Newsletter. Psychological first aid in and around Ukraine

Newsletter No. 2 March 2022 Psychological first aid, information for helpers in and around Ukraine

24.03 2022

Overview of content:

Psychological first aid
Some relevant links
What is psychological first aid?
Psychoeducation
About Better Learning Programs
Download the manuals

Dear friends and colleagues,

The war in Ukraine has devastating consequences for the mental health of Ukraine’s people; consequences that might reverberate for years to come. The heavy challenges and continuing task to address the consequences of the war will fall on helpers, volunteers or professionals living and working in extremely difficult conditions in Ukraine and the neighbouring countries.

The information in the following is compiled or developed for helpers, volunteers and professionals engaged in emergency work and support to

  • Persons exposed to war trauma, separation, loss, including sexual violence

Working with

  • Adults – individually or in groups
  • Adolescents or children – individually or in groups
  • Helpers and others engaged in emergency work

Important and practical information and handbooks about psychosocial support to be used in work with Ukrainian refugees inside Ukraine and in neighbouring countries have been developed by international and very experienced organisations.

 

Psychological first aid (PFA) for helpers
Working with people within Ukraine and impacted countries

What is psychological first aid?

  • a set of skills and knowledge that can be used to help people who are in distress.
  • a way of helping people to feel calm and able to cope in a difficult situation.

PFA rarely stands alone and is usually accompanied by other support and skills such as:

  • knowing how to assess a situation
  • familiarity with common patterns of reactions to crises
  • how to approach someone in distress and how to calm them if needed
  • how to provide emotional support and practical help.

Psychological First Aid is psychosocial support and is based on the intervention principles for providing psychosocial support in emergencies:
1. The first principle is about promoting a psychological sense of safety, which can be done on an individual, group, organization, and community levels.
2. The second principle is promoting calming. It is natural in emergency and crisis situations that people feel anxiety. In fact, some anxiety is a normal and healthy response required to make people pay attention. However, high levels of continued feelings of anxiety and difficult emotions are not good.
3. The third principle, promoting a sense of self and collective efficacy, supports the importance of having a sense of control over positive outcomes. When we are exposed to crises and emergencies an immediate effect is often a feeling of having lost control. It is important to support people to regain a sense of competency and belief in themselves that they can act and handle the situation.
4. The fourth principle is promoting social connectedness which provides opportunities for knowledge to essential emergency response information, as well as opportunities for social support activities, including emotional support and understanding.
5. The fifth principle is about promoting and instilling hope. Those who remain positive are likely to have favourable outcomes after going through tough experiences.
PFA is a method of helping people in distress that is based on the fundamental principle of DO NO HARM that we always follow in Mental Health and Psychosocial Support responses.
To ensure that we do no harm, we pay attention to offering help that promotes safety, dignity and is rights-based. This means that we make efforts to

  • Avoid putting people at further risk as a result of our actions and do everything we can to ensure the people we are helping are safe and protected from physical or psychological harm.
  • Concerning dignity, it means always treating people with respect and in accordance with their cultural and social norms.
  • Fulfilling people’s rights involves making sure people can access help fairly and without discrimination. It also means helping people to claim their rights and access available support.
  • We always act only in the best interest of any person we encounter. (@WHO, @IFRC-RC)

The information about PFA is from IFRC and WHO designed to orient helpers to offer psychological first aid (PFA) to people following a serious crisis event. PFA involves humane, supportive and practical assistance for people who are distressed, in ways that respect their dignity, culture and abilities in English and in Ukrainian.

Psychoeducation
(this information is available as a toolbox both in English and in Ukrainian)
Information about how the body and mind work and why we as human beings react the way we do in situations where life is threatened can be useful. This includes both the automatic responses in the situation and reactions that may come after the danger is reduced or over. This information may strengthen a person’s ability to understand and even deal with the reactions in alternative ways.

This knowledge implies an understanding of what traumatic events may do to a person, what she/he may expect and is aware of the reactions she/he may have. We believe that the more a person is aware and informed about reactions, the way these may affect the person and others, and how possibly to deal with these, the more the person can have control over their own life, and the better he or she can live with the reactions. In this way, information about trauma may empower both the person experiencing trauma and you as a helper.

 

‘Trauma’ means wound. In both medicine and psychology, it refers to major physical or mental injuries, including threats to life or physical integrity.

A ‘traumatic event’ is one characterized by the following:
-The situation is overwhelming, inescapable, and very frightening
-Life and integrity threatened
-Person feels the loss of control
-The situation is beyond what we are prepared to deal with
-The stressors surpass the capacity for mastering the situation
-Most people will struggle with serious reactions such as intrusive memories,
re-experiences, flashbacks and sleeping problems afterward
-Suffering can be recognized in thoughts, feelings, breathing, heart and body
Such events may cause mental and/or physical trauma. Faced with events that may threaten life, and/or physical and mental integrity, the immediate response is to struggle for survival. Behaviourally this is expressed by ‘fight, flight or freeze responses, submission or ‘faking dead’.
A severe traumatic event often changes the way in which people understand the world around them. 

