Bushfires: GPs administering psychological first aid

Fires rage on Canberra’s doorstep and Sydney’s air is once again filled with smoke.
 
‘The fires are still front of mind for a lot of people. There’s still smoke everywhere [in NSW], there’s fear and heatwaves, people are still in evacuation centres, and many fires are still very active.’
 
That is NSW GP and disaster medicine specialist Dr Penny Burns.
 
As people displaced by the fires return to their towns and consider how to rebuild, GPs will be needed more than ever to help people in distress.
 
Dr Burns said a key technique helping people and communities adjust to losses this summer is psychological first aid.
 
GPs regularly offer psychological first aid to patients in distress. But the technique is particularly helpful for disaster survivors.
 
Offering simple practical and emotional support can help people emerge from their initial responses to their new circumstances and begin to tackle the psychological fallout.
 
‘[Psychological first aid] is really simple – it means a common sense approach of human compassion and kindness shown to another person in distress,’ Dr Burns said. ‘Providing a calm, caring environment helps decrease distress and helps them start to process events.
 
‘It’s an evidence-informed approach. The belief is that it helps calm people down enough that they can then start to do adaptive coping.
 
‘The majority of people affected by disasters will recover beautifully on their own. They just need someone to sit with them before they can move forwards.’
 
Many people will only require this level of support from their GP, and will be able to return to normal function.
 
Dr Burns said psychological first aid promotes five key aims: safety, calm, connectedness, self-efficacy, and hope.
 
‘It helps people work out what they need, what’s most pressing and what they can start to do. It might involve connecting them with family,’ she said.
 
‘We often do this in general practice, but we often don’t know that it comes as a parcel and has that label. We’ve all had glassy-eyed patients who don’t respond to verbal questions and seem disoriented and incapacitated by worry.
 
‘GPs use calm to de-escalate their stress and help them start to adapt and cope. I think of it as like a cup of tea with a neighbour. You don’t want to overthink it. It’s a simple thing.’
 
But Dr Burns said the technique could be easily confused with mental health first aid.
 
‘Mental health first aid is different. That’s about providing care to people with mental health conditions to make sure they’re safe,’ she said. ‘It’s also not the same as critical instance stress debriefing, where we asked people to talk about what had happened. We now know that’s not helpful.
 
‘Psychological first aid is not counselling or assessing. It’s basically just calming them down. We don’t ask what happened.’
 
When a distressed patient arrives at the clinic, Dr Burns recommends asking them to sit down. Then she speaks calmly to them. She tells them her name and says she wants to make sure they’re okay.
 
Dr Burns will listen to them to see if there is anything they want to bring up. She then begins speaking calmly and clearly to them. If she does not know them, she may ask them what their name is and what day it is, to see how overwhelmed they are.
 
If they are totally overwhelmed, she may sit with them quietly until they gain some control.
 
‘Slowly you can work out their issues and immediate needs and concerns. It might be they can’t find their pet or their daughter,’ Dr Burns said. ‘Then you can start to work out how to help them do what they want to do. You might want to say that this is normal in such an extraordinary event – their heart beating faster, feeling more anxious.’
 
Dr Burns said some people will be particularly distressed, especially those who thought they were going to die, who lost loved ones, who were injured or who were exposed to horror.
 
‘These people will have higher levels of distress,’ she said. ‘Children are also particularly vulnerable. It may come out in a different ways to adults; a bouncy child might become quiet, a quiet child might regress and become clingy, or act out. Tummy pains, bedwetting, baby talk – that can be distress.’
 
For Dr Burns, psychological first aid is core GP business.
 
‘I’ve seen this happen many times in GP waiting rooms. It happens a lot,’ she said.
 
The RACGP has a fact sheet on mental health and emergencies which covers psychological first aid.
 
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bushfires disaster medicine mental health psychological first aid