During the first weeks of 2016 alone, more than 82,000 people have made desperate, often dangerous, sea crossings to reach Europe’s shores. These latest migrants follow more than 1 million men, women and children who made the same trip last year. Most travel on inflatable dinghies or decrepit fishing boats across the Aegean Sea to Greek islands near the Turkish coastline.
When they arrive, first responders are often there to provide first aid as well as blankets, dry clothes and other relief items. These initial contacts are critical in promoting both physical and psychological well-being for migrants, and identifying those who may be in need of more support.
In such conditions, psychological first aid is a little-known but crucial skill needed to assist those experiencing enormous stress.
These interactions come during the first minutes of safety, on dry land after hours at sea on a perilous voyage that has already claimed over 400 lives in 2016. Migrants frequently arrive physically exhausted and emotionally overwhelmed, not knowing what lies ahead in the days and weeks of an uncertain journey to countries to the north. A majority of those who land have abandoned their homelands, close relatives and their communities after enduring years of war and persecution.
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As a mental health professional I have worked in various humanitarian emergencies, including areas of conflict along the Turkey-Syria border, in Iraq and the occupied Palestinian territories, and after earthquakes in Nepal and Haiti. I understand the psychological and social challenges facing those who have experienced unthinkable violence, loss and suffering. Typically, I focus on making counseling and case management services available as well as strengthening the capacity of first responders to provide basic support.
But here on the small Greek island of Lesbos, refugees and migrants pass through quickly, leaving Greece on their way to Germany and other European destinations, which makes more in-depth counseling sessions difficult because there is limited — if any — time for follow-up.
Over the past few weeks, my colleague and I have trained dozens of first responders, including nongovernmental organization and United Nations staff, volunteers, and others in Lesbos, Samos, Leros, Kos, and Athens in psychological first aid as part of our work with International Medical Corps. The approach encourages those interacting with refugees and migrants to respond in a way that is humane, culturally appropriate, and sensitive to the fact that they have just gone through a highly stressful event.
This includes promoting a sense of calm, showing empathy, establishing a human connection, helping make people feel safe and secure, and putting them in contact with services that can address basic and urgent needs. In such conditions, psychological first aid training is essential.
When an unstable overloaded raft filled with women and children arrives on a beach or if migrants are rescued from a shipwreck, it can be easy to react frantically. The context demands responders move fast, not just to be sure people’s physical needs are quickly met, but also to assure they are moved swiftly onto a bus that will take them to a registration site, where they will stay until they continue their journey to Athens and beyond.
Here are 5 things for people to remember about PFA:
1. PFA is a humane, supportive response for people in distress who may need and want support, in ways that respect their dignity, culture and capacities.
2. Looking: Check for safety and identifying people with obvious urgent basic needs and those with serious distress reactions.
3. Listening: Comfort people in distress and assess their needs and concerns.
4. Linking: Help people meet their basic needs, linking people to information.
5. PFA providers should recognize the importance of self-care when preparing to help, as well as after providing support.
In the rush, it can be easy to neglect taking basic steps that can provide an enormous boost to someone’s emotional welfare. One important step: give people basic information — where they will sleep, get clean clothes, find food and water, and receive services such as health care and psychosocial support.
Such clarity around the next steps and how basic needs will be met can significantly reduce stress and uncertainty. The information can also be empowering because it enables migrants to make decisions and regain a degree of control following a harrowing experience where they had very little.
Psychological first aid also encourages respondents to look out for potentially worrisome symptoms of deeper emotional distress. Such distress can take many forms, from shock to intense bereavement, especially for those whose boats sank and had to be rescued, and who may have witnessed loved ones drowning in front of their eyes. The responses may be normal reactions to traumatic experiences — or they may be more acute or long-lasting, indicating who could really benefit from professional mental health and psychological support.
First responders trained in psychological first aid can take immediate measures to provide non-intrusive support to those in distress, such as “grounding” techniques, which focus on reorienting someone to their present place and time. This can be as simple as telling someone to focus on their breathing or to sit in a chair with their feet solidly on the ground. Such steps help in two ways: They promote relaxation while also helping someone break free from overwhelming thoughts and emotions by focusing on the physical. If needed, first responders can then make a referral for mental health and psychosocial support for those who desire these services.
It is also critical that those working with refugees and migrants take care of themselves. Some of those working on the frontlines of this crisis have witnessed horrific events, including shipwrecks and the bodies of small children washing ashore. They must process those experiences and conduct their own reality checks in order to successfully support others. Psychological first aid offers some tools to do that, too.
With the tide of refugees and migrants showing no signs of slowing in 2016, we are expanding our trainings to include Greek authorities, such as members of the coast guard and the police. My hope is that by sharing psychological first aid skills with those working directly with refugees, from the shores of the islands to reception centers in Athens, we will foster a greater sense of safety, security, dignity and support for those in search of refuge.
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