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It is not controversial to suggest that the psychosocial impact of COVID-19 is going to have significant effects on people’s mental health down the line; the Royal College of Psychiatrists have warned of an impending tsunami of mental health problems over time, putting huge pressures on mental health services (and us in primary care). But what about the here and now? I’m sure we have all already seen a significant increase in mental health difficulties related to COVID-19, with many patients phoning us in psychological distress, the reasons for which are likely to be multifactorial. And this is where PFA may be helpful.
So, what on earth is PFA? Until a few weeks ago I would have made a stab at ‘profunda femoris artery’, but in this context it stands for Psychological First Aid, and an excellent document from the International Federation of Red Cross and Red Crescent Societies gives guidance on how to deliver PFA remotely during the COVID-19 outbreak. There is considerable overlap in their guidance with our basic principles of primary care consulting, but there were some really useful learning points and phrases to help us deal with distressed patients.
PFA is ‘a method of helping people in distress so they feel calm and supported to cope better with their challenges. It is a way of assisting someone to manage their situation and make informed decisions. The basis of psychological first aid is caring about the person in distress and showing empathy.’ That word empathy again…Very distinct from sympathy, it is ‘the art of stepping imaginatively into the shoes of another person, understanding their feelings and perspectives, and using that understanding to guide your actions’ (Krznaric, 2014) - which nicely encapsulates what we try to do in all our consultations, but is particularly important in the context of speaking to distressed patients….I fully understand that you are feeling this way….
So what are some of the other principles and ideas of PFA? One phrase that has really helped me is the aim to ‘normalise worry and other emotions’…. In this situation, your reaction is quite natural…; we are living through extraordinary times, and many of the feelings and emotions people are experiencing are normal, given the situation they are in - we should not underestimate the importance of validating peoples feelings and emotions. ‘Listen actively’ is also a phrase I liked - easier said than done, and exhausting, but something to strive for. Time limits? Interestingly the guidance does suggest time limiting the call e.g. 10 minutes for listening, and 5 minutes for summarising and making practical suggestions, which fits well with our current remote consultations….When we have talked for 10 minutes we can take stock and decide how to proceed… And finally ‘Look for or inject humour into the situation if appropriate’..as the guidance recognises a laugh, or even a smile, can provide relief from anxiety and frustration.
Recently we have had mental health awareness week, with the theme of kindness, so it is a pertinent time to remind us about the importance of kindness to both ourselves and our colleagues. Whilst we are seeing lots of patients in distress, we need to recognise the toll COVID-19 could have on health care workers. A recent BMJ editorial (BMJ 2020;369:m1815) discussed the potential impact, and highlighted PFA as an important tool to help healthcare workers in acute psychological distress or trauma. It could easily be one of us taking that call from a distressed ICU nurse, porter, nursing home carer, GP receptionist, doctor, or any one of the brilliant people that make up our health and social care system, who is in need of an empathetic ear. Using some of the PFA principles may be invaluable.
Dr Rob Walker
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