Psychological First Aid

History

The first noteworthy mention of PFA was in the context of a curriculum developed in 1944 for the U.S. Merchant Marine during World War II. The curriculum was developed in acknowledgment that psychological distress on shipboard was a significant risk factor for poor performance and the development of psychological “casualties” at sea, especially during wartime. Later, in 1954, the American Psychiatric Association published a monograph wherein PFA was operationally defined and advocated as a desired skill for all disaster workers. The motivating historical context was the threat of nuclear attack during the so-called Cold War. Nevertheless, PFA was viewed as being applicable to all disasters, large or small. PFA was largely abandoned as a mental health intervention of interest in the late 1950s through the 1980s, a period when the practice of psychotherapy grew in leaps and bounds. The provision of mental health-related services was largely viewed as the domain of the formally trained mental health clinician.

The field of disaster mental health was largely defined and put into use in the early 1990s. A new interest in the provision of psychological support was engendered, especially within the context of critical incidents and disasters. Crisis intervention services gained newfound popularity. Crisis intervention may be thought of as time-limited psychological intervention in the wake of a crisis (some disruption in usual psychological or behavioral functioning). PFA may be considered a subset of crisis intervention.

After the terrorist attacks of September 11, 2001, interest in PFA was rekindled. The following years saw the development of many models of PFA. Initiatives from the Johns Hopkins Bloomberg School of Public Health were among the first to lead to the curriculum development and subsequent training of nonmental health clinicians to deliver PFA. More specifically, disasters were seen as challenges to the nation's public health and thus fell under the mandate to develop training programs that fostered the public health of the nation. This public health perspective recognized that in the wake of disaster three important dynamics would come into play:

• 1.
  Mental health “casualties” would far outnumber physical casualties by a projected factor ranging from 4:1 to 50:1 depending on the cause of the disaster.
• 2.
  Psychological distress and trauma were potentially contagious.
• 3.
  There would be a distinct shortage of mental health clinicians available to provide acute psychological services.

As a result, and consistent with historical precedents, it was accepted that nonmental health personnel should be trained to deliver psychological first aid. Thus, public health workers, educators, law enforcement personnel, fire fighters, emergency medical technicians, and military personnel were identified as high-priority target groups to receive training in PFA.

Core Competencies of PFA

PFA is not the practice of medicine, psychology, or social work. PFA does not entail diagnosis, nor does it entail treatment. PFA is a form of crisis intervention. As physical first aid is to the practice of medicine, so psychological first aid is to the practice of mental health. Thus, anyone who would typically be taught physical first aid can be taught psychological first aid.

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