PSYCHOLOGICAL FIRST-AID 1

The Importance of Psychological First-Aid

and Its Impact on Communities in the Philippines

Aleyna R. Caras

Global Connections

Gregory Falls

December 2017
PSYCHOLOGICAL FIRST-AID 2

Abstract

This paper explores the psychological and economic impacts of natural disasters, what

Psychological First-Aid is, how it helps disaster survivors, why it is important, and why it should

be improved in the Philippines to benefit their communities. Natural disasters cause tremendous

amounts of damage, not only to the environment and infrastructure, but to the people affected

along with their livelihoods and futures. Psychological First-Aid plays a vital role in helping

disaster survivors cope with their trauma and be lead to and through the path of recovery. It is

crucial that it is available for any individual in need of it at any time. The Philippines is known to

be one of the top most disaster-prone countries, which makes the presence and availability of

Psychological First-Aid very crucial. With the implementation of improved Psychological First-

Aid in The Philippines, the country can be better prepared for natural disasters and improve the

quality of the aid they can offer to individuals affected by them.

PSYCHOLOGICAL FIRST-AID 3

Table of Contents

Abstract…………………………………………………………………………………………....2

Table of Contents………………………………………………………………………………….3

Introduction………………………………………………………………………………………..4

Limitations………………………………………………………………………………………...5

Literature Review…………………………………………………………………….……………6

Discussion………………………………………………………………………………………....8

Natural Disasters and their Effects………………………………………………………..8

Psychological First-Aid……………………………….………………..………………..16

PFA in the Philippines………………………………...…………………..……………..23

Conclusion……………...…………………………………………………………..…………....25

References……………………………………………………………………………..………....27

Appendices………………………………………………………………………...…………......31
PSYCHOLOGICAL FIRST-AID 4

Introduction

It all began with the shifting of a few tectonic plates along the East Bohol Fault. On

October 15th, 2013 at 8:12 a.m., a deadly magnitude 7.2 earthquake hit The Philippines, with the

epicenter at the island of Bohol. The earthquake affected 3 million people, displacing more than

300,000 of them and damaging 73,000 homes along with historic buildings, ports, schools, and

airports. There were over 800 people injured, over 200 killed, and some that went missing and

were never found. However, Mother Nature was not done with The Philippines just yet.

Less than a month following the Bohol Quake, Typhoon Haiyan struck. One of the

strongest typhoons recorded in history, it affected the lives of hundreds of thousands of people.

Forming on November 3rd, 2013, it continued to develop and intensify until finally dissipating

on November 11th, 2013. Throughout its rampage, nearly 800,000 people were forced to flee,

millions of homes were damaged, at least 6,300 people were killed in the Philippines alone, and

over a thousand people still remain missing. Within the span of a few weeks, the lives of millions

were altered forever, and these are only two of the countless tragic calamities that the Philippines

has come across over the years.

The Philippines is one of the most disaster-prone countries in the world. Over the past

two decades, almost 300 natural disasters have occurred. From earthquakes to floods to tsunamis

and hurricanes, natural disasters are large scale catastrophic events that cause tremendous

amounts of damage in many ways. The severity of disasters are measured in regards to the

amount of lives lost, economic losses, and a population’s ability to recover and rebuild. The

people that survive them are more likely to develop mental health issues due to their experiences.

Not only are they psychologically distressed, but they can be physically injured as well as

financially unstable due to expensive medical bills or the extensive loss or damage of property.
PSYCHOLOGICAL FIRST-AID 5

With all of these unfortunate events piling up on thousands of individuals, it is critical that they

receive the proper care they need. Psychological First-Aid is one of the most necessary

immediate responses following a natural disaster that helps individuals affected, and in disaster-

prone areas like The Philippines, with the proper aid, they can be helped psychologically and

economically.

Limitations

Geographical Limitations. While natural disasters have occurred and continue to occur in

numerous locations around the world, the author has decided to narrow down the geographic

region to one specific country: the Philippines. The Philippines has a long history of being

disaster-prone and offers a plethora of research, experimental results, records, and other sources

of information throughout the years on the topic area. Narrowing down the research to this one

country makes for a more centralized and in-depth analysis of the issue. However, this does not

lessen the impact of natural disasters on other countries around the world.

Aspects Addressed. Although there are several aspects that are affected following natural

disasters, the author chooses to focus on the psychological and economic effects, and further

focus on on a few aspects of the economic effects. This does not lessen the importance of other

aspects and procedures concerning Psychological First-Aid. This helps to further narrow down

the research and provide the most important information necessary to support the research.

Access to Information. The author does not have the ability to physically retrieve information

from the Philippines. They can not travel there to conduct research such as physically

interviewing individuals that have been affected by natural disasters. They are limited to

databases, finding connections electronically, and local resources. However, these resources still

provide plentiful information regarding the topic issue.

PSYCHOLOGICAL FIRST-AID 6

Literature Review

Psychological First-Aid is typically needed following the damage caused by natural

disasters. As they are common geologic and meteorological occurrences, they can be

earthquakes, tsunamis, volcanic eruptions, floods, droughts, mudslides, tropical storms, and even

famine such as pandemics. Technological disasters usually result from industrial accidents or the

failure of large scale infrastructures. Regardless of the type of natural disaster, it is important that

workers providing PFA have the ability to provide basic mental health support to survivors.

Organized and supportive interventions can reduce stress, increase efficacy, and help to prevent

future mental health issues like depression and Posttraumatic Stress Disorder (PTSD). Mental

health issues such as depression and PTSD are described in Sustainable community mental

health: psychological first aid in humanitarian emergencies, a report done by Thomas F. Ditzler,

Patricia R. Hastings and Richard B. Deleon, conductors of humanitarian assistance training

activities for civilian and military personnel.

