Psychological first aid as a tool in SA mental healthcare

In the theatre of modern medicine, we understand “triage” as the visceral geometry of bandages for wounds and tourniquets for life-threatening bleeding. This structured prioritisation of care – deciding who needs minor treatment or a life-saving intervention – is well established for physical trauma. However, as mounting research confirms, repairing structural damage while ignoring internal shock leaves the job only half done.

In South Africa, a substantial proportion of individuals is exposed to recurrent trauma and chronic adversity, which often leave no visible physical scars yet have enduring effects on their mental health and wellbeing.

The new first-aid kit

The traditional first-aid kit – the red and white box with gauze and antiseptic – is not sufficient. First-aid kits for physical wounds remain a crucial line of defence for the body, but for at least a decade, researchers have been arguing for the additional adoption of psychological first aid (PFA).

PFA – also referred to as mental health first aid – is an internationally developed framework widely ­solidified by the World Health Organization (WHO) in 2011. Its local adoption gained momentum in the first two years of the Covid-19 pandemic (2020 to 2021).

PFA involves providing immediate, non-intrusive support to someone in the wake of a crisis by stabilising their emotional distress. The WHO defines its core tenets as a triad: ensuring (physical) safety, active listening and linking individuals to the correct services.

In recent years, PFA has evolved into a dedicated discipline with institutions such as the South African College of Applied Psychology and the University of Cape Town (UCT) formalising the field through specialised and accredited short courses.

Professor Stephan Rabie, chief research officer in UCT’s Department of Psychiatry and Mental Health and convenor of the PFA short course in the Faculty of Health Sciences, contends that PFA is anchored by a formidable evidence base: “There’s a reason PFA is endorsed by several international agencies, including the WHO and Red Cross. It is effective and can be applied by anyone.”

Rabie argues that psychological first aid can both improve helpers’ (i.e. responders’) ability to identify and “contain” individuals in distress and navigate a stressful event.

“Psychological first aid doesn’t solve individuals’ problems; it equips people with skills and information about how to address the challenges they’re experiencing. It is a front-line stabilisation technique rather than a replacement for professional clinical debriefing,” Rabie says.

A shared survival strategy

This transition, from an individual mental health crisis to a shared survival strategy between helpers and recipients of care, is foundational to the South African Depression and Anxiety Group (Sadag).

Sadag founder and managing ­director Zane Wilson didn’t build the country’s largest mental health advocacy group from a textbook, but from the reality of people suffering panic attacks.

As Wilson immersed herself in research and the experiences of people living in South Africa’s rural communities, she realised that clarity was often the primary casualty in a mental health crisis. To address this, Sadag’s toolkit – comprising brochures, talks and media presence – dovetails with PFA’s core philosophy by equipping individuals with the skills to recognise signs of distress. This educational outreach aims to ensure that individuals in distress receive practical skills and guidance, whether through formal protocols or community support.

Wilson asserts that these initiatives include proactive approaches: “We don’t wait for action. Over time, we’ve fought for patient rights, advocacy, psycho­education and improved treatment.

“We visit South African schools and speak to learners often. In a crisis, we have over 300 counsellors, and 40 toll-free telephone lines operating 24/7.”

Empowering ordinary citizens

Addressing the persistent chasm in access to mental healthcare, Rabie argues that the movement to equip ordinary South Africans with PFA skills is not an abstract theory. Instead, it is a survival strategy that evolved from years of clinical research and grassroots intervention in the Western Cape’s Cape metro.

But although psychological first aid promises accessible, evidence-based intervention, some researchers have pointed to a looming “professional creep” whereby an ordinary person could be misconstrued as a professional therapist.

Professor Christine Lochner, co-director of the South African Medical Research Council’s research unit on risk and resilience in mental disorders, and affiliated with the Mental Health Information Centre at Stellenbosch University, contends that this concern would be valid only if human goodwill was equated with professional competence.

“Encouraging people to reach out is important, but communities should not be expected to replace professional care. Psychological first aid at a community level does not require advanced clinical skills – it requires the capacity to listen, recognise distress and facilitate referral,” she says.

At Sadag, new recruits are only allowed to interact with patients after many months. Says Wilson: “Our training is good and often when people leave Sadag, they’ve learned so much that they are able to go out into communities and work with churches or other institutions where people might seek help.”

Lochner says strengthening goodwill with practical guidance and clear referral pathways may be more feasible and sustainable than trying to train all community members as quasi-professionals.

“The challenge is not a lack of compassion, but ensuring that compassion is supported by boundaries. Simple scalable approaches – like the ‘listen-support-refer’ framework – could provide necessary crisis pathways without the cost of formal clinical training.”

Ultimately, PFA recognises that the first responder in a mental health crisis is rarely a paramedic or a doctor. Often, it is a neighbour or a friend. By democratising these psychological tools, we can do more than just treat a crisis: we could build a more resilient society from the ground up. DM

Helpline numbers

Suicide crisis helpline: 0800 567 567
Cipla mental health helpline: 0800 456 789
Mental Health Information Centre of Southern Africa (MHIC)

Dr Florence de Vries is a director on the board of the Ithemba Foundation, a South African mental health awareness non-profit organisation.

This story first appeared in our weekly DM168 newspaper, available countrywide for R35.