This tool is to be used by medical and non-medical personnel to help those in significant distress related to workload, moral distress, loss of life or property.

Key considerations related to psychological first aid during a pandemic:

1. During a pandemic, individuals and the population experiences some degree of increased stress. Fear, anxiety, grief, and anger, are normal responses to an abnormal situation and may be mitigated by brief counselling and other immediate measures.
2. Non-specialized personnel may be required to deliver much needed immediate support to patients, health care workers and others.
3. WHO/PAHO recommends psychological first aid to help guide medical and non-specialized personnel in how to provide immediate support and identify those who need more specialized care. WHO/PAHO Protecting Mental Health During Epidemics: https://www.paho.org/en/documents/protecting-mental-health-during-epidemics
4. All providers should follow the most up-to-date recommendations from health agencies regarding social distancing, isolation and quarantine. Be sure to adjust responses to the situational context.
5. Most reactions are normal responses to stress and do not require specialized care or medications.
6. Medications should only be used when considered necessary and only when prescribed by a physician. Avoid indiscriminate and prolonged use of psychoactive drugs.

Listen

• Listen actively, give your full attention and show concern.
• Let them vent, tell their stories, and express their feelings.
• Be patient and calm. Don’t invalidate their feelings (“you shouldn’t feel…”)
• Don’t underestimate the value of listening, it is therapeutic in itself.
• Be non-judgmental and do not impose your own beliefs.
• Ensure confidentiality; don’t share personal details of person’s story with others.
• Listen first (and wait until individual is calmer) before jumping to problem solving

Answer

• Provide truthful and accurate information. (e.g. from CDC, WHO, local health agencies). Know about and communicate available services and support.
• Help address concerns about basic needs.
• Due to their acute distress, individual may need help with even basic problem-solving. Help solve problems and focus on how to face the future.
• You are not expected to know everything; offer the best support and information you can. Help the individual recognize and use their own strengths.

Refer

• Sadness, suffering, fear, anger and intense emotional pain can accompany grief.
  It can be challenging to recognize if symptoms warrant referral.
• Recognize and accept the individual’s emotions with compassion and kindness.
• If symptoms are severe and/or red flags are present, refer individual for specialized care. Make use of crisis teams and available mental health services.
• Red flags for referral:
  – symptoms persist or worsen despite initial management
  – serious difficulties in family, work, social life
  – risk of complications, especially suicide
  – problematic substance use or other addictions
  – major depression, psychosis, post-traumatic stress disorder

Group

• Encourage and help the individual connect with their loved ones, family, and friends.
• During social distancing, isolation or quarantine, make use of phone, video options, social media. Some groups may offer to connect by video/web conferencing or by dialing in by phone. Encourage connection with other groups in the community (e.g.: arts, music, singing, reading) Religious and spiritual organizations can provide support and may have groups for grief

Engage

• Encourage individual to follow-up with you or a responsible designated person.
• Encourage individual to engage in supportive relationships (even if by phone, video).
• A meaningful connection with even one person in their life is protective (e.g.: mentor)
• If possible, plan a specific time (later the same day or the next day if possible) to check in.
• A brief phone call can help confirm whether the initial assessment of risk was accurate.
• If symptoms have become severe and/or red flags are present you can refer for more specialized care.

Source: Dr. Marcia Kostenuik MD CCFP, April 2020.

1 Referal Criteria
• symptoms persist or worsen despite initial management
• serious difficulties in family, work, social life
• risk of complications, especially suicide
• substance abuse
• major depression, psychosis, post-traumatic stress disorder