In an article from the Journal of Consulting and Clinical Psychology, Treatment of Acute

Stress Disorder: A comparison of cognitive-behavioral therapy and supportive counseling,

promoting calmness in individuals following trauma help to reduce distressing situations. In

another article from the Journal of Applied Social Psychology, Coping self-efficacy and

psychological distress following the Oklahoma City bombing, with an increase in self-efficacy,

people develop increased positive outlooks on their abilities to cope with and manage distressing

events, which can be done through self-regulation of thought, behavior, and emotions. From the

Journal of the American Medical Association, the research from the article Exposure to

terrorism, stress-related mental health symptoms, and coping behaviors among a nationally

representative sample in Israel indicates the relation between social support and improved
PSYCHOLOGICAL FIRST-AID 7

emotional well-being and recovery following mass trauma is the basis for promoting

connectedness.

Collective traumatization, a traumatic psychological effect shared by a group of people of

any size, up to and including an entire society, can be a complex issue to deal with. In

'Psychological first aid': education is essential in post-conflict situations, an article by Nila

Kapor-Stanulovic, a writer for the UN Chronicle, Kapor-Stanulovic writes:

“One can only try to support their recovery by re-establishing dignity, self-worth
and appreciation for life and individuals; some will recover on their own, while
others will not. Unfortunately, people tend to return to violence soon after being
exposed to chronic, continuous trauma. The future is very bleak for countries
where the population has been heavily traumatized as a whole.”

With this said, providing PFA can be quite difficult dealing with different types of people

in several different types of situations. This makes the need for the implementation of PFA as

well the proper training for workers providing it even more crucial. From the article

Bioterrorism: what are we afraid of and what should we do? by RM Demartino, between 4 and

50 people are psychologically affected by a traumatic event for each person physically affected.

From the article The behavioral consequences of terrorism: a meta-analysis by Charles

DiMaggio, PhD, MPH, PA-C, and Sandro Galea, MD, DrPH, of those directly affected by

trauma caused by humans, 12% to 16% of them will develop PTSD. 75% of those people will

continue to experience PTSD symptoms after 1 year.

There are several aspects of the lives of individuals that are impacted by natural disasters.

Not only are there the obvious possible physical and psychological effects, but there are the

social and economic effects as well. Property becomes damaged, lost, or completely destroyed,

which can range from small personal belongings to entire homes. The right to housing is

discussed in Sheltering and Housing Recovery after Disasters: Dissecting the problems of policy
PSYCHOLOGICAL FIRST-AID 8

implementation and possible solutions by Agyemang Frimpong, PhD Assistant Professor of

Public Administration at the BJ-ML School of Public Affairs, in the International Journal of

Humanities and Social Science. Access to resources may be limited and those in poverty suffer

extensively. On a report from VOA news by Joe DeCapua, Natural Disasters Worsen Poverty,

the connection between the two issues and how not only do natural disasters worsen poverty, but

how poverty itself causes disasters as well. Schools may be destroyed or damaged, and without a

place to conduct education, education is hindered as a whole. This issue is discussed in the report

Education Disrupted: Disaster Impacts on Education in the Asia Pacific region in 2015 Article

by Sarah Ireland, Humanitarian Advocacy and Policy Advisor from Save the Children Australia.

Discussion

Natural Disasters and their Effects

Natural disasters are natural events that cause great damage or loss of life. They fall into

3 broad categorized groups. There are those that are caused by the movements of the Earth, those

caused by the weather that can usually, to some degree, be warned of in advance, and those

caused by extreme weather conditions, usually the result of extreme and unforeseen conditions.

Their impacts can vary depending on different aspects, such as the type and size of the disaster

and the population affected and their vulnerability to disasters. Some examples of natural

disasters include earthquakes, volcanic eruptions, tsunamis, hurricanes, tornadoes, floods,

mudslides, landslides. The lives of those affected by disasters like these can be impacted in

several ways. This paper will focus on the psychological and economic effects of natural

disasters.

Psychological Effects. Natural disasters cause mass traumatization in populations

affected. Evidence has provided that they can severely compromise the wellbeing of affected
PSYCHOLOGICAL FIRST-AID 9

persons and inhibit their ability to function normally and various studies have been conducted to

show the impact natural disasters have on humans psychologically (Sandhu & Kaur, 2013). Most

psychological responses to trauma are relatively immediate, mild, and transient (Norris,

Friedman, Watson, Byrne, Diaz, & Kaniasty, 2002). However, there is a significant amount of

individuals that develop trauma from stress reactions of higher degrees. Among these

psychological impacts, the most common consist of Peritraumatic stress reactions, Post

Traumatic Stress Disorder (PTSD), grief symptoms, depression, anxiety disorder, substance

abuse disorders, distorted perceptions, pessimism, and thoughts of suicide and attempts at

suicide.

Traumatic events can all begin with some type of stress. Stress is a response that can be

physical or emotional caused by heightened tension or worry. Natural disasters cause changes in

social systems, which in turn requires people to adapt. Peritraumatic stress reactions are an

extreme tier of stress reactions, which can be considered extreme if they cause a significant

decrease in the ability to be oriented in reality, issues with communicating, a negative influence

on relationships, and effects on recreation, self-care, education, or work. Some examples of

Peritraumatic stress reaction are dissociation, avoidance, intrusive re-experiencing, anxiety,

depression, problematic substance use, psychotic symptoms, and hyper arousal.

Posttraumatic stress disorder, or PTSD, is the condition where re-experience of a

traumatic event, avoidance, numbing, and hyper arousal occurs. In order for PTSD to be

diagnosed, symptoms must be present for at least one month in the individual. It must also cause

significant distress or inhibit proper functioning in order to be categorized as PTSD. Depression

is the second most common psychological disorder observed in disaster survivors. Research

suggests that PTSD prevention and decreased depressive symptoms, in comparison to repeated
PSYCHOLOGICAL FIRST-AID 10

assessment, self-help, education, and support, can be done through immediate intervention,

which in turn benefits in psychological functioning (Bryant, Moulds, Guthrie, Dang & Nixon,

2003).

Grief is a response to loss following a tragic event, typically the loss of a loved one or

several loved ones. Although grief itself is a normal response, complicated grief involves

stronger and deeper emotions. It can consist of an extensive yearning for the deceased, intense

sorrow, bitterness, hopelessness, preoccupation with the loss, and the inability to go on living

life. Individuals with extreme grief tend to focus on things that remind them of loved one or

loved ones or try to avoid those reminders at extreme measures completely.

