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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 38  |  Issue : 2  |  Page : 205-208

Impact of lockdown and psychological first aid: A case study


1 Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences, Delhi, India
2 Department of Psychiatric Social Work, Institute of Human Behaviour and Allied Sciences, Delhi, India

Date of Submission15-Dec-2020
Date of Decision10-Mar-2021
Date of Acceptance28-Jun-2021
Date of Web Publication30-Jun-2022

Correspondence Address:
Dr. Ruchi Varma
Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_446_20

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  Abstract 


Introduction: The COVID-19 pandemic and the subsequent lockdown declared by the Indian Government in March 2020 lead to an unexpected turn of events for many, causing a huge psychosocial impact on them. Methodology: The study focused on evaluating a family from Kerala with major language difficulties and the distress being faced by them during their stay in the government provided shelter home in Delhi. The family was assessed by the multidisciplinary team from the Institute of Human Behavior and Allied Sciences visiting various shelter homes across the state. The study was aimed to assess the importance of psychological first aid (PFA) on the individual and the family in distress. Results: The family was assessed by the student counselor, who was well versed in their native language Malayalam. They were able to connect well, and hence, an appropriate psychosocial intervention was provided to them under the guidance of her supervisor. The family was highly distressed and had almost developed xenophobia. They were very happy to get a Malayalam-speaking counselor and were provided with all possible support. The authorities were also explained about their specific needs, which was not possible earlier due to the language barrier. They were ultimately successfully integrated with the other residents and returned to their home state, i.e., Kerala. Conclusion: Although PFA is definitely not a substitute for mental health care, ample research and experience has shown that it is a useful tool to assist people in acute distress when applied with a truly professional yet sensitive, empathetic approach.

Keywords: Distress, lockdown, psychological first aid, reintegration


How to cite this article:
Varma R, Yannawar PB, Antony R. Impact of lockdown and psychological first aid: A case study. Indian J Soc Psychiatry 2022;38:205-8

How to cite this URL:
Varma R, Yannawar PB, Antony R. Impact of lockdown and psychological first aid: A case study. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Aug 18];38:205-8. Available from: https://www.indjsp.org/text.asp?2022/38/2/205/349362




  Introduction Top


Psychological first aid (PFA) describes a humane, supportive response to a fellow human being who is suffering and may need immediate support. PFA is an attempt to reduce the initial distress caused by traumatic events and to encourage short- and long-term adaptive functioning and coping in an individual.

According to one of the early researchers in the field of psychological crisis intervention, “A little help, rationally directed and purposely focused at a strategic time, is more effective than extensive help given at a period of less emotional accessibility”.[1]

PFA may be defined as a supportive and compassionate presence aimed at preventing the stress from worsening, mitigating or de-escalating acute distress, and facilitating access to continued supportive care, if necessary. PFA does not necessarily make a psychiatric diagnosis or plan for treatment. Nevertheless, like physical first aid, it requires basic training to be effective and reduce the risk of inadvertently making things worse.[2]

The Johns Hopkins Center for Public Health Preparedness has worked to develop a simple, yet evidence based, model of PFA referred to as RAPID Psychological First Aid.[2]

The most important goal of PFA is to identify the immediate needs and concerns of the affected individual, gather additional information, and tailor PFA interventions best suited for the individual. The extent of literature suggests PFA has widespread appeal and has been safely administered by a range of nonprofessional in a variety of settings.[3]

It was also learned from the literature that the management of people in such pandemics, mainly during isolation and quarantine, also contributes to stress, with individuals reporting despair, fear, loneliness, extreme boredom, and anger, including some taking their life as well.[4]

There is a need to be flexible in providing PFA, and the interventions need to be adapted for specific individuals, and their identified needs and concerns. Gathering information and clarifying it further begins immediately after the initial contact and continues throughout the process of providing PFA.

Although a formal assessment may not be always possible due to a limited time, individual's needs and priorities, and a number of other factors, it is still important to examine the need for an immediate referral or any other services and offer follow-up meetings. It is worthwhile to explore the possible components of PFA that may be useful.

