Chapter 17, Psychological support¶
Part III, ACTING: WITH OUR OWN MEANS
PTSD, post-traumatic stress disorder, is real. It affects survivors. It affects volunteers. It affects the leaders who coordinate the operation. Psychological support is not an optional supplement to the humanitarian response. It is an essential component, on the same footing as water, food and shelter.
You are not psychiatrists, and that is not what is being asked of you. This chapter gives you the tools to recognize distress, apply psychological first aid, and refer to professionals. Rotary has specific resources to fund this work, they are underused.
Who is at risk¶
Everyone is vulnerable in a disaster, but some groups more so. Knowing them allows you to anticipate and target actions.
| Group | Vulnerability factor | Main risk |
|---|---|---|
| Survivors directly affected | Loss of loved ones, loss of home, injuries | PTSD, depression, complex grief |
| Displaced persons | Loss of bearings, overcrowding in collective shelter, uncertainty | Chronic anxiety, isolation |
| Children (< 12 years) | Emotional immaturity, total dependence on adults | Regression, developmental disorders, PTSD |
| Adolescents (12-18 years) | Identity-building period, need for control | Risk behaviors, anger, isolation |
| Elderly | Uprooting, loss of autonomy, chronic illnesses | Disorientation, treatment abandonment, rapid decline |
| Persons with psychiatric history | Pre-existing vulnerability | Decompensation, relapse |
| Rotarian volunteers | Repeated exposure to suffering | Vicarious trauma, compassion fatigue |
| Volunteers who are themselves victims | Double burden: helping others while being a victim | Total exhaustion, delayed collapse |
Critical point: Rotarian volunteers are often the last to be cared for. They feel "less legitimate" than direct victims. This minimization is itself a risk factor.
Signs of distress: knowing how to recognize them¶
Psychological distress does not always express itself through tears. It can take forms that even experienced leaders do not recognize immediately.
Comparative table: adults vs children¶
| Domain | Signs in adults | Signs in children |
|---|---|---|
| Emotional | Uncontrollable crying or, conversely, total absence of emotion (shock). Disproportionate irritability. Feeling of helplessness or guilt. | Regression: return to bedwetting, infantile language, thumb sucking. Sudden tantrums. Crying without apparent cause. |
| Behavioral | Disorganized hyperactivity (aimless agitation). Unusual aggressive behavior. Increased alcohol or tobacco consumption. | Refusal to separate from parents. Nightmares. Reproduction of the trauma in play. Sudden refusal to go to certain places. |
| Social | Voluntary isolation. Refusal of help. Avoidance of conversations about the event. Break with social routines. | Withdrawal from play. Muteness. Loss of friends. Refusal to participate in group activities. |
| Somatic | Persistent insomnia. Chronic headaches. Muscle pain without cause. Intense fatigue despite rest. Marked loss or gain of appetite. | Recurrent stomach aches. Refusal to eat. Growth delay (if prolonged). Vague and repeated physical complaints. |
| Cognitive | Flashbacks (reliving of the event). Confusion. Inability to make decisions. Difficulty concentrating. | Sudden school difficulties. Unusual forgetfulness. Regression in learning. |
| Functional | Inability to perform daily tasks (washing, eating, working). | Loss of interest in usual toys and activities. Refusal to sleep alone. |
Warning: These signs can appear immediately or several weeks after the event. A volunteer who seems perfectly functional during the operation may collapse a month later. Follow-up at D+30 is not a luxury.
When the situation is urgent¶
Some signs require immediate referral to a mental health professional. Do not delay.
| Warning sign | Action |
|---|---|
| Suicidal or self-harm statements | Immediate referral to psychiatric emergency services. Do not leave the person alone. |
| Severe dissociation (person does not know where they are, does not recognize their surroundings) | Secure the person. Call a doctor. |
| Prolonged panic attack (> 30 minutes) | Move away from noise and crowd. Guided breathing. If no improvement, call a doctor. |
| State of shock with complete prostration (does not speak, does not move, does not react) | Do not force. Speak calmly. Protect physically. Call a doctor. |
| Aggression dangerous to self or others | Keep distance. Do not confront. Call emergency services if necessary. |
Psychological First Aid (PFA)¶
Psychological First Aid (PFA) is the approach recommended by the World Health Organization for non-professionals. Any Rotarian can apply it. PFA is not psychotherapy, it is simple, structured gestures of humanity.