When put into a situation with limited information, humans tend to make decisions based

on just the information given at the specific moment in time (Sandhu & Kaur, 2013). For

example, people in more positive moods are more likely to handle a situation with a more

positive outlook and make more favorable evaluations rather than people in more negative

moods who would lean more towards pessimism. Pessimism can have detrimental effects on a

person’s behavior and actions. Metacognitive feelings can modify the effect on judgments and its

impacts (Sandhu & Kaur, 2013). As a result, these feelings and moods influence the views

people have on their capabilities and their futures.

Economic Effects. Natural disasters impact the lives of people in several ways

economically. They can affect those living in poverty, impact education, damage homes and

infrastructure, and cause difficulties to accessing resources.

Natural disasters hits those in poverty the hardest. Until they’re better prepared to face

them, extreme poverty cannot be eliminated. Dr. Tom Mitchell, ODI’s head of Climate Change
PSYCHOLOGICAL FIRST-AID 11

and author on a report on The Geography of Poverty, Disasters and Climate Extremes in 2030,

had this to say on the connection between poverty and disasters:

“What we found is there’s a very close overlap between the countries that we
expect to have very high levels of poverty still in 2030 and the countries most
exposed to natural hazards. And now this shouldn’t really come as a surprise
because we know that the poorest and most vulnerable people get hit hardest by
extreme events. So there really is a very close link between poverty and
disasters.”

He also stated the following on how their misfortune is not solely due to bad luck:

“Natural hazards don’t discriminate. It’s actually people who discriminate and
governments who discriminate. So what you find is that the poorest and most
vulnerable people are living in the most exposed areas – whether in informal
settlements on the edge of cities or in remote rural areas with poor access to early
warnings or to infrastructure. And in that regard they are in an acute position in
terms of their exposure, and they have very little assets to cope.”

With this said, it is evident that those in poverty are in no financial position to account for the

damage or loss of their properties or belongings.

In countries that have been affected by natural disasters, government programs tend to

focus more on big cities or areas with infrastructures with higher value rather than areas with the

poorest and most vulnerable people, even if they are the most affected by the event, this results

in socio-economic inequality. Those living in poverty are more likely to live in areas that are

more exposed to hazards and are less able to develop or maintain risk-reducing measures

(UNISDR, 2015). Because they lack access to insurance and social protection, they are forced to

use up the limited assets they have, driving them even further into poverty. Therefore, poverty is

not only a consequence of disaster risk, but also a cause of them and are a determinant to what

extent and extremity risks reach following disasters. Along with loss of life, injury, and damage,

disasters cause displacement, food insecurity, poor health, and several other negative
PSYCHOLOGICAL FIRST-AID 12

consequences. Health-related and social aid are not always readily available (See Appendix B for

a table with information on High-Quality Health, Behavioral Health, and Social Resources).

Poverty is affected in both rural and urban areas when natural disasters hit, but in

different ways. Rural areas have a very limited capacity to handle the damage of disasters and

recover from them. This is due to the area being highly vulnerable and exposed to weather-

related hazards. In poor urban households, shelter is the principal economic asset that provides

people with sanctuary and security. Natural disasters cause physical damage to these households,

destroying personal possessions as well as housing as a whole. As a result, replacing these assets

cause extensive negative effects on household economies. Capabilities and entitlements

determined by a wide range of economic and social factors shape disaster risk (Shepherd,

Mitchell, Lewis, Lenhardt, Jones, Scott, & Muir-Wood, 2013). Disaster risk and resilience are

directly affected by access to resources, political voice, and economic and social status.

Underprivileged areas have insecure and low-quality housing. This limits access to basic

services, including public communications, transportation, healthcare, and infrastructure

(Satterthwaite & Mitlin, 2014).

The following are a few more facts and data from Disasters and Responses, News, an

article by Beth Kanter from FAMVIN, NewEN, on the connections between poverty and natural

disasters. “About 95 percent of deaths caused by disasters occur in poor countries. A disaster of

similar nature and size causes more deaths in poor countries than in rich ones” (Kanter, 2005).

After a disaster, disease spreads quickly if there is no clean water and limited toilets available.

Limited healthcare resources in poor countries can be inadequate for dealing with the health

emergencies that result from disasters” (Kanter, 2005). “Children orphaned by disasters in poor

countries are vulnerable to exploitation of various sorts, including sex trafficking. Poor countries
PSYCHOLOGICAL FIRST-AID 13

have limited or no resources to deal with the post-traumatic stress that survivors may face for

decades to come, especially for parents who feel guilty that their children perished” (Kanter,

2005).

Along with those in poverty, disasters majorly impact children and youth and their

education. The lives of around 200 million children per year will be severely impacted in the

Asia Pacific region in future decades due to natural disasters. Natural disasters prevent children

from getting the quality education in which they have a right to. Disaster risk reduction is not

prioritized and the resources for them are not provided by governments. This makes the recovery

of the damage or complete destruction done to schools extremely difficult.

Communities and countries as a whole can gain benefits with the support of education,

prior to, during, and after disasters hit. Schools can have a catalytic effect on strengthening

humanitarian effectiveness, reducing vulnerabilities and supporting risk mitigation for future

hazards (Ireland, 2016). Investing in the protection of national education systems and reducing

their vulnerability would allow for a smoother and less expensive recovery. Thus, children will

be able to continue their education quicker.

The following are a few facts from the report Education Disrupted by Sarah Ireland on

disaster impacts on education in the Asia Pacific region. “Pre-existing challenges with school

enrolment, alongside the damage to education infrastructure, often leave many children in need

of critical education support to help ensure their longer-term development” (Ireland, 2016).

