Module 3.5
Helping without causing harm
Psychological first aid is not therapy. It is not counselling. It is not asking survivors to tell you what happened to them. It is a set of practical, evidence-informed actions that support the natural recovery process and avoid inadvertently causing harm in the hours immediately after a traumatic event.
The first contact a survivor has with crew aboard a SAR vessel is often with non-medical, non-specialist personnel. What happens in those minutes — how they are spoken to, whether they feel safe, whether their immediate needs are met — has a genuine impact on their psychological trajectory. This is not abstract. The things crew say and do in the first moments matter.
PFA is not psychotherapy
Psychological First Aid does not require you to assess, diagnose, or treat psychological conditions. It does not require you to speak the same language as the survivor. It does not require you to ask about their experiences or encourage them to talk. It is about safety, calm, connection, and practical support — and knowing what not to do.
What you'll cover
- Common trauma responses — what they look like and why they happen
- The five WHO/IASC principles of Psychological First Aid
- Practical do and don't guidance for immediate survivor contact
- Specific considerations for children and SGBV survivors
- When to escalate to specialist support
Estimated time
10 minutes — followed by a knowledge check
Section 1 of 3
Understanding trauma responses
Survivors arrive on board having experienced extreme events — fear of drowning, loss of people from their vessel, violence before departure, prolonged uncertainty, and the intense experience of the rescue itself. The responses you will observe are not signs of weakness or mental illness. They are normal human responses to abnormal situations.
Acute stress reaction
Immediately after a traumatic event: shaking, crying uncontrollably, appearing dazed or "absent," hyperventilating, or being unable to speak. This typically resolves within hours. Do not interpret this as permanent psychiatric distress.
Dissociation
A survivor who appears disconnected, not responding normally, staring blankly, or not reacting to what is happening around them. Dissociation is a protective response — the mind creating distance from an unbearable experience. Do not try to "snap them out of it."
Agitation and aggression
Some people in extreme stress become agitated, raise their voices, or act in ways that appear aggressive. This is usually fear, not hostility. De-escalation is the appropriate response, not confrontation. Give space, speak calmly, avoid threatening posture.
Grief reactions
Many survivors have watched people die during the crossing. Grief in this context can be raw and intense. Your role is not to comfort the grief away — it is to be present, calm, and non-intrusive. Do not say "it will be okay" or "you're safe now." Be present without adding pressure.
Children experience trauma differently
Children may appear calm and composed when adults are distressed — this is not reassurance. Children often suppress their distress to match the emotional state of adults around them, or may not have the conceptual framework to process what is happening. They may also become suddenly distressed when appearing calm earlier. Never separate a child from their primary caregiver unless there is a specific safety reason. Familiar adults are the most powerful source of safety for a traumatised child.
Section 2 of 3
Psychological First Aid — five principles
The WHO Inter-Agency Standing Committee framework for Psychological First Aid identifies five core actions that support survivors in the immediate aftermath of a crisis. These are practical, not therapeutic — they require no special qualifications and can be applied by any crew member.
1
Safety
Ensure the person feels safe. This includes physical safety (warm, dry, away from danger) but also perceived safety — being around calm, non-threatening people who are not demanding things of them. Safety is the foundation. Without it, nothing else works.
2
Calm
Your affect — how you appear — is contagious. Calm crew create calm survivors. Rushed, stressed, loud crew create more distress. If you are managing your own stress, you are automatically providing one of the most important interventions available. Breathe, slow your speech, lower your voice.
3
Connection
Connect people with their own support networks — family members on board, people who speak their language. This is not about you becoming their support. Reconnecting people with their own people is the most powerful thing you can facilitate. If people are separated, work with cultural mediators to help families locate each other.
4
Self-efficacy
After a crossing, survivors have had no control over anything. Small moments of agency matter enormously — being asked what they need, being given a choice of blanket colour, deciding where to sit. Offer choices where possible. Explain what is happening. This restores a sense that the world is not completely out of their control.
5
Hope
In the immediate aftermath, the goal is not to fix trauma — it is to support the natural recovery process that occurs in the vast majority of people over time. Most people who experience traumatic events do not develop long-term psychological disorders. The things that protect against lasting harm are safety, social support, practical assistance, and being treated with dignity. All of these are within a crew member's influence.
Section 3 of 3
In practice — do and avoid
Acute stress reactions — what to expect
Acute stress reactions are normal responses to abnormal events. They typically last from hours to days, and can extend to short weeks. If significant symptoms persist beyond a month, this may indicate post-traumatic stress disorder (PTSD) — which requires professional support. As crew, your role is in the immediate period only. You are not managing long-term psychological recovery.
The most common errors in survivor interaction are well-intentioned. People want to help. The challenge is that some instinctive responses — asking about what happened, giving reassurance that isn't true, making physical contact without consent — are counterproductive or harmful in a trauma context.
Do
Introduce yourself calmly, even if they cannot understand you. "Hello. I am crew. You are safe." A calm tone communicates before language does.
Avoid
Asking "what happened?" or "where are you from?" or "how long were you in the water?" These questions may seem caring but put survivors in the position of narrating their trauma before they are ready or safe to do so.
Do
Offer practical assistance: blanket, water, a place to sit. Practical help meets immediate needs and communicates care without requiring conversation.
Avoid
Saying "you're safe now" or "everything will be okay." These may not be true, and survivors know it. Hollow reassurance damages trust. Offer presence, not promises.
Do
Avoid initiating physical contact. If a survivor initiates contact — reaching for your hand, gripping your arm — you can respond calmly. If you are unsure, ask via gesture or through an interpreter. Cultural differences in what physical comfort means are significant — what feels natural to you may be unwelcome or distressing to someone else. Never assume physical contact is welcome.
Do
Provide accurate, specific information where you have it. "We will be on land in approximately four hours" is more useful than "we will be on land soon." If you don't know — because the port is uncertain, the timeline has changed, or the information isn't available yet — say so honestly. "I don't know yet, but I will find out" is more trustworthy than vague reassurance.
Avoid
Photographing or filming survivors. At any time, without explicit consent. Your organisation has strict protocols on this — follow them. Photo documentation by non-authorised crew creates serious protection and trust risks.
Do
Keep family groups together wherever possible. The priority is physical proximity to people they trust. Separation — even brief — can cause significant distress, especially for children.
Avoid
Pushing people to talk, express gratitude, engage, or respond. Some survivors will be quiet. Some will be withdrawn. Allow this. Recovery is not a performance.
SGBV survivors — specific considerations
Sexual and gender-based violence is prevalent along migration routes and may have occurred very recently. Signs may include visible distress when physically examined or touched, withdrawn behaviour, visible injuries, or direct disclosure. Your organisation has specific SGBV protocols. Do not attempt to assess SGBV without specialist training. Ensure privacy, maintain dignity, escalate to a specialist or the medical team immediately if disclosure occurs or is suspected.
Further reading — WHO Psychological First Aid
The WHO/IASC Psychological First Aid Field Guide is the primary reference document for PFA in humanitarian contexts. It is free and publicly available.
Download the WHO PFA Field Guide →
When to escalate
Escalate to your organisation's mental health specialist, the medical team, or a cultural mediator when: a survivor appears to be in acute psychiatric crisis; there is disclosure of SGBV; a survivor is expressing suicidal intent; a child appears to be without a guardian; or a survivor is not responding to basic PFA. Not every difficult moment requires escalation — but knowing when it does is important. If in doubt, escalate. It is not your job to manage what a specialist should be handling.