The 3 principles: Look, Listen, Link¶
| Principle | Action | What you concretely do |
|---|---|---|
| LOOK | Observe the situation | Assess environmental safety. Identify persons in obvious distress. Spot immediate physical needs (injury, hunger, cold). |
| LISTEN | Listen actively | Approach calmly. Introduce yourself. Ask: "How are you?" Listen without interrupting. Do not judge. Do not minimize ("it could have been worse"). Do not force the person to speak if they do not want to. Validate their emotions: "It is normal to feel that way." |
| LINK | Connect to resources | Help the person identify their immediate needs (water, food, shelter, family). Connect them to available services (doctor, social worker, family, shelter). Give practical information (where to find help, what numbers to call). Make sure they are not alone. |
What PFA is not¶
| PFA is NOT... | Why |
|---|---|
| Psychotherapy | You are not a therapist. Do not try to be one. |
| A forced psychological debriefing | Forcing someone to tell their trauma can worsen their condition |
| An interrogation | Do not ask intrusive questions about the details of the event |
| Unsolicited advice | "You should do this" is rarely helpful. Listen first. |
| A promise that everything will be fine | Do not promise what you cannot guarantee |
Phrases that help vs. those that hurt¶
| To say | Not to say |
|---|---|
| "I am here. You are not alone." | "I know what you feel." (No, you don't.) |
| "It is normal to feel this way after what happened." | "Be strong." (Minimization.) |
| "What would help you most right now?" | "It could have been worse." (Invalidation.) |
| "Take the time you need." | "You have to move on." (Injunction.) |
| "I can put you in touch with someone who can help." | "You are lucky to be alive." (Unintended guilt-tripping.) |
| "Would you like a glass of water? A quiet place?" | "Stop crying." (Never.) |
Recommended actions: before, during, after¶
BEFORE the disaster (preparation)¶
What your club should do now, in peacetime:
| Action | Detail | Responsible |
|---|---|---|
| Identify mental health professionals | Psychologists, psychiatrists, social workers among members or in the club network | Disaster committee |
| Train volunteers in PFA | Minimum 1 training per year (3 hours). Training available via WHO, Red Cross, or local psychologists. | Disaster Coordinator |
| Build a list of local resources | Hotlines, crisis centers, emergency psychologists, toll-free numbers | Secretary |
| Include the psychological component in the preparedness plan | Budget, contacts, protocols | Disaster committee |
| Pre-position materials for children | Coloring books, pencils, simple games, balls, this is not a luxury, it is a therapeutic tool | Logistics |
DURING the response¶
| Action | When | Who |
|---|---|---|
| Integrate psychological support from D+0 | From the start of the intervention | Coordinator |
| Train volunteers in signs of distress | Quick 15-minute briefing at deployment | Club professional or trained team leader |
| Create calm and reassuring spaces | In each collective shelter, a quiet, separated corner with minimum comfort | Site manager |
| Mobilize club psychologists | Priority for the most serious cases | Coordinator |
| Organize activities for children | Drawings, games, readings, songs, daily, 2 hours minimum | Dedicated team (2-3 volunteers) |
| Apply volunteer rotation | No more than 8h/day, mandatory rest, right to withdraw | Team leaders |
| Observe volunteers among themselves | Team leaders monitor signs of exhaustion in their members | Team leaders |
Children's activities are not entertainment. Drawing allows the child to express what they cannot verbalize. Group play restores a sense of normality. Routine (even improvised) reduces anxiety. It is a care protocol, not a pastime.
AFTER the response: the Florida model¶
Hurricane Helene (2024, Florida) highlighted a post-disaster follow-up model that Rotary helped develop. This model rests on three pillars.
Pillar 1, Compassion teams
Professional therapists (psychologists, social workers) conduct home follow-up visits with the most affected. These visits are not home therapy, they are well-being check-ins and referrals to appropriate services.
| Parameter | Florida standard |
|---|---|
| Time to first visit | D+7 to D+14 |
| Duration of a visit | 30-45 minutes |
| Visitor training | Mental health professionals or PFA-trained volunteers |
| Frequency | D+7, D+14, D+30, then as needed |
| Tool | Standardized well-being questionnaire + active listening |
Sizing the PFA team, target ