Psychological aid in emergencies: A new perspective

Three children were left alone without parental care in Nur-Sultan when a fire broke out in a neighboring building. The lights went out outside which frightened the children a lot. A psychologist from the Ministry of Emergency Situations was able to support and reassure them in their mother’s absence.

Liliya Borona has worked as a psychologist at the capital’s firefighting service for almost 13 years. She enjoys sharing her and her colleagues’ experiences. She comments on the above story: “My colleague had to help the mother when she got back home.” The specialist explains that even if children have witnessed the emergency situation, adults are the ones to get immediate attention from a psychologist. 

“Children are like a sponge. Their parents’ emotional state trickles down to them,” she notes.

Although Liliya acknowledges that a person may find a way out of an emotional crisis on their own, there are certain risk groups. Stress-susceptible people are likely to get overwhelmed in emergency situations. “The work of psychologists is crucial at the early stages, when the emergency has just occurred. The earlier psychological aid is provided, the less likely the development of post-traumatic syndrome is and thus the need to resort to psychiatric help in the future,” she comments on the importance of her work

The same principle applies to children that psychologists treat when an emergency is unfolding. Liliya recalls the successful case of her colleague who had to help a group of children cope with fear and anxiety. “The psychologist gathered all the children and took them to the bus, where she resorted to fairy tale therapy. She began to tell them: ‘now our bus is turning into a spaceship and going to intergalactic space.’ Children were drawn into the story, and their attention was diverted.”

Now, she confidently shares her support techniques that she and her colleagues use to assist adults and children, but in the early days of the psychological service of the MES RK, the picture was far from ideal.

“In the beginning we had almost nothing: a lack of knowledge, a lack of documents. There was no basic legislation we could rely on to protect ourselves,” remembers Liliya.

Years later, we are still somewhat understaffed and underequipped, but in terms of knowledge and skills, the MES psychologists are beyond reproach

“We study on a yearly basis, do advanced training to renew our theoretical knowledge and practice therapeutic techniques,” says Liliya.

In November 2021, she took advantage of a 4-day training course organized by the Center for Emergencies and Disaster Risk Reduction and the United Nations Children’s Fund (UNICEF). This educational event for 58 psychologists of MES RK was part of UNICEF’s program for children protection in emergency situations.

The basis of training course is the guidance on the mental health care in emergencies for specialists from non-specialized medical institutions of the Republic of Kazakhstan. The document is an adapted version of the humanitarian guidance of the WHO Mental Health Gap Action Programme (mhGAP). Last year, Aigulim Abetova, head of the Scientific Management and Education Department of the Republican Scientific and Practical Center of Mental Health of the Ministry of Health of the Republic of Kazakhstan, participated in the development of the Kazakhstani version of the guidance, together with psychologists from the Center for Disaster Medicine of the Ministry of Health.

“Working on this guidance, I learned a lot,” Aigulim Abdurasulovna describes her impressions of working on the document, which is new for psychologists here. “It deviates from our approach to psychiatric examination which requires a long time for establishing a diagnosis. In emergencies, we need to provide help as quickly, appropriately, and effectively as possible. And there are specific steps, algorithms for reaching a diagnosis, ruling out of various pathologies and providing help in the process. I liked this approach, as it is very accessible for non-psychiatrists too”.

The specialist at the mental health center also acted as a trainer. She emphasizes that during the 4-day seminar, the MES psychologists took active interest in the topic of mental disorders and their medication-based treatment.

“Almost every participant found the course useful and informative,” notes Aigulim Abdurasulovna.

At the same time, she said that psychologists demonstrated remarkable skills in analyzing the borderline states between mental disease and norm.

Liliya willingly confirms the trainer’s words: “The speakers gave us up-to-date information on psychiatric care. Everything was structured, the presentation was accessible! The participants worked responsibly, we were on the same wavelength, it wasn’t boring at all because it was not a monologue but a dialogue. She explains that the knowledge they acquired helped psychologists gain confidence that they can provide “as much help as possible.

The chance to utilize the new knowledge came very soon, on January 11, when early in the morning the capital’s firefighting service was called to a fire in a dormitory. “Three people died: a woman and two children. When I arrived at the scene, I had to work with her husband. He was hysterical and in denial. He wouldn’t believe that his common-law partner was dead. As a psychologist, I explained that what was happening to him was normal, provoking the crying reaction, just talking to him,” she recalls excitedly.

Children who find themselves in the midst of an emergency are treated differently. Liliya tells us how during the floods her colleague was able to help children through art therapy: “Children were taken to a safe place. Then crayons, paper, plasticine, children’s toys were brought out, and depending on the condition (in this case, it was fear), the children tried to depict their mental state under the guidance of the psychologist. At first, children drew or molded their “fear,” then they were prompted to do what they liked with the result — trample on it or add bright colors; and then, on another sheet of paper or with another piece of plasticine, children were asked to draw or mold a magic character that would make them feel good.

The work of the MES psychologists does not end when they return from the field. Firstly, specialists try to monitor the victim’s condition as closely as possible to see if the person is capable of coping with the stress on their own or if they need professional support. Secondly, psychologists hold debriefings with those of their colleagues who directly participated in the fire extinguishing.

“We described the event in detail, and they started to gradually share their thoughts, feelings, experiences. The purpose of this method is to put in words, to experience, to remember what bothered them, disturbed them, so that in the future there would be no muscle clamps, no negativity,” explains Liliya.

She adds that during major emergencies, not only firefighters and rescuers from the MES work on site, but also volunteers. In addition, the collaboration between the MES and the Ministry of Health is gaining momentum. There is no established format for such work yet, but it has long been obvious that it’s necessary. Liliya believes disaster response may become more efficient through combining the efforts of the MES psychologists, who have skills of providing emergency care, and psychiatrists at the Ministry of Health, capable of providing assistance and prescribing the right medication.

Aigulim Abdurasulovna is also convinced that psychologists, psychiatrists, and social workers should cooperate “in a unified way” during emergencies. She mentions the problem of suicide among children. It brought medical and school psychologists to realize the importance of a comprehensive approach and find a way to join forces. The above guidance which formed the basis of training for psychologists of the Ministry of Emergency Situations, by the way, promotes such an interdepartmental approach.

“It describes a procedure which we do not yet have in place. Now we are nearing the point where we will all have to work together,” finalizes the specialist of the Mental Health Center of the Ministry of Health.