“Education is generally not prioritised in a disaster response, and reconstruction or rehabilitation

of damaged schools is often belated. Almost a year after the earthquakes in Nepal and Cyclone

Pam in Vanuatu, children are still being taught in temporary learning centres that were meant for

use for weeks or months, not years” (Ireland, 2016). “There are significant gaps in information
PSYCHOLOGICAL FIRST-AID 14

from the education sector on both the short- and long-term impact disasters have on education. A

lack of official data collection and analysis on the number of children and schools affected by

disasters is reported as often inhibiting coordination amongst response agencies, government

bodies and community organizations, and on the effectiveness of the education response as a

whole” (Ireland, 2016).

Along with the impact natural disasters have on groups of people, there is the evident

physical damage done to homes and infrastructure. It deals with not only the recovery of houses,

but also debris removal, infrastructure, and economic development. In Chapter 14 of the

Handbook of Disaster Research, authors Smith and Wenger write about sustainable disaster

recovery. They describe the recovery phase as the process of restoring, rebuilding, and reshaping

the physical, social, economic, and natural environment through pre-event planning and post

disaster actions (Smith & Wenger, 2006).

Many people run into problems restricting their right to housing. The right to housing is

one of the most recognized social, economic, and cultural rights, yet people still fail to acquire

housing, especially following natural disasters. Housing and sheltering issues are very important

in many places all around the world, especially to victims that are vulnerable and at a social

disadvantage following natural disasters (Bolin & Bolton, 1986; Smith, 1999). The United

Nations Economic and Social Council established the Committee on Economic, Social and

Cultural Rights (CESCR). CESCR stated that, “victims of natural disasters” and “people living

in disaster prone areas” as among those disadvantaged groups should be ensured “some degree of

priority consideration in the housing sphere” (CESCR, 1985).

The right to housing goes hand in hand with the process in which housing recovery

occurs. Whenever communities experience natural disasters that cause substantial damage or
PSYCHOLOGICAL FIRST-AID 15

complete destruction of houses, the recovery process is usually slow and extremely painful to go

through. People must find temporary housing, food and clothing, and receive psychological

counseling. Many people also run into issues with their jobs and need to find further assistance,

and businesses must recuperate from their losses and attempt to restart themselves with what

little they may have left.

As discussed, there are several aspects in which natural disasters impact different groups

of people, communities and populations as whole, homes and structures, and the lives of people

and their livelihoods. Although there are many more aspects that could be addressed in regards to

the effects of natural disasters, the psychological and economic effects are very prominent and

make the biggest impacts on individuals, with the economic effects also not limited to the lives

of those in poverty, children and youth and their education, and the physical effects on homes

and infrastructure. The psychological and economic effects also inversely affect one another.

When individuals are experiencing mental issues, it can affect their education or their work, and

with economic strains such as financial instability and the overload of stress, their risk of

developing mental health problems increase. Therefore, disaster survivors that are negatively

impacted in these aspects are stuck in back and forth cycle of stress and struggle. With this said,

it is evident that natural disasters have the capability to cause massive damage and change the

lives of many, but now the question is: How can these people be helped?

Psychological First-Aid

Today, the term and concept of Psychological First-Aid is relatively new and is

frequently misinterpreted. Psychological First-Aid (PFA) is defined as an approach to provide

immediate, practical mental health support to disaster survivors. It consists of a systematic set of

helping actions with the goal to reduce initial post-traumatic distress and supporting adaptive
PSYCHOLOGICAL FIRST-AID 16

functioning, short and long term. The belief that Psychological First-Aid implies the presence of

psychopathology is a common misconception. Its entirety does not consist of providing a formal

diagnosis or traditional forms of mental health care. Its overall purpose is to identify and respond

to immediate emergency situations and aid individuals involved. This is done by going through

specific tasks and using short-term practical interventions that have demonstrated their utility in

a diverse range of humanitarian spaces. PFA is designed in order to be applied in a disaster or

trauma response intervention that is on a larger and more comprehensive scale, as well as

collectively addresses a wide range of disaster-related problems and associated needs (Ruzek,

Brymer, Jacobs, Layne, Vernberg, & Watson, 2007). The basic goals of PFA are to reduce stress

of affected persons from trauma, direct them away from further traumatic stimuli, meet their

immediate needs, and to provide them a means of further recovery (Ditzler, Hastings, & Deleon,

2009).

Some key objectives of Psychological First-Aid are establishing a human connection in a

compassionate and non-intrusive manner, providing emotional and physical comfort while

securing safety, offering practical information and assistance in order to address immediate

needs, calming individuals and helping to reduce their stress, connecting individuals to additional

help and support, encouraging positive coping means, and linking for further recovery (Ditzler et

al., 2009). More specifically, Psychological First-Aid consists of Eight Core Actions. These core

actions are Contact and Engagement, Safety and Comfort, Stabilization, Information Gathering,

Practical Assistance, Connection to Social Supports, Information on Coping, and Linkage with

Collaborative Services (See Appendix A for a table with an overview from the Psychological

First Aid Field Operations Guide 2nd Edition).

PSYCHOLOGICAL FIRST-AID 17

Contact and Engagement. Affected persons may not seek out help from providers or

want it. This means the provider must assess situations by using their judgement to determine

how to initiate contact. Providers should be non-intrusive, compassionate, and helpful. Once they

are introduced they can should about any needs that need to be met immediately. This initial

interaction is very important because it gives the person affected a sense of connectedness,

making them more willing to trust the provider and accept further aid.

Safety and Comfort. The first steps to providing practical help consist of ensuring

immediate physical safety, promoting a sense of psychological safety, as well as physical and

emotional comfort. PFA providers may need to obtain assistance from a medical or security team

when it comes to persons that may be a potential threat to themselves and others. Assisting to

immediate physical safety means PFA providers should be alert to attend to critical medical

concerns and help to protect affected persons from further trauma. PFA providers should

encourage affected persons to be active, facilitate their reconnections with family members and

other affected persons, and inform them on accurate information on the event such as what is

currently known about the event and the services that are helping to aid survivors of the event.

Above all, it is especially important to judge every person’s situation properly in order to decide

how to approach their needs while protecting their privacy and respecting their wants at the same

time.