Persons exposed to traumatic events may lose their sense of safety and feel vulnerable and helpless. If the event involves acts of violence and the intention to hurt, trust in other people may be lost and the relationships with others seriously disturbed.

Personal encounters with human or man-made violence are considered the most disturbing forms of trauma, likely to have the most lasting impact.

Loss of safety, control and trust commonly lead to depression (deep sadness, loss of the will to live, etc.) or anxiety. It is important to emphasize that the reactions experienced are “normal” reactions to an abnormal event. The person has not lost his or her mind!
Some important things to know about acute trauma:

  • When a person is traumatized, her/his feelings are intense and chaotic
  • Fear and shame may cause a survivor to withdraw and refuse social contact
  • Trauma causes a survivor’s confidence to collapse
  • It is important to act but, at the same time, you as someone who can support
  • The survivor must allow the survivor to decide at what point she/he is ready to
  • Make contact and open a conversation
  • The following reactions may be expected

Flashbacks are sudden, often strong, and uncontrollable re-experiences of a traumatic event or elements of that event. People may feel disconnected from their bodily sensations and feel numb or may be unable to recall traumatic memories. A state of heightened arousal is also quite usual. Persons exposed to traumatic events may be on their guard all the time, startle easily, sleep poorly, be irritable, or find it difficult to remember and concentrate.

A personal encounter with violence and death may also haunt the survivor, who may painfully re-experience the event in dreams or daily life (also called intrusion). We call the reminders that cause intrusion ‘triggers’.

Triggers, or trauma-reminders, are events, objects or situations that remind survivors of their painful experiences and memories. Such reminders may elicit trauma reactions over and over again. They can be extremely distressing and create such anxiety that people are afraid to go out, see people, hear certain sounds, or do many ordinary usual things.

Some key points to know about triggers:

  • Unexpected situations can suddenly trigger trauma reactions
  • It is possible to prepare against these, by using the senses to feel more present

Calming a survivor who has been triggered: 

In order to help a survivor, it is useful to assist her/him in coming back to the here and now. You may say things like this to the survivor:

  • “You are at home/a café/in a park (or where you are at the present moment) now”
  • “You are safe here in this room”
  • “You are here now and not where the traumatic event happened”
  • “You are strong and courageous”
  • “Remember to breathe”
  • “Look around, try to be present here and now” (for example, you can point at different objects in the room and say things like “Do you see the white table over there? Do you see the green carpet? The yellow chair?”)

You may also practice grounding exercises (that are also available in the toolbox both in English and Ukrainian on page 10) together and try to use them if/when the survivor is being triggered.
We have now provided you with information about how trauma and traumatic events may affect the body and the mind. We hope that this information will be helpful in understanding your/the survivor’s reactions better. We have also given some information about how to calm a survivor who has been triggered.

The grounding exercises that we have described under the heading Self-care: grounding exercises explain how practicing grounding exercises regularly, either alone or together, may help the person to deal with traumatic memories, triggers, flashbacks, and nightmares if they occur. We, therefore, recommend that you have a look at the page with grounding exercises and try some of them. Maybe this can be helpful in handling the trauma reactions, making good decisions for oneself and others, and taking some control back in life.

Remember that, with time, most survivors will get better. Also, remember that nobody can take your dignity away from you.  You are you.

Being aware of secondary traumatization and how to take care of yourself as a helper
Talking to people who have experienced trauma can also affect the helper. For all helpers, empathy is an essential aspect of good help. This is also a source for compassion fatigue, vicarious traumatisation or secondary traumatic stress (STS). How can helpers manage their own stress? Early recognition and awareness are crucial to being resilient to these symptoms. Awareness of this is important for workers in areas of conflict and disaster, and in extreme environments such as these, people may be more vulnerable to secondary traumatisation. We also know that professionals under this kind of stress may be at risk to perform less efficiently and not perform as they would normally do. Even large organizations that have the resources and knowledge about this particular kind of stress may have reduced capacity to deal with or take care of the affected personnel. As for local helpers, there may often not be any support or resources at all to deal with this. On MHHRI´s thematic page for helping the helpers, we have gathered links that can be useful for all persons engaged in this kind of important but heavy work.

Warning signals that can occur after a prolonged period of time on a stressful job.

• Wounded ideals and cynicism
• Feeling unappreciated or betrayed by the organization
• Loss of spirit
• Grandiose beliefs about own importance
• Heroic but reckless behaviours
• Neglecting one’s own safety and physical needs (not needing breaks, sleep, etc.)
• Mistrusting colleagues and supervisors
• Antisocial behaviour
• Excessive tiredness
• Inability to concentrate and Inefficiency
• Symptoms of illness or disease
• Sleep difficulties
• Excessive use of alcohol, tobacco or drugs.

It is important to develop strategies to cope with situations that might cause vicarious trauma reactions. What helps you to take your mind off your work or your thoughts? How can you rest your body as well as your mind? Does an activity inspire you or put you in a better mood? If you find it useful, you can also use the grounding techniques that you teach survivors. Helpers who have been personally exposed to GBV have additional reasons to be stressed. At the same time, their experience can give them a special understanding of the hardships and vulnerability of survivors, and this should be recognised and valued. Like survivors, helpers need support groups. If possible, meet regularly with other helpers to discuss your experiences and feelings, or do things together. If there are too few helpers in your area to create a support group, find friends and other people you trust with whom you can share your feelings without breaking the confidentiality of the survivors you are helping.

