Psychological first aid: helping people after a crisis

WHO lists these themes

• Assessing needs and concerns
• Comforting people and helping them feel calm
• Helping people connect to information, services and social supports
• Helping people meet basic needs like food, water and information
• Listening, without pressuring people to talk
• Practical care and support that doesn’t intrude
• Protecting people from further harm

According to WHO, PFA is not

• Asking someone to analyse what happened or put events in order
• Pressuring people to share their feelings or reactions
• Professional counselling
• “Psychological debriefing”, a detailed retelling of the event
• Something only professionals can do

WHO notes that psychological debriefing, which asks people to systematically recount their thoughts and feelings soon after an event, is not recommended. PFA is a gentler alternative.

PFA is usually offered at first contact, during or just after a crisis, though sometimes days or weeks later. It can happen at an accident scene, a shelter, a school or a health centre, ideally with some privacy.

PFA focuses on people shaken by a recent crisis event, often a disaster. For helping someone through everyday mental health crises, like panic, suicidal thoughts or confusion, see the Mental health first aid: helping in the moment guide.

Helping people move away from danger, find shelter and get reliable information all build a sense of safety.

Strong reactions are common after a crisis. A calm voice, slow breathing and a quiet space can help someone settle.

PFA aims to help people help themselves and regain control, rather than doing everything for them.

WHO notes that people who feel well supported after a crisis cope better than those who don’t, which is why reconnecting people matters so much.

Hope grows from small signs: a meal, a phone call that connects, a clear next step.

WHO recommends helping through an organisation or community group. Acting alone can put you at risk, get in the way of coordination, and make it harder to link people with the help they need.

A buddy system, where helpers check in with each other, offers support and safety.

• Follow the direction of the people managing the crisis
• Don’t get in the way of search-and-rescue or medical teams
• Know your role and its limits

WHO suggests thinking about your own health and any personal or family stress, then making an honest decision about whether you’re ready to help in this situation, at this time.

Look for

• Damaged roads, unstable buildings, fire or flooding
• Ongoing danger or conflict
• People who are trapped or need rescuing

WHO lists people who need immediate advanced support

• People so upset they can’t care for themselves or their children
• People who may hurt others
• People who may hurt themselves
• People with serious, life-threatening injuries

WHO describes reactions like

• Being jumpy or on guard
• Crying, sadness or grief
• Fear, worry or anxiety
• Feeling numb, dazed or unreal
• Guilt or shame, for example about surviving
• Irritability or anger
• Shaking, headaches, tiredness or aches
• Trouble sleeping or nightmares
• Very quiet, still or not responding

Some people are only mildly distressed, or not at all. All of these are human responses to a frightening event, not a sign that someone is weak.

Look for children separated from caregivers, people with health conditions or disabilities, and people at risk of discrimination or violence. The section on people who need special attention has more.

Even when a need seems obvious, always ask what people need and what worries them most. Help them sort out what matters right now and what can wait.

WHO suggests

• Keep your voice calm and soft
• Remind them you’re there to help, and that they’re safe, if it’s true
• Invite them to feel their feet on the floor or tap their hands on their lap
• Ask them to notice and name things they can see or hear
• Encourage slow breathing

• Acknowledge losses: “I’m so sorry. This must be very hard.”
• Allow silence
• Be honest about what you don’t know: “I don’t know, but I’ll try to find out.”
• Keep information simple and clear
• Name their strengths and the ways they’ve helped themselves
• Nod or make small sounds to show you’re listening

• Calling people “crazy” or other negative labels
• Interrupting, rushing or checking your watch
• Making up answers or false promises
• Pressuring someone to tell their story
• Saying “You should feel lucky you survived” or “You shouldn’t feel that way”
• Talking about your own troubles or someone else’s story
• Touching someone if you’re not sure it’s welcome

• Help with the basic needs people ask for
• Learn about specific needs, like clothing or baby bottles, and link people to help
• Make sure vulnerable people aren’t overlooked
• Follow up if you promise to

• Ask how they’ve coped with hard times before
• Ask what usually helps them feel better
• Help them identify friends or family who can help now
• Help them pick the most urgent problem first
• Share practical steps, like how to register for aid

WHO encourages healthy coping, like rest, regular meals and water, time with loved ones and helping others, and gently discourages leaning on alcohol or drugs, isolating, or working without rest.

