and disasters, and life or death situations. But more often than that, people experience crises on an individual level – an accident, loss of a family member, or as is the case for all of the beneficiaries we treat in our project: receiving the diagnosis of a life-threatening illness like HIV or TB.
Any type of serious stress event carries with it physical, emotional, and social effects for those affected, and psychological first aid has been designed to reduce the impact of these effects on people in need.
For a full run down of psychological first aid, I highly recommend checking out the relevant World Health Organisation materials online.
Much about psychological first aid is based on the idea of presence, about the transformative power of providing a trustworthy, calming, and supportive presence to people who have recently undergone a crisis.
I’ve found that people often think mental health provision is largely about words – that it is up to the counsellor to solve all of a patient’s problems with some concoction of magical counselling manoeuvers and tricks.
HIV and TB counsellor La Ring modelling active and empathic listening in training. Photo: MSF.
And while I like the idea that counselling has a certain a degree of magic in it, I also know how much of supporting others is based simply on being able to provide a safe, nonjudgmental and compassionate space, just as psychological first aid promotes. And sometimes, especially as a Mental Health Officer in MSF's international staff, I’ve found that providing that safe space is sometimes my only option.
Much of supporting others is based simply on being able to provide a safe, nonjudgmental and compassionate space.
Earlier this year I met an MSF beneficiary whose story has resonated with me ever since.
This young woman was eight months pregnant when I met her, and she had experienced multiple, horrific personal traumatic stressors in the past, in addition to being on antiretroviral therapy for HIV.
On top of that, this woman was living in a state in Myanmar that had been torn apart by civil war for the last five years. And on top of all of that, she was just diagnosed by our MSF team with Multi-Drug Resistant Tuberculosis (MDR-TB), a horrible strain of TB that requires patients to undergo 20 months of intensive medical treatment.
The treatment for this strain of TB involves multiple medications per day, at times including injections. The medications carry with them side-effects that range from uncomfortable to downright misery-inducing. TB is an airborne illness, so patients must also practise limiting isolation precautions so as to not spread their illness to others, including and especially their loved ones.
It's an extremely taxing treatment and this patient was refusing to consent to it, putting her life at serious risk.
At first, I coached my counsellors (via my truly priceless translator) on the basics of Motivational Interviewing (MI), an evidence-based type of counselling designed to reduce people’s defences and encourage behavioural change.
But the counsellors reported that their efforts consistently fell flat, so I soon started accompanying them to their visits to the TB ward, where this patient was on bed rest.
I did my best to demonstrate and model MI, much of which is based on providing clients with unqualified empathy, made all the more difficult behind the uncomfortable and awkward respiratory masks we all had to wear for infection control.
Warmth, comfort, and unconditional positive regard are key to psychological first aid, to mental health more broadly, and, really, to humanity.
Shortly after I started visiting her regularly, the woman gave birth to a very small and fragile baby, who lived three days before passing away. And after that, I felt I could actually see any motivation she had left to live vanish from her eyes.
Her physical health declined rapidly and I had the terrible feeling that there was nothing that we could do. But we stayed with her. Continuing to discuss her need for MDR-TB medication no longer felt like the compassionate way so instead we just focused on being there for her. We had little else to provide her with aside from the warmth, comfort, and unconditional positive regard that is key to psychological first aid, to mental health more broadly, and, really, to humanity.
Another of the core tenets of psychological first aid is “protecting people from further harm.” Sadly, we were not successful in this, and within weeks of her baby dying, this patient also passed away.
I have reflected on this woman’s story and our times together more times than I can count.
We were granted only a small window in which to impact the life of this woman and the suffering she endured, and I can only hope that we provided some comfort and solace to her in her final days.
World Mental Health Day was established to raise awareness of mental health and to mobilise efforts to support mental health efforts around the world. This year’s focus on psychological first aid encourages people of all backgrounds to consider learning more about how to provide meaningful psychological and social support to people who are suffering.
World Mental Health Day is an opportunity to honour those who wrestle with various mental health challenges.
As my year with MSF continues to remind me, some stories have happy endings, but some most certainly do not.
World Mental Health Day is an opportunity to celebrate those who’ve benefited from mental health services in addition to those who provide it, as well as to honour those who have struggled or continue to wrestle with various mental health challenges.
Personally, it is also a time for me to reflect on experiences from the field, where my best hasn’t always felt like enough, like this magical counselling potion I’m supposed to confidently dispense has failed.
But I have to trust that almost any comfort or support that my team and I provide – even those that are awkwardly obfuscated by a mask, language differences, and my own internal feelings of helplessness – can and do have the power to restore a person’s humanity. And maybe that’s a bit magical in and of itself.