Gender-based violence in conflict and emergencies
Violence against women, girls, men and boys manifests itself in physical, sexual and psychological forms. Even so, during times of instability, women and girls are disproportionately impacted by sexual and gender-based violence. Gender-Based Violence Area of Responsibility (UNFPA) has made collection of useful tools related to this.

In addition, MHHRI has written a manual on how to support survivors of SGBV in war and conflict. “Mental health and gender-based violence Helping survivors of sexual violence in conflict – a training manual” Based on our collaboration with AHALAR this manual is also available in Ukrainian. The manual explains, among other things, how trauma affects mental health. It refers to methods and techniques that can be used to meet the psychological needs of women survivors of sexual abuse in contexts of war and conflict. The handbook can also be useful for people who already have knowledge and experience in the field.

For parents, teachers and helpers working with children

About Better Learning Programs

Supporting Students’ Recovery in Emergencies Children affected by stress from conflict and crisis situations often have difficulties learning and functioning at school. They experience a sense of chaos, loss of concentration and reduced memory, making it hard to keep up in the classroom or do their homework. Teachers, with the support of parents, have an important role in supporting children to stabilise and recover, so they can learn and thrive.

The Better Learning Programme 1 (BLP 1) provides teachers with a simple psychosocial support framework, the “Recovery Box”, which they can use on a daily basis to promote children’s recovery from traumatic experience and stress. BLP 1 also helps teachers and children understand normal reactions to fear and stress, and provides ways to manage these reactions, including easy calming exercises that can be done as part of the regular classroom practice.

Remember:

Safety – it can take days, weeks and months to re-establish a sense of safety
Calming – … regulate your own feelings
Connectedness – continue relations to gain social support
Self-efficacy – the belief that you can change your own situation
Hope – If you don’t have hope: then it’s hopeless
This does not always happen by itself – needs some sort of facilitation.
In a good school – these principles are in place – and they are facilitated by the teacher.

We can’t change what happened, but we can change the way you think and feel about it now – and that can be rather hard work.

  • Psychoeducation – understand stress reactions – Identify stress reactions and connect them to the traumatic event
  •  Recovery techniques – reduce stress – a combination of breathing exercise (relaxation) / concentration / Cognitive exercises:
  •  Learning strategies – regain lost learning capacity

UKRAINE: 5 ways to talk to children about conflict | Save the Children International
A film about nightmares made for children in Palestine, but nevertheless also important for children in Ukraine End the nightmares | NRC

The Norwegian Psychological Association, in collaboration with RVTS East, has written material on crisis reactions and childcare. The texts are prepared for refugees and affected families. The material can be used freely by health personnel and others as part of the follow-up and information work.
How to support children during crisis
Як допомогти дітям у кризовій ситуації (How to support children during crisis)

For family and relatives:

You may be worried about friends and family in Ukraine and don’t know what to do. Pictures and news of the current situation in Ukraine are disturbing and can be triggering and bring flashbacks. Use grounding exercises and stabilization techniques to calm down if you yourself, family or friends are triggered (see page 5). It may be helpful to know about trauma and what type of mental and physical reactions that can be expected among survivors of severe human rights violations, both for survivors and for people who are close to a survivor.

Download manuals from the MHHRI website

There are three different manuals, which respectively address working with women, with boys and men, and with children who have experienced sexual violence.

The manuals are translated into several languages. The page numbers in each manual remain the same across languages. This allows survivors and helpers to work from copies in their preferred language and read the same content on the same pages. It also makes it easier to teach participants when participants and trainers work in more than one language. The manuals include a toolbox. Survivors can use it individually to regulate their own emotions through grounding exercises or in collaboration with a helper. Helpers can also use grounding exercises to take care of themselves as helpers.

Strengthening Women’s Rights to Mental Health and Freedom from Violence – by changing behavior, practices and attitudes and facilitating safe and adequate care.

Supporting Human Rights Defenders who risk their lives in difficult and dangerous situations, side by side with families of victims of enforced disappearance and internally displaced (IDPs).

Treatment methods after traumatic human rights abuse. Remembering the body, promoting resilience; arts and culture, traditional and indigenous approaches.

Post-conflict reconciliation, reconstruction and re-socialisation Community mental health, justice human ecology, ethnic approaches to social action, empowerment and reconciliation.

We appreciate feedback and comments 

Welcome to our new subscribers, we hope you will find our content useful. The Mental Health and Human Rights Info Newsletter is a newsletter with the aim to provide insight on a certain subject across the scope of our work; human rights violations in war and conflict areas and mental health. Our intention is to deliver a newsletter as a short “lecture” where you can find relevant information regarding a specific subject from a mental health perspective. You will receive our newsletter 5 times a year.

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We are longing for peace in Ukraine with justice and human rights for all.

Sincerely yours,
Take care – and wishing you all the best.

Mental Health and Human Rights Info teampost@hhri.orgwww.hhri.org