The basic objectives of PFA:

  • To establish a human connection in a nonintrusive, compassionate manner
  • To ensure physical and emotional comfort
  • To calm down an emotionally overwhelmed individual
  • To encourage them to specify what their immediate concerns are and gather as much information as appropriate
  • To offer practical assistance and information to help them address their immediate needs and concerns
  • To connect them to social support networks, including family members, friends, neighbors, and community helping resources
  • To support adaptive coping, acknowledge coping efforts and strengths, and empower them, encourage them to take an active role in their recovery
  • To provide information that may help them cope effectively with the psychological impact
  • To link them to mental health services, public-sector services, or organizations according to their specific needs.[5]



  Brief Background Top


The case study presented here is of a family who were living in one of the shelter homes which were set up at Delhi government schools, during the nationwide lockdown from March to June 2020. The current study focuses on understanding the difficulties encountered by the individuals and the intervention in the form of PFA, received by them during the pandemic. It was aimed to assess the psychological impact of the pandemic on this particular family from Kerala who were staying in one of the shelter homes visited by the Institute of Human Behavior and Allied Sciences (IHBAS) team and were taken up for the present study. The family was assessed by a Malayalam-speaking student counselor and her supervisor and provided appropriate intervention.


  Methodology Top


Descriptive case study method was used, where the family was lodged in Government run shelter home near New Delhi Railway station. Prior to the interview informed consent was obtained from the index client.

Mr. A, a 50-year-old male, his wife, Mrs. R, a 36-year-old female, and their three children aged 6, 11, and 13 years, belonging to a Muslim nuclear family of upper middle socioeconomic status in Kerala, found themselves in a crisis situation during the lockdown that was imposed during the COVID situation in India. They were leaving the country for permanently settle down in the Middle East and had stopped over in Delhi for visiting a dargah before their departure. Once the lockdown was imposed, they were shifted to a shelter home as there was a complete prohibition on group gatherings and international travel. The family hence had to comply with the government regulations and stay at the shelter home, where they had to face a number of significant difficulties that required immediate psychosocial intervention. The family was thus referred to the Psychosocial Support and Counseling Team of IHBAS Hospital for appropriate care and necessary management.

The difficulties the family faced shed light on the lesser-known psychological and social consequences of a sudden lockdown on the lives of common people. The couple was highly distressed that they were unable to reach their destination. They reported that even though the lockdown was a necessary measure to safeguard public health, being forced to stay at the shelter home in a new place, where they did not know anyone, was difficult to come to terms with. This led to feelings of anger, uncertainty, hopelessness, and despair. They were totally clueless about their future course of action. Away from their native place and stuck in a situation that was so peculiar and unexpected was something like a bolt from the blue. They were anxious and unsure, felt insecure, and developed a sense of mistrust toward one and all including the staff and other inmates at the shelter home. A prominent difficulty they faced was that of communication. Although they could manage to speak in and understand English, they were not familiar with the Hindi language, having never been exposed to it in their lives. This language barrier made it difficult for the staff or the authorities to know about the problems they were facing. The staff at the shelter home was not able to understand their needs despite their best efforts, leading to frustration from both sides. It also led to several misunderstandings between them. The staff felt that they were angry at them for simply following the government regulations. The family, on the other hand, felt that they were being treated unfairly because of their religious background. Therefore, a counselor who could speak in their native language was requested to facilitate communication and understanding between them.

In the session with the family, it could be observed that each member was under significant stress and there was some degree of hostility initially toward the team. They expressed a feeling that their rights were being violated as well as helplessness regarding the inability to communicate their needs.

Having been provided a counselor who could understand their native language, they ventilated their feelings and the difficulties faced since the lockdown. The couple had been trying to contact their acquaintances so that they could shift from the shelter homes, but due to restrictions in traveling, this was not possible. It was difficult to adjust to the food being provided as they were not used to it. The quantity of the food being provided was also reportedly inadequate, especially for breakfast, with just two slices of bread and tea. With the starting of Ramzan, the family was also fasting, which meant that they missed the meals provided at specific hours of the day. This added to the authorities' belief that they were not ready to adapt to the situation and were being defiant, thus increasing the strain between them. Another concern was that even though adequate care was being taken to provide all basic amenities and maintain cleanliness, the other members who were lodged in the shelter home often did not know how to make use of them properly. This included their lack of awareness of how to use Europe toilets so that it had to be cleaned before each use. They also raised the issue of other members who smoked cigarettes at night, making it difficult for them to sleep as one of them had asthma.

The session focused on facilitating ventilation of pent-up emotions and providing empathic listening. Special care was taken to acknowledge their concerns as genuine and provide validation to the distress experienced without challenging or negating them. The nature of the pandemic and the preventive measures taken by the government were explained to them. A problem-solving approach was adopted and the possible courses of action that could be taken up were discussed in detail, weighing the pros and cons of each, keeping in mind the restrictions of the lockdown. The counselor provided reassurance that their concerns shall be communicated with the authorities and the existing communication gap resolved. It was observed that the initial hostility got replaced by more openness, accompanied by feelings of relief and a sense of acceptance of the crisis situation.

