CO19099 | Lessons From Sri Lanka: Psychological Bandage in Times of Crisis

SYNOPSIS

In times of crisis, the right kind of support can help to reclaim our emotional footing and increase our psychological resilience as a nation. How can Singaporeans prepare themselves for crisis?

COMMENTARY

WHILE THE world is still recovering from the shock of the Christchurch mosque shootings, the series of coordinated bomb attacks in Sri Lanka came as grim reminders that these attacks will hardly be the last. The immediate trauma may be over, but the after-effects on the mental health of survivors and the larger community are both lasting and ubiquitous; they highlight the fact that timely and practical psychological support for victims of crises are necessary.

“Not everyone will admit that they are affected and think that they are ok” were the words of a survivor of the Surabaya church bombings in 2018. Indeed, the impact of trauma is often understated, and has far-reaching consequences on the mental well-being of those affected. Experts have recommended the use of Psychological First Aid (PFA) in the immediate aftermath of traumatic events as it has been proven to be useful in alleviating feelings of distress.

Psychological First Aid (PFA) as Emotional Bandage

PFA can be performed by anyone who has undergone relevant training, without the need to be a mental health professional. Analogous to first aid, PFA is akin to applying a psychological bandage in the immediate aftermath of a crisis to help mitigate potential symptoms of acute distress, and improve mental well-being in the long run.

Its benefits were evident in the 2013 Lushan Earthquake in China’s Sichuan province, in which victims’ general mental health, acute stress reactions, and anxiety and depression status were reported to have significantly improved after receiving PFA.

Since the 9/11 attacks, PFA has also been consistently recommended by experts as an early intervention for disaster survivors. Therefore, as part of their emergency preparedness and response plans, many countries such as Japan, Hong Kong and the United States alongside multiple NGOs in Asia, the Middle East and Africa have undertaken large-scale PFA capacity-building efforts.

WHO Model of PFA

However, the concept of PFA is not a new one. As early as the 1940s, it was already used to help soldiers who were suffering from ‘war stress’. Today, several models of PFA exist, and one of the most widely-used frameworks is the World Health Organisation (WHO) model. The WHO model of PFA is now endorsed by 24 international organisations including the United Nations Children’s Fund (UNICEF) and the American Red Cross.

There are three basic action principles: Look, Listen and Link. Look to see if the environment is safe or appropriate to carry out PFA. It also means looking for symptoms of distress exhibited by an affected individual. Listening requires paying attention to the needs of the affected individual, be it for food, shelter, information or discomfort arising from any existing medical conditions.

Linking involves connecting those affected with their loved ones (e.g., family and friends) or organised support (e.g., NGOs), thereby reducing the feeling of anxiety in a chaotic situation. It can also mean referring them to continued supportive care in the aftermath, if necessary.

Helping Singaporeans

As Singaporeans, how do we reach out and help one another in times of crisis?  One way is to get ourselves equipped with the 3 ‘L’s of PFA – Look, Listen and Link − and the efforts to promote it is apparent in the SGSecure national movement. One of the more significant initiatives is the launch of the Human Emergency Assistance and Response Team (HEART), which comprises psychologists and counsellors from various ministries.

HEART has been training volunteers and grassroot leaders in their respective constituencies the basic skills of PFA since its inception. Dr Majeed Khader, Chief Psychologist at the Ministry of Home Affairs, explained that grassroot volunteers trained by HEART will be better equipped to recognise discreet signs of trauma amongst affected individuals.

It is envisioned that with more people being trained in PFA, the chances of emotional support being rendered promptly will be improved, thereby facilitating the return to normalcy after a crisis such as a terror attack.

Need for Sensitivity

Singapore also adopted the WHO model of PFA because it places emphasis on cultural sensitivity, making it very applicable to our diverse social fabric. As the reaction to traumatic events would differ based on one’s cultural background – amidst other factors – displaying cultural sensitivity and insight is much needed even in the process of helping.

For example, sensitivity to dietary requirements, the comfort level of maintaining eye contact or the use of physical touch to express empathy can go a long way in making one feel better, especially in a state of chaos and uncertainty, when used appropriately.

Failing to tailor the provision of PFA according to individual needs will not only impede the effectiveness of PFA-providers, it will also cause them to come across as inconsiderate and unempathetic.

No Magic Bullet

In the 2019 SGSecure Conference held earlier this year, Minister of Law and Home Affairs K Shanmugam drove the point home when he reiterated that the aim of the SGSecure movement is to “make everyone aware and to take responsibility, individually and as a community”. Indeed, it is necessary for Singaporeans to be crisis-ready as one united people, and one way forth is to encourage as many people as possible to be trained in PFA.

PFA is no magic bullet, nor is it a replacement for long-term mental health interventions, but it has proven to be a useful tool in supporting people with acute distress when applied by those who are sufficiently trained.

One does not need to be a health care professional to administer PFA and everyone can be trained to do it, making it a much-needed skillset in building the psychological resilience of our nation.

About the Authors

Verity Er is a Behavioural Sciences Research Analyst with the Home Team Behavioural Sciences Centre (HTBSC) at the Ministry of Home Affairs. Neo Loo Seng is an immediate past Visiting Associate with the National Security Studies Programme (NSSP) at the S. Rajaratnam School of International Studies (RSIS), Nanyang Technological University (NTU), Singapore. He is also a PhD Candidate at NTU’s School of Social Sciences (SSS).