Table 3 Statements accepted as mental health first aid guidelines for assisting adults

Item:

Round:

Actions to be taken immediately

The first aider should determine whether or not it is safe to approach the person before taking any action (for example, danger from fire, weapons or debris)

The first aider should explain to the person what their role is and why they are present.

The first aider should create a safe environment.

The first aider should be calm in the face of the trauma.

The first aider should ascertain the person's basic human needs for the immediate future and attempt to meet them.

If helping someone they do not know, the first aider should find out the person's name and use it when talking to them.

The first aider should attempt to ascertain and meet the basic human needs of the person (for food, drink, shelter and clothing), but should not take over the role of professionals helpers better able to meet those needs.

If the person has been a victim of crime, the first aider should consider the possibility that forensic evidence may need to be collected (for example, cheek swabs, evidence on clothing or skin) and should work with the person in preserving such evidence.

The first aider should watch for signs that the person's physical or mental state is declining, and be prepared to seek emergency medical assistance for them (for example, an apparently uninjured person may have internal injuries which reveal themselves more slowly, or a person may suddenly become disoriented).

Guidelines for communicating with the traumatised person

The first aider should speak clearly and avoid clinical and technical language.

The first aider should communicate with the person as an equal, rather than as a superior expert.

The first aider should remember that behaviour such as withdrawal, irritability and bad temper may be a response to the trauma, and should avoid taking such behaviour personally.

The first aider should be friendly, even if the person is being difficult.

The first aider should show that they understand and care.

The first aider should be aware that the person may not be as distressed about the trauma as might be expected.

The first aider should remember that they are not the person's therapist.

The first aider should tell the person that everyone has their own pace for dealing with trauma.

The first aider should encourage the person to talk about their reactions only if the person feels ready to do so.

The first aider should remember that providing support doesn't have to be complicated, and can involve small things like spending time together, having a cup of tea or coffee, chatting about day-to-day life or giving them a hug.

The first aider should remember that it is more important to be genuinely caring than to say all the "right things".

The first aider should be aware of cultural differences in the way some people respond to a traumatic event; for example, in some cultures, expressing vulnerability or grief around strangers is not considered appropriate.

The first aider should be prepared to repeat themselves several times if the person seems unable to understand what is said.

The first aider should ask the person how they would like to be helped.

Talking about the trauma

The first aider should not force the person to tell their story.

The first aider should not interrupt to share their own feelings and opinions.

The first aider should be aware that the person may need to talk repetitively about the trauma and be willing to listen.

The first aider should avoid saying things which minimise the person's feelings, such as "don't cry" or "calm down".

The first aider should avoid saying things which minimise the person's experience, such as "you should just be glad you're alive."

The first aider should not tell the person how they should be feeling.

The first aider should be aware that the person may be experiencing survivors' guilt.

The first aider should not make promises they can't keep such as "I'll take you home soon".

Immediate assistance at large scale traumatic events

The first aider should follow the directions of professional helpers at the scene.

The first aider should get medical help for the person if this is needed.

The first aider should find out what emergency help is available.

The first aider should provide truthful information and admit that they lack information if this is the case.

The first aider should identify basic needs (food, drink, shelter and clothing) and attempt to meet them.

The first aider should be aware of and responsive to the person's comfort and dignity, e.g., by offering the person something to cover themselves with (such as a blanket) and asking bystanders and the media to go away.

If the person does not want more information about the event, the first aider should not try to give them any.

The first aider should tell the person about any available sources of information which are offered to survivors (for example, information sessions, fact sheets and phone numbers for information lines).

The first aider should try not to appear rushed or impatient.

After trauma care at a large scale event

No items accepted.

Coping strategies: talking

The first aider should encourage the person to identify sources of support including loved ones and friends.

The first aider should respect the person's need to be alone at times.

The first aider should encourage the person to tell others when they need or want something, rather than assume others will know what they want.

Coping strategies: actions

The first aider should encourage the person to think about what coping strategies they have successfully used in the past and encourage them to continue to use these.

The first aider should encourage the person to do whatever they need to do to take care of themselves.

The first aider should encourage the person to do things that feel good to them (for example, take baths, read, exercise, watch television).

The first aider should encourage the person to get plenty of rest when they are tired.

The first aider should encourage the person to spend time somewhere they feel safe and comfortable.

The first aider should discourage the person from using negative coping strategies such as working too hard, using alcohol and other drugs, or engaging in self-destructive behaviour.

The first aider should assist the person to find local sources of support.

The first aider should give the person information about community resources that are available (for example, crisis lines and health centres).

The first aider should be aware that the person may not remember all the details of the event.

The first aider should be aware that the person may suddenly or unexpectedly remember details of the event.

When to seek professional help

If at any time the person becomes suicidal, the first aider should seek professional help.

The first aider should encourage the person to seek professional help if the post-trauma symptoms are interfering with their usual activities for 4 weeks or more.

The first aider should encourage the person to seek professional help if they feel very upset or fearful for 4 weeks or more.

The first aider should encourage the person to seek professional help if they are unable to escape intense ongoing distressing feelings for 4 weeks or more.

The first aider should encourage the person to seek professional help if their important relationships are suffering as a result of the trauma (eg, if they withdraw from their carers or friends) for 4 weeks or more.

The first aider should encourage the person to seek professional help if they abuse alcohol or other drugs to deal with the trauma at any time.

The first aider should encourage the person to seek professional help if they feel jumpy or have nightmares because of or about the trauma for 4 weeks or more.

The first aider should encourage the person to seek professional help if they can't stop thinking about the trauma for 4 weeks or more.

The first aider should encourage the person to seek professional help if they are unable to enjoy life at all as a result of the trauma for 4 weeks or more.

The first aider should be aware of the sorts of professional help which are available.

If the person does not like the first professional they speak to, the first aider should tell the person that it is okay to try a different one.