The staff was intimated about their fasting needs so that they could be allowed to buy food from outside for breaking the fast. Their issues regarding cleanliness and the need for creating awareness among all members of the shelter home were also conveyed to the authorities, considering the immense risk to health it posed. It was also ensured that any misgivings of the staff were clarified to facilitate healthy interaction with the family and prevent any kind of discriminatory treatment based on their background.


  Discussion Top


As the family members were in distress due to the unprecedented situation in which they had landed in Delhi and more so in the shelter home, the following steps were undertaken while providing them with psychosocial intervention and psychological aid.

The first step was to establish a good rapport with the family. Since they were Malayalam speaking, it was highly desirable to arrange for a person who could communicate with them in their language and make them feel at ease. Once this was identified, an immediate attempt was made to work on the language barrier. A Malayalam-speaking person was especially arranged to smoothen up this communication gap. The student counselor being fluent in Malayalam language herself would enable them to put across their needs and issues.

The counselor started interacting and observing them closely but definitively was not intrusive. To begin with, she asked simple respectful questions to determine how they could be helped. The contact was initiated only after observing the situation and the person and the family, and determining that contact was not likely to be intrusive or disruptive. She spoke calmly, was patient, responsive, and sensitive in her approach. She used simple terms while speaking, and in the same language and dialect avoiding the use of technical jargon.

This helped the therapist to identify and define the problem at hand. Due to the language barrier, there was a major communication gap between the family, other residents as well as the staff. The family members were encouraged to ventilate and talk about how they had landed in that situation and their day-to-day difficulties ever since they had been staying in the shelter home. In this case, the family was given time to respond and when they were willing to talk, the counselor was prepared to listen and to pay attention to what they wanted to share. After establishing the rapport, the family was comfortable in expressing their concerns and issues. They often felt misunderstood and had to compromise for many things. They felt isolated and neglected. They were encouraged to talk about whatever happened and their reactions to those events, and in the process, if they did not want to speak at that time, their decision was respected. They were also asked if anything else was needed after the initial conversation.

While delivering PFA, it was of utmost importance to maintain high standards of professional behavior and model healthy responses. The student counselor remained calm, courteous, organized, and helpful in her approach. She maintained confidentiality, besides being sensitive to their cultural belief systems and sociocultural diversity. While remaining within the scope of her expertise and designated role, she communicated the family's specific needs owing to the ongoing Ramzan, following which appropriate arrangements were made for them. This involved seeking assistance from staff and other agencies for their well-being. The team did plan to follow-up later to see how the family was doing.

Thus, the entire exercise was done with the following in mind that the goal of PFA is not to elicit details of traumatic experiences and losses but to reduce distress, assess their current needs, and promote adaptive functioning.

While providing the PFA, the professionals tried to avoid labeling the distressed family. No assumptions were made about what the individuals were experiencing or what they had been through. Most acute reactions were understandable and expected given the severity of the situation. These reactions were not labeled as “symptoms,” or spoken in terms of “diagnoses” or “disorders.”

An attempt was made not to focus on their helplessness, weaknesses, mistakes, or disability. Focus was instead on what they had been able to do that was effective or may have contributed to helping others in need. It was not assumed that all individuals would necessarily want to talk or even needed to talk. A calm and supportive physical presence at times helped the affected individuals to feel safe and secure. No inaccurate information was offered. If the student counselor could not answer a question, the same was acknowledged. No false assurances or promises were made.


  Conclusion Top


In sum, PFA is definitely not a substitute for mental health care. Ample research and experience has shown that it is a useful tool to assist people in acute distress when applied by those with a truly professional yet sensitive, empathetic approach. It may actually go a long way in preventing or minimizing the burden on the already overburdened health-care system of our country besides reducing the overall toll on the quality of life of an individual.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgments

We would like to extend our gratitude to the participating family and the staff of the shelter home where the study was carried out for their cooperation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rapoport L. The state of crisis. In: Parad H, editor. Crisis Intervention: Selected Readings. New York, NY: Family Service Association of America; 1965. p. 30-8.  Back to cited text no. 1
    
2.
Everly GS Jr., Lating JM. Johns Hopkins Guide to Psychological First Aid. Baltimore: Johns Hopkins Press; 2017.  Back to cited text no. 2
    
3.
Fox JH, Burkle FM Jr., Bass J, Pia FA, Epstein JL, Markenson D. The effectiveness of psychological first aid as a disaster intervention tool: Research analysis of peer-reviewed literature from 1990-2010. Disaster Med Public Health Prep 2012;6:247-52.  Back to cited text no. 3
    
4.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.  Back to cited text no. 4
    
5.
International. Psychological First Aid: Guide for Field Workers. Geneva: WHO; 2011.  Back to cited text no. 5
    




 

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Abstract
Introduction
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Methodology
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