Psychological First Aid Training in the Community : Malaysian Journal of Psychiatry

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Psychological First Aid Training in the Community

Qamruddin, Asraf Ahmad Bin

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Malaysian Journal of Psychiatry 31(2):p 113-115, Jul–Dec 2022. | DOI: 10.4103/mjp.mjp_27_22
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Mental health has always been defined as among the three essential dimensions of health by the World Health Organization (WHO). The WHO defined health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity”.[1] Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to contribute to his or her community.[2]

Even before the COVID-19 pandemic, the burden of mental health problems globally and in Malaysia has shown an upward trend. Mental health disorder is the leading cause of disability, and the third-leading cause of overall disease burden (as measured by disability-adjusted life-year), after cardiovascular disease and cancer.[3] In 2018, one in four people globally was affected by mental disorders at some point in their lives.[1] The COVID-19 pandemic was a catastrophic occurrence that led to unprecedented public health measures such as the movement control order, closure of nonessential businesses, and limits on one’s movement outside.[4] This has led to numerous social, financial, and familial difficulties. Combined with fear and anxiety toward COVID-19, this has overwhelmed and heightened the mental stress of society. Undeniably, social distancing minimizes social contact and thus aids in decelerating the spread of COVID-19. However, it also disrupts human social needs and support, which is a coping mechanism for mental stress.[4]

Prior studies indicate that the COVID-19 pandemic is associated with distress, anxiety, fear of contagion, depression, and insomnia in the general population.[5] A systematic review of eight countries reported high rates of symptoms of depression (14.6%–32.8%) compared to an estimated 1-year prevalence of 7.2% before the pandemic.[6] Studies have also shown an elevated suicide risk during the COVID-19 pandemic and among survivors.[5] Malaysia has also seen a rise in suicide cases and attempts during the pandemic.[7] It is important to realize, that no matter what the next crisis is, whether it is a pandemic caused by disease, natural disasters, or artificial disasters, the impact on the community’s mental health may be tremendous.[8] Floods are a common occurrence in Malaysia, and it has been found that there is an increased incidence of mental distress among flood victims, whether from rural or urban areas.[6]


Despite good interaction between primary, secondary, and tertiary care, and the availability of community-based mental services such as psychosocial rehabilitation, there remains to be a lack of social support for mental health in the Malaysian community. Stigma toward mental health problems remains high. Prior studies have shown that stigma is the primary barrier to help-seeking for mental health problems.[9] The stigma surrounding mental health problems can result in the individual not wanting to seek treatment primarily due to fear of being labeled or treated differently by society. This is worsened by the shortage of resources for mental health and inadequate intersectoral collaboration among stakeholders. Mental health encompasses many social factors and cannot be tackled by the Ministry of Health (MOH) alone. Therefore, the involvement of other stakeholders, especially the empowerment of the community, is of utmost importance.


Psychological first aid (PFA) is among the vital tools in delivering psychological interventions to those with mental distress in the absence of early professional intervention. PFA is defined by the WHO as a “humane, supportive response to a fellow human being who is suffering and who may need support.”[10] PFA is a group of skills applied to limit distress and maladaptive behaviors that could negatively impact people in mental distress. PFA’s ability to provide immediate and crucial psychological care is vastly significant in enhancing the resiliency of the population from trauma. PFA has been adopted by several key players, such as the American Red Cross and WHO. The WHO has produced a training manual to enable the education and training of health-care workers, community leaders, teachers, and social workers.[11] The WHO manual allows for a shorter half-a-day program to train community member’s in the delivery of PFA compared to the certified 2-day program. PFA’s capability in mounting psychological early interventions makes it a beneficial tool for enhancing the mental well-being of the community.[12]

PFA has proven effective in past outbreaks such as SARS in aiding people with emotional distress.[10] It is thus crucial to realize that PFA is not something that can only be done by trained and certified professionals. At this time of distress, as communities are recovering from the pandemic, PFA can provide immediate help to individuals who are experiencing distress. The current challenges we are facing are due to the limited availability of skilled or trained PFA members to provide support.[12] During PFA training, they are trained to approach a situation safely, for themselves and others; to say and do the most supportive things for distressed people, to connect them with support if needed, and most importantly, to not cause further harm by their actions. Hence, the PFA training should be extended to community members to support each other.

We already have various successful volunteer programs in the community in Malaysia. One of that programs is The MOH Malaysia and Community Development Department (KEMAS) community participation program known as “Komuniti Sihat Perkasa Negara” (KOSPEN) or “Healthy Communities, Building the Nation” in 2013. The KOSPEN’s goal is to prevent and reduce the occurrence of noncommunicable diseases (NCDs) as well as related risk factors in the population. The initiative is to empower Malaysians in self-care to reduce the burden of NCDs by empowering the community. Briefly, KOSPEN consists of training community members as health volunteers who act as the health agents of change toward positive behavioral changes in the community.

There are currently 901 localities with KOSPEN activities in Malaysia. KOSPEN has the strength that community volunteers are empowered to increase the coverage of NCDs in the community. A study conducted in 2015 among the implementers, volunteers, and community reported positive feedback on KOSPEN.[13] Almost 90% of the implementer from KEMAS and MOH were aware of their role and mentioned that the program added value. The majority of the volunteers (89.6%) had a positive perception of KOSPEN, and almost two-thirds of the community members were aware of the existence of this program, all of whom understood KOSPEN activities and had a positive perception toward the program.

Since MOH with JKM has already established KOSPEN volunteers in the community, training the volunteers using the WHO manual allows the mobilization of societal resources and increases universal health coverage for mental health. The volunteer could be trained to:

  1. Deliver mental health promotion and awareness messages in the community
  2. Apply the principle of PFA: Look, Listen, and Link
  3. Identify, Listen, and comfort anyone in distress; and Help to connect to information, services, and social support if needed while doing their community activities.

Studies have shown that PFA is effective in helping long-term recovery in the community following a crisis, even when delivered by individuals without professional mental health training.[14] In breaking the stigma and improving access to mental health services, KOSPEN volunteers could be trained to deliver mental health promotion and awareness, conduct screening in the communities, and provide basic PFA. The general public that is trained in community-based PFA improves mental health and resilience in the community.[15,16] This will increase community engagement and empowerment in mental health matters, and promote and protect optimal mental health among the population nationwide. As the PFA will be provided by a recognized member of their community, the community will also be more likely to seek help from their own trusted community members. Volunteers may also have the opportunity to identify individuals at risk for suicide and direct them to proper evaluation and treatment.


There are structures/programs that are available in governments and communities that could be utilized to improve the mental health services of the country. However, this requires reliable commitment from all the stakeholders involved.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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Community volunteer; mental health; psychological first aid

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