Wait til the midnight hour

Its almost the midnight hour here in downtown Elwood. Most cats should be asleep, but I’m not. You see, it’s not often you get to participate in a webinar with one of the legends of Psycho-social support, Stevan Hobfall. A decade ago, as critical incident stress debriefing was starting to be questioned as to whether it worked, a group of people people, led by Hobfall, including the delightful Patrica Watson, whom we met last year, and our own Richard Bryant, got together under the premise, of, if we are going to tear down CISM, what should be in its place. Through a consensus approach, they agreed upon the five principles of psycho-social support, promoting  a sense of Safety, Calming, COnnection, Self and community Efficacy and Hope, and published a legendary paper in the journal Psychiatry Five Essential Elements of Immediate and mid term mass trauma intervention: empirical evidence.

Over 75 people from across the world joined into the webinar. How amazing is technology. Stevan took us through aspects of these five principles. He made the comment that the 5 principles really are distilled wisdom, and when you look at them, it makes sense. His reflection of the past ten years was there was an improvement in planning for these events, with the inclusion of the various professional organisations in the planning processes, as well as the dramatic improvement in resources, through written materials, apps etc. He made the point that mass casualty events have adhoc responses. They are never strategic in response, but they must be. He also made the sad reflection that they have become very good at responding to school shootings

One of his general comments was that mental health workers focus on appraisal, but this takes the risk of denying reality.  Appraisal might work in a middle class environment, but in a situation where all safety has been stripped away, you need to focus on the reality, the practical stuff. Safety is a physical statement in which the potential for harm is limited. How you message and respond to threats, however is psychological, as it shapes what safety might mean and what you want people to do. There is a temptation to not be realistic with messaging, but he was adamant that you cannot hide, you need to be realistic, as this reduces the risk of catastrophising the situation. It is difficult to back track once confidence is lost. better to say we don’t know, rather than change the story.

Getting people reconnected, important to set up connections early on is critical The first time you hear the voice of a loved one is critical for both sides mental health.  Those that are well connected are least of the problems. need to identify isolates, and use informal and formal networks. How do foster connection is important, this need to be done with prework, such as get connected. This highlights the importance of services such as Register Find Reunite, that we offer. Its also important to have places where people can meet and connect. This maybe limited in a disaster situation, and should be focused upon as a priority. He made the reflection that as people’s wealth increased, they moved from sitting on the front steps of the porch and chatting with neighbours, through the house, to the private backyard and losing that connection.He noted that promoting connection pre disaster is relatively straightforward, but not well done. This is where I think we are leading the way, through our get connected focus on REdiplan.

To have hope is important,  but it must be reasonable hope other wise people are going to be crushed at some point. Optimism is only going to go so far. Connecting to resources is critical, as this is what provides hope. Do not create a false sense of hope, it will backfire. This particularly applies to religion, the statement that God will support you, in some cultures it might be OK, in others won’t

Dr Leslie Snider talked us through the WHO Psychological First Aid guide, and linked it to what she called the Hobfall 5  She made the comment that PFA is not new, it was actually coined in 50s,60s. PFA, like first aid, is not enough on its own. SHe was interested in whether these five principle have been applied well to the current PFA technique  have the Hobfall 5 been applied to PFA well. Stevan believed that they had been applied well. Leslie also indicated that there were  lots of great examples of training community members, and that it was very good to train them, as they are the best placed to deliver and support. Anyone can offer that support, its like First Aid

She also wondered if you can use the five as outcome measures. Which stevan indicated you could. They are process and outcome. They speak to where you want to get to . You can test community efficacy.

So, its now well after the midnight hour. The webinar will be up on the Reference Center for Psychosocial Support’s website in the next week. I’m off to bed.







3 thoughts on “Wait til the midnight hour

  1. John,

    This one and your previous post about grief have taken your contribution up a notch!

    Essential reading.

    Well done!


    Liked by 1 person

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