Stabilization. Stabilization is helping to calm and reorient affected persons by reducing

their stress. It isn’t necessary to stabilize expected expressions following traumatic events such

as expressions of strong emotion, but rather reactions that inhibit their ability to comprehend the

situation or respond to guidance. These reactions may consist of a person being unresponsive to

questions, hyperventilating, crying uncontrollably, or experiencing intense physical reactions that

PSYCHOLOGICAL FIRST-AID 18

they cannot control. PFA providers have several ways in which they can take action, they can

comfort the distressed person by taking them aside or allow their loved ones to provide comfort

to them, giving them time alone, simply being present for support, or seeking other professional

assistance.

Information Gathering. Focusing on the immediate assistance of affected persons,

gathering information consists of identifying immediate needs and concerns and properly

tailoring means of intervention. This process is repeated as needed throughout the course of

disaster response. Meanwhile, the PFA provider should look for the needs for potential referral,

additional services, or follow-up contact. Relevant information that may be important to gather

would be pre-existing social support network, prior mental health treatment, and use of alcohol

or drugs. The PFA provider must use judgment while gathering information in order to

determine how much information that must be gathered, what questions must be asked and to

what extent while remaining respectful and sensitive to affected persons.

Practical Assistance. A central part of PFA is aiding affected persons and their current

or anticipated problems. Added problems following those of the disaster can contribute to even

more stress for affected persons Problem-solving, discussing immediate needs, and generating

ideas are helpful. With this, it is important to follow up with an active response. This can lead

into further assistance, which is where the next core action, Connection to Social Supports,

comes in.

Connection to Social Supports. Reestablishing contacts with sources of support is

important. One of the immediate duties of a PFA should be to locate and contact the loved ones

of an affected person. Doing this implements a sense of predictability and normalcy in the

disaster environment. If an affected person is not able to contact a form of social support, it may
PSYCHOLOGICAL FIRST-AID 19

be a good idea for them to engage in interactions with other survivors if appropriate in order to

provide support to others while receiving support for themselves.

Information on Coping. PFA providers must provide information on common reactions

to stress, ways to reduce their stress, and how to promote adaptive functioning. It may be helpful

to discuss positive and negative actions of coping. They should also educate on disaster-related

information such as what is known about the current event, what is being done to help survivors,

and the services that are being offered.

Linkage with Collaborative Services. Many affected person will require additional

services following PFA, making it important to link them with those needed services in order for

them to contact certain agencies or resources. It would be beneficial to involve local community

leaders or other indigenous authority figures that can be principal sources of support. When

making referrals, it is important to discuss all the needs of the affected person and give them

their options for referral. It may be necessary to physically aid them in getting to further

assistance or organizing a meeting with a community representative that can provide appropriate

referrals.

PFA can be provided by a wide range of individuals. Examples include caregivers from

traditional mental health fields, such as psychology, psychiatry, social work pastoral care, or

nursing. It can also be provided by trained paraprofessionals, usually community leaders, from

village elders and traditional healers to teachers and law enforcement or security personnel

(Ditzler et al., 2009). With the different types and levels of aid PFA involves, a variety of

qualifications must be met as well as receiving varying levels of training. Because the knowledge

and capabilities of members of different professions differ, the capacity in which they can

competently carry various interventions varies and which groups or individuals they can work
PSYCHOLOGICAL FIRST-AID 20

with too. Therefore, added consultation services and referral networks are available in order to

ensure quality and continuity of care, which helps to prevent adverse effects (Ruzek et al., 2007).

Several studies and experiments have been conducted dealing with Psychological First-

Aid. In South Korea, a preliminary evaluation was done in order to examine the training effects

of a didactic and simulation-based psychological first aid program in students and school

counselors. Recognition of the importance of aiding in psychological needs from disasters has

been increasing in Korea. This has especially occurred in response to recent disasters nationwide,

including the Sewol ferry disaster in 2014 and a series of earthquakes since 2016. The nation is

now more aware how important PFA is and the training that comes with it.

A study was conducted by Jong-Sun Lee, Sungeun You, Yun-Kyung Choi, Hye-young

Youn, and Hye Sook Shin to examine if a PFA program on knowledge and skills would

significantly impact training effects. They did so with thirty-seven students, undergraduates

studying psychology to obtain their Bachelor’s degree and graduates studying clinical

psychology to obtain their Master’s Degree. On August 30, 2016 the students participated in a

one-day workshop at Keimyung University. They took part in a 3-hour didactic lecture delivered

a licensed clinical psychologist and a 3-hour simulation-based practice delivered by licensed

clinical psychologists. The study assessed their knowledge on PFA and perceived competence in

PFA skill.

This study provided results showing that a day of training for PFA with a didactic lecture

and a simulation-based practice yielded medium to large effect sizes. They found “a medium-

sized effect on PFA knowledge and perceived confidence to provide psychological assistance for

future disasters and large effects on perceived competence in PFA skills and perceived

preparedness” (Lee, You, Choi, Youn, & Shin, 2017). They concluded that using an evidence-
PSYCHOLOGICAL FIRST-AID 21

based PFA program to train qualified disaster mental health providers could lead to a well-

organized community response following a disaster (Lee et al., 2017).

Another similar study was conducted by Suzanne Hawley, Gary Hawley, Theresa St.

Romain and Elizabeth Ablah, but in the state of Kansas in the United States. It assessed

perceived mental health preparedness knowledge following mental health preparedness training.

The participant consisted of 157 first and secondary response responders from public health

allied fields. The training consisted of 10 presentations developed by the Department of

Preventive Medicine and Public Health at the University of Kansas School of Medicine-Wichita

on mental health emergency preparedness topics. Topics included stress reactions, mental health

and physical consequences from a disaster or terrorist event, factors of resilience, and the

importance of including mental health plans in preparedness planning.

Taking this training, participants demonstrated significant improvements in mental health

preparedness knowledge from their pretests to their post-tests. On a 6-point Likert scale, from

pretest to post-test, there was an increase from 3.17 (“adequate”) to 4.63 (“good” to very good)

of mean perception of knowledge about typical stress reactions from terrorist or disaster events.