• Explain where your information comes from and how reliable it is
• Keep messages simple, and repeat them
• Let people know when and where updates will come
• Never make up information or give false reassurance

Rumours spread fast after a crisis. If people get frustrated with you when help is slow, try to stay calm and understanding.

• Help bring people together to support each other
• Help people contact friends and relatives, for example by lending a phone
• Keep children with their parents and loved ones

Prayer and ritual can be a great comfort in a crisis, while others may find their faith shaken. WHO advises listening respectfully, connecting people with their spiritual community if they ask, and never imposing your own beliefs or interpretation of the crisis.

Ways to help

• Keep children with their caregivers whenever possible
• Link unaccompanied children with a trusted child protection agency, and don’t leave them alone
• Protect them from upsetting scenes, stories and media
• Talk at their eye level, in words they understand
• Offer play or simple conversation about their interests

Caregivers can

• Give young children extra time and reassurance that they’re safe
• Explain that they are not to blame
• Give simple answers without scary details
• Keep routines as much as possible
• Let older kids and teens be sad, listen without judging, and find safe ways for them to help

Young children may cling or return to earlier behaviours like bedwetting. Teens may feel numb or isolated. Patience helps.

• Help them get to a safe place
• Help with eating, drinking, clean water and self-care
• Ask about health conditions and help them reach the health care they rely on
• Stay with them, or make sure someone else will
• Share how to access services

This may include older adults, pregnant and nursing women, people with severe mental health conditions, and people with vision or hearing difficulties.

Some people may be left out of services or decisions, or targeted for violence. WHO suggests helping them find safe places to stay, connect with trusted people, and link directly with services.

WHO suggests thinking about

• Customs around touch and eye contact
• How to greet people, and what language they speak
• Religious beliefs and practices that matter to them
• Whether women should be approached by women helpers
• Whom to approach first, such as the head of a family

• Be aware of and set aside your own biases
• Be honest and trustworthy
• Behave in ways that fit the person’s culture, age and gender
• Make clear that even if they refuse help now, they can get help later
• Respect people’s right to make their own decisions
• Respect privacy and keep their story confidential, if appropriate

• Ask for money or favours for helping
• Exaggerate your skills
• Exploit your relationship as a helper
• Force help on people, or be pushy
• Judge people for their actions or feelings
• Make false promises or give false information
• Pressure people to tell their story, or share it with others

• Explain that you’re leaving
• Introduce the next helper, if there is one
• Make sure they have details for any services you linked them to
• Wish them well

• Check in with fellow helpers, and let them check in with you
• Keep reasonable hours, share the load and take breaks
• Remember you aren’t responsible for solving every problem
• Take time to eat, rest and relax, even briefly
• Think about what helped you cope in the past

WHO also suggests cutting back on alcohol, caffeine and nicotine while helping.

• Accept what went well, what didn’t, and the limits of what you could do
• Notice the ways you helped, even small ones
• Rest before picking up work and home duties again
• Talk it through with a supervisor, colleague or someone you trust

If you have upsetting memories, feel very nervous or sad, can’t sleep, or find yourself drinking or using drugs to cope, get support from someone you trust. WHO advises speaking to a health professional if these last more than a month.

The National Child Traumatic Stress Network offers PFA Online, a free interactive course where you take the role of a helper after a disaster. You need a free Learning Center account to finish it.

The WHO guide for field workers is free to read and comes in many languages.

1. Contact and engagement
2. Safety and comfort
3. Stabilization (if needed)
4. Information gathering: current needs and concerns
5. Practical assistance
6. Connection with social supports
7. Information on coping
8. Linkage with collaborative services

These come from the PFA Field Operations Guide by the National Center for PTSD and the National Child Traumatic Stress Network. They line up closely with look, listen and link.

Free crisis counselling for anyone distressed by a disaster, including helpers. Press 2 for Spanish; interpreters are available in over 100 languages. Deaf and hard of hearing callers can use their preferred relay service.

Free, confidential support for any kind of emotional distress. You can call for yourself or for someone you’re helping.

Free, confidential support by text with a trained volunteer.

Find A Helpline (findahelpline.com) lists free, confidential helplines by country. Learn the local emergency number wherever you’re helping.