Psychological first aid

Conversations with distressed people can be daunting. Here are some principles to bear in mind:

Observation. The first sign that someone needs help may be in their appearance, or what they say, but it may come from someone else telling you that they are in distress.
Rapport. All human interactions work better when the parties are in rapport. Do whatever you can in the circumstances to make them feel safe and at ease, and make it clear that, for now, you are focused on them and are going to try to help. Even little things like helping someone with their coat can make them feel less uncomfortable.

Kindness. Be kind and respectful. Be careful about touching – wait to see if he or she touches your hand or arm, but if they do a brief, light touch on the hand or arm can be reassuring.
Assist. Where possible, investigate what basic needs you can help with – this may mean practical help, or it may mean psychological needs such as attention and security.
Listen. Let people talk about whatever it is they would like to talk about. Sometimes people just need an opportunity to share their frustrations. This is not a long-term strategy – in the end the causes will have to be addressed.

Realistic reassurance. “Everything will be fine” is not realistic, but saying “I’m sorry to hear that” or “I can see how you would be feeling that way” helps people see their reactions as normal. Reassure them that it is normal for people to feel overwhelmed sometimes, but resilience can help carry them through.

Skills. People problems will generally need to learn new skills – initially for coping and then for behaving in ways that prevent the problems from recurring. Some people have developed strategies that don’t really help, so discussion about what skills are needed and how they might be acquired can be useful.

Social connections. Unhappy people often become disconnected from close family and isolated from their wider social circle and colleagues. Encouraging them to reconnect and develop new connections can be a vital step.

Take care. Share information if you know it to be accurate and likely to be helpful, otherwise refer.

Refer. There are many helpful resources for information and services – start with Mental Health First Aid, and get some staff MHFA trained.

End. It can be difficult to end conversations with distressed people, but sooner or later you will have to; in the end they will need to sort out their problems and get their social needs met elsewhere. However, leave the person with the impression that you care, even if you are unlikely to see them again in this context.

There are some extra considerations to bear in mind when people are angry – see Talking to Angry People.