The study exhibits the potential mental health-related and non-mental related occupations have in

improving mental health preparedness knowledge through further training. The conductors of

this study stated that:

“Continuing to train representatives from a wide variety of public health and

allied health agencies would ensure that mental health preparedness knowledge
would be transmitted throughout the public health workforce. Future mental
health preparedness training should include follow-up evaluation to determine
whether participants continued to perceive gains in their knowledge over time.”
PSYCHOLOGICAL FIRST-AID 22

These studies evidently provide support for the effectiveness of mental health preparedness

training to increase the knowledge of the topic for public health professionals and that have high

potential to be responders in emergency situations.

PFA in the Philippines

The Philippines has it’s long history of natural disasters, from Tropical Depression

Winner in November 2004 to Guinsaugon Landslide in February 2006, Cyclone Durian in

November 2006 and Tropical Storm Washi in December 2011, and the Bohol Quake in October

2013 and Typhoon Haiyan in November 2013, the list goes on (See Appendix C for a transcript

of an interview with a Filipino Immigrant on natural disasters in the Philippines). With the

country being one of the most disaster-prone countries in the world, it is extremely important that

those in the country affected by natural disasters receive the Psychological First-Aid they need.

One of the major issues faced following traumatic disaster events are psychological.

However, mental illness is an issue that Filipinos still find difficult to understand. The

Philippines Daily Inquirer in Makati, the Philippines stated that Filipinos “feel uncomfortable

when discussing, for instance, depression, anxiety and bipolarism, or they tend to stigmatize

these illnesses-criticizing those who open up about their condition, calling them 'OA,' (meaning

they are overacting or being dramatic) or disregarding the seriousness of their condition.” It is

crucial that when people have been psychologically affected by an event that they are helped in

the coping process in order to properly recover and in a healthy manner.

Along with psychological impacts, education is affected as well. There is a total of over

46,000 primary schools and 12,000 secondary schools in the Philippines. Over 20 million

students are enrolled in private and public schools. Because the country experiences natural

disasters frequently, education is often disrupted. School buildings are damaged, teaching
PSYCHOLOGICAL FIRST-AID 23

materials and school supplies are lost, teachers are unavailable for long periods of time, students

and teacher are injured or killed, and students often drop out (Ireland, 2016). The growth and

educations of the youth are put to a halt and their lives severely affected.

The country as a whole is still developing and still lacks and resources, technology, and

funding developed countries have. The recovery process can be slow and long due to the lack of

resources and aid. Those living in rural areas and in poverty especially may not have the

transportation or means to be reached or offered Psychological First-Aid (See Appendix C for a

transcript of an interview with a Filipino Immigrant on the presence of PFA in the Philippines).

These difficulties and drawbacks make it evident that improved PFA is very much needed and

extremely crucial to have in the Philippines in order to manage the effects of natural disasters.

PFA has, however, improved in the Philippines on multiple occasions in past years. The

Government of the Philippines and the international community has done work to reduce the risk

of impacts of such disasters and alleviate them. The Philippines has created binding frameworks

and legislation, addressing disaster risks and response in a comprehensive manner, to improve its

disaster management capacity significantly. However, it still continues to face challenges of

coordinating the work of the large amount of government and non-government agencies and

institutions involved (Ireland, 2016).

The Mindanao conflict in the Philippines first began in the 1960s. The Muslim minority

began an armed struggle in order to regain their ancestral homeland in the southern island. Since

then, peace has been interchanged with clashes between the Bangsamoro rebel forces and the

Armed Forces of the Philippines (AFP). This has caused the displacement of tens of thousands of

people. In November 2008, the Medecins Sans Frontieres or MSF began working to provide

medical care for those displaced. Psychologists trained community health workers to be able to
PSYCHOLOGICAL FIRST-AID 24

identify and refer cases of mental disorders and epilepsy to the MSF mobile clinics. There, the

mental health team would provide persons with proper diagnosis and treatment. The Mindanao

project in the Philippines provides support that in an emergency humanitarian context, mental

health approaches, such as PFA, can be integrated into primary health care (Mueller, Cristofani,

Rodriguez, Malaguiok, Gil, & Grais, 2011).

In December 2013, Filipino health professionals were given the opportunity to learn how

to teach others to provide PFA in support of typhoon survivors of Typhoon Haiyan. The

Philippine Department of Health (DOH) with support from the World Health Organization

(WHO) gathered 25 professionals from the government, professional associations, universities,

and community agencies to learn about PFA recommended by WHO. Filipino psychologists,

physicians, and psychiatrists used the train-the-trainer method to teach people in the community

how to perform PFA. This approach showed that anybody is capable of being of help during

crisis situations. “Filipinos, we are very compassionate. So it is kind of cultural for us to be warm

to people and aid someone who is seeking help. This makes the approach very conducive for our

local context” stated Dr. Criselda Abesamis, the Director of the Special Concerns Technical

Cluster at DOH.

Conclusion

Natural disasters result in various effects on people and their communities. Psychological

effects should be handled with great care due to their sensitive nature, and economic effects

should be focused on in order to build back up lives that have been broken down. Those in

poverty, children and youth and their education, homes and infrastructure, and access to

resources are aspects that are majorly impacted when it comes to natural disasters. People all

around the world every year, every month, and every day are suffering from their effects.
PSYCHOLOGICAL FIRST-AID 25

Psychological First-Aid helps to aid in all aspects and responds to immediate needs. It is the

most crucial first-step in aiding disaster survivors and provides for an easier, faster, and more

efficient recovery.

The Philippines faces many challenges dealing with natural disasters, especially with how

frequent they occur. It is evident that it experiences the major psychological and economic

effects commonly present following natural disasters. Poverty is still very prevalent, education is

still vulnerable to disruptions, and overall there is an absence of resources and financial support

in the country to go towards PFA so that all people, regardless of who they are or where they

live, are able to receive it. With the knowledge of what PFA is able to provide, the improvement

of it can be supported and should be implemented in order to lessen the damage done physically

and emotionally. The Philippines still remains a developing country and requires additional aid

in PFA among other aspects. Although, it is still important to acknowledge the successes the

Philippines has had with trying to advance PFA in past years. Psychological First-Aid and the

proper training for individuals to provide it should be a priority in the Philippines, because

although natural disasters can not be prevented, mankind still has the capability of ensuring that

people affected by them can recover with as little difficulty as possible.

