Psychological First Aid: a band-aid for the soul

Monika is in Pakistan working as MSF's Mental Health Activities Manager. She blogs about how a lack of understanding about mental illness contributes to stigma.

Monika and the team at Mental Health Day event

World Mental Health Day is celebrated every year to raise awareness of mental health issues around the world, creating a space for those working in mental health to discuss the importance of their work. 

The theme of this year’s World Mental Health Day was “psychological first aid”, assisting people in the immediate aftermath of a disaster to reduce their initial distress.  

You don't need to be a mental health expert to give psychological first aid to people in distress; for example a health worker, a fireman or anyone in a helping role can be of assistance.

I am amazed by how much can be achieved by 45 minutes of empathetic listening

We used this year’s mental health day as an opportunity to create an engaging event at MSF's Timergara hospital. Patients, attendants and staff alike participated in activities conducted by the Mental Health and Health Promotion teams.

Group discussions, quizzes and a role playing session served to psycho-educate participants and reduce the stigma attached to the mentally ill. But, most importantly, my team and I had a great time with the people we treated!

Welcome sign for Mental Health Week event

Welcome sign for Mental Health Day event. Photo: Nasir Gaffor / MSF

In Timergara's District Headquarter Hospital, four MSF psychosocial counsellors provide support to patients and attendants. Although there have been no recent disasters or major conflicts, it often feels like our counsellors can only offer “first aid”, instead of more in-depth counseling.

A lot of patients are in need of counselling, sometimes too many for the current staff. But this is not the only problem our mental health department faces in Timergara.

Information session on Mental Health Week.

Information session at Mental Health Day event. Photo: Nasir Gaffor

Patients, especially women, rarely return for follow up sessions - no matter how severe their psychosocial or social distress.

Firstly, this is related to cultural sensitivities. Women traditionally cannot take medical decisions independently.

Second, women have to be accompanied by an attendant, travel long distances to the hospital and find somebody to take care of their children in the meantime.

Third, there is a general stigma associated with seeking counselling and mental health problems.

In the beginning I struggled with our single session approach - I expected it to make little impact on patients. But now, close to the end of my assignment, I am amazed by how much can be achieved by 45 minutes of empathetic listening, psycho-education and resource activation. I am very thankful for my great team of counsellors, who change people’s lives every day.

Photo of Monika and the team celebrating with cake on Mental Health Day

Monika and the team celebrate Mental Health Day. Photo: Nasir Gaffor

Our counsellors see a wide range of patients who suffer from a variety of issues. These include grief, depression and anxiety, coupled with psychosomatic complaints, reproductive health problems and family conflicts.

Additionally, the Emergency Room refers survivors of sexual violence and suicide attempts.

She claimed to be possessed by a bad spirit, telling her to kill herself or family members if she does not get married

Let me share the story of a patient with trance and possession disorder (ICD 10, F44.3), whose counselling I supervised recently. Interestingly, this diagnosis is only found in certain cultural contexts and it helped broaden my view on transcultural psychiatry. 

The 22-year-old female patient was brought to the ER by her mother - after threatening to kill herself with a knife.

She claimed to be possessed by a bad spirit, who told her to kill herself or family members if she did not get married. It transpired that her wedding was delayed, as she had to care for her sick mother.

During a joint session with the mother, the patient fell in a “trance” and the “bad spirit” started to threaten both mother and counsellor. Only when both agreed the patient will be married within three days, the patient regained orientation with impaired memory of events.

In supervision we interpreted that "possession" and other dissociative/conversion disorders are ways to express patients' needs and wishes.

Unfortunately the young woman did not return for a follow up, so we're still in the dark about what happened to her.

There are so many reasons why it is important to celebrate Mental Health Week every year: to destigmatise mental illness, create awareness in the community and connect the hospital staff with the patients.

If you add creative and fun Mental Health and Health Promotion teams to the equation, you’re up for an unforgettable event! 

Photo of Monika and the team on Mental Health Day

Monika and the team at Mental Health Day event. Photo: Nasir Gaffor / MSF