PSYCHOLOGICAL FIRST-AID 26

References

Associated Press. (2013, November 9). One of world's strongest typhoons lashes
Philippines. Retrieved from http://newsinfo.inquirer.net/523635/yolanda-one-of-worlds-
strongest-typhoons-blasts-philippines

Bolin, R. and P.A. Bolton.(1986). Race, Religion and Ethnicity in Disaster Recovery.
Institute of Behavioral Science, University of Colorado, Boulder. Retrieved from
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.951.7502&rep=rep1&type=pdf

Bryant, R. A., Moulds, M. L., & Nixon, R. V. (2003). Cognitive behaviour therapy of
acute stress disorder: a four-year follow-up. Behavioral Research and Therapy, 41, 489-
494. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12924676

Brymer, M., Watson, P., Vernberg, E., Steinberg, A., Ruzek, J., Pynoos, R., . . . Layne, C.
(n.d.). Psychological First Aid Field Operations Guide. 2Nd Edition. Retrieved from
http://www.cidrap.umn.edu/sites/default/files/public/php/146/146_guide.pdf

Chandra, A., Acosta, J., Stern, S., Uscher-Pines, L., Williams, M., Yeung, D., . . .
Meredith, L. (2011). Access: Ensure Access to High-Quality Health, Behavioral Health,
and Social Resources and Services. In Building Community Resilience to Disasters: A
Way Forward to Enhance National Health Security (pp. 15-18). Santa Monica, CA;
Arlington, VA; Pittsburgh, PA: RAND Corporation. Retrieved from
http://www.jstor.org/stable/10.7249/tr915dhhs.12

Deadly Philippine quake hits Bohol and Cebu. (2013, October 15). Retrieved from
http://www.bbc.com/news/world-asia-24530042?scrlybrkr=25941573#

DeCapua, J. (2013, October 16). Report: Natural Disasters Worsen Poverty. Retrieved
from https://www.voanews.com/a/natural-disasters-poverty-17oct13/1770717.html

Demartino RM. Bioterrorism: what are we afraid of and what should we do? Paper
presented at: Biosecurity 2002 Conference; November 19, 2002; Las Vegas. Cited in:
Stein BD, Tanielian TL, Eisenman DP, Keyser DJ, Burnam MA, Pincus HA. Emotional
and behavioral consequences of bioterrorism: planning a public health response. Milbank
Q 2004;82:413-455.

DiMaggio C, Galea S. The behavioral consequences of terrorism: a meta-analysis. Acad

Emerg Med 2006;13:559-566.
PSYCHOLOGICAL FIRST-AID 27

Ditzler, Thomas F., et al. "Sustainable community mental health: psychological first aid
in humanitarian emergencies." Journal of Human Security, vol. 5, no. 2, 2009, p. 35+.
Opposing Viewpoints In Context,
eztcc.vccs.edu:2048/login?url=http://go.galegroup.com/ps/i.do?p=GPS&sw=w&u=viva2
_tcc&v=2.1&it=r&id=GALE%7CA212102786&asid=738e596dd8d1291fe21e214a5170
1a83

Education Disrupted: Disaster Impacts on Education in the Asia Pacific region in 2015.
(2016, June 22). Retrieved from https://reliefweb.int/report/world/education-disrupted-
disaster-impacts-education-asia-pacific-region-2015

Evans, M. (2011, May 14). Natural Disasters. Retrieved from

http://www.earthtimes.org/encyclopaedia/environmental-issues/natural-disasters/

Frimpong, A. (2011). Sheltering and Housing Recovery after Disasters: Dissecting the
problems of policy implementation and possible solutions. International Journal of
Humanities and Social Science , 1(20). doi:10.6000/2371-1655. Retreived from
http://www.ijhssnet.com/journals/Vol_1_No_20_December_2011/1.pdf

Hawley, S. R., Hawley, G. C., St. Romain, T., & Ablah, E. (2007). Quantitative impact of
mental health preparedness training for public health professionals. Biosecurity and
Bioterrorism: Biodefense Strategy, Practice, and Science, 5(4), 347+. Retrieved from
http://go.galegroup.com/ps/i.do?p=GPS&sw=w&u=vbcps&v=2.1&it=r&id=GALE%7C
A174819709&asid=d129fabdef9920ff44cc5b9715ad8383

Ireland, S. (2016, April). Education Disrupted: Disaster impacts on education in the Asia
Pacific region in 2015. Retrieved from
https://resourcecentre.savethechildren.net/sites/default/files/documents/education_disrupt
ed_save_the_children_full_report.pdf

Kanter, B. (2015, October 07). Poverty and Natural Disasters. Retrieved from
https://famvin.org/en/2005/10/15/poverty-and-natural-disasters/

Kapor-Stanulovic, Nila. "'Psychological first aid': education is essential in post-conflict

situations." UN Chronicle, Dec. 2003, p. 53+. Global Issues in Context,
eztcc.vccs.edu:2048/login?url=http://go.galegroup.com/ps/i.do?p=GPS&sw=w&u=viva2
_tcc&v=2.1&it=r&id=GALE%7CA114007099&asid=ab2df0a2ba07b463e9ef1a4e0a7dc
791
PSYCHOLOGICAL FIRST-AID 28

Lee, J.-S., You, S., Choi, Y.-K., Youn, H.-Y., & Shin, H. S. (2017). A preliminary
evaluation of the training effects of a didactic and simulation-based psychological first
aid program in students and school counselors in South Korea. PLoS ONE, 12(7),
e0181271. Retrieved from
http://go.galegroup.com/ps/i.do?p=GPS&sw=w&u=vbcps&v=2.1&it=r&id=GALE%7C
A501760195&asid=ea6407328ee0699ceaf01a8a379d0177

Mueller, Y., Cristofani, S., Rodriguez, C., Malaguiok, R. T., Gil, T., Grais, R. F., &
Souza, R. (2011). Integrating mental health into primary care for displaced populations:
the experience of Mindanao, Philippines. Conflict and Health, 5, 3. Retrieved from
http://go.galegroup.com/ps/i.do?p=GPS&sw=w&u=vbcps&v=2.1&it=r&id=GALE%7C
A251678291&asid=66d7099c9ab0bf790d8e6e69221021e7

Oliver-Smith, A. (1999). Post-disaster housing reconstruction and social inequality:

challenge to policy and practice. Disasters, vol. 14, 1989, pp. 7-19. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/20958690

Oskin, B. (2013, October 15). What Caused the Deadly Philippines Earthquake?
Retrieved from https://www.livescience.com/40432-what-caused-bohol-philippine-
earthquake.html

Poverty and inequality. (2015, November 12). Retrieved December 08, 2017, from
http://www.preventionweb.net/risk/poverty-inequality

Reyes, A. (2017, December 4). Natural Disasters and PFA [Personal interview].

Ruzek, J. I., Brymer, M. J., Jacobs, A. K., Layne, C. M., Vernberg, E. M., & Watson, P.
J. (2007, January). Psychological first aid. Journal of Mental Health Counseling, 29(1),
17+. Retrieved from
http://go.galegroup.com/ps/i.do?p=GPS&sw=w&u=vbcps&v=2.1&it=r&id=GALE%7C
A158907275&asid=f86cb6b177f6c4aa9ae72044f6985c72

Sandhu, D., & Kaur, S. (2013). Psychological impacts of natural disasters. Indian Journal
of Health and Wellbeing, 4(6), 1317-1319. Retrieved from
https://search.proquest.com/docview/1611830458/D351EFD690FC4CD8PQ/2?accountid
=3785

Santos, E. P. (2016, January 21). Philippines among world's most disaster-prone

countries. Retrieved from http://cnnphilippines.com/news/2015/11/25/philippines-fourth-
most-disaster-prone-country.html
PSYCHOLOGICAL FIRST-AID 29

Smith, G and Wenger, D. (2006). Sustainable disaster Recovery: Operationalizing and

existing framework. In H. Rodriguez, E. Quarantelli and R. Dynes (Eds). Handbook of
Disaster Research (pp. 234-257). New York: Springer). Retrieved from
https://link.springer.com/chapter/10.1007/978-0-387-32353-4_14

Understanding mental illness. (2017, November 13). Philippines Daily Inquirer [Makati
City, Philippines]. Retrieved from
http://go.galegroup.com/ps/i.do?p=GPS&sw=w&u=vbcps&v=2.1&it=r&id=GALE%7C
A514410159&asid=08346533cf5991f2faabaa76a5cedbec

Wingard, J., & Brändlin, A. (2013, December 11). Philippines: A country prone to
natural disasters | Asia | DW | 10.11.2013. from http://www.dw.com/en/philippines-a-
country-prone-to-natural-disasters/a-17217404?scrlybrkr=bb83767b
PSYCHOLOGICAL FIRST-AID 30

Appendices

Appendix A: Overview of Psychological First Aid from the PSYCHOLOGICAL FIRST AID
Field Operations Guide 2nd Edition
PSYCHOLOGICAL FIRST-AID 31

Appendix A: Overview of Psychological First Aid

PSYCHOLOGICAL FIRST-AID 32

Appendix B: Key Elements of High-Quality Health, Behavioral Health, and Social Resources
and Services from the book Building Community Resilience to Disasters.

Appendix C: Transcript of interview with Aurea Reyes, a Filipino Immigrant from the

Philippines, on natural disasters and Psychological First-Aid.

PSYCHOLOGICAL FIRST-AID 33

Q: Could you please give a little introduction of who you are and where you’re from?
A: My name is Aurea Reyes. I’m a 74 year-old Filipino Immigrant from the Philippines and I
lived in Asingan, Pangasinan in Central Luzon of the Philippines from my birth in 1943 to when
I immigrated to the United States in 1966.

Q: Did you ever experience effects from natural disasters during your life in the Philippines?
A: Yes, there were typhoons every single year where I lived, especially during the rice planting
season and rainy season, those were the months where there were a lot of typhoons. Every time
there was a typhoon we would have to stay inside the house because of the heavy rain and strong
wings that could last up to 24 hours. There would be a lot of damage to crops, the branches of the
trees fell down and some uprooted, and there would be flooding. There were usually no
casualties in my neighborhood because people knew to take precautions.

Q: Was there ever any type of aid that was provided to help those affected?
A: When natural disasters hit The Philippine Red Cross would come and help to provide aid,
food, water, and shelter.

Q: Can you describe the degree in which poverty exists in the Philippines?
A: When I was still living in the Philippines, for those families that were not educated and their
parents had no occupation, they depended on farming. My mother was a teacher and my father
was a farmer. Poverty was definitely worse before, it is still present in the Philippines today, but
now it has improved because education has improved. More people have jobs in the city, and
many are able to go abroad and make more money to send home.

Q: Was there any Psychological First-Aid available?

A: In the rural areas, called barrios, there was no such help such as Psychological First-Aid. It’s
too far out and there’s no transportation for people in town to go there. Those living in the rural
areas are living in poverty and they have to cope on their own.

Q: Do you think it would be beneficial to implement improved Psychological First-Aid for those
in the Philippines and why?
A: Now a days, there is available help known as Public Health Services, medical people like
doctors, nurses, and midwives go to the rural areas to deliver babies of pregnant women, give
immunizations, treat minor illnesses, and for major illnesses they take people to the hospital in
the city, but they can’t reach everyone. The U.S. is more developed because it has the money,
resources, and advanced technology to aid in the recovery from natural disasters, but in the
Philippines, there’s a lack of money and resources, so it’s harder for them. So I think it would be
beneficial to have better Psychological First-Aid so that they can provide the help people need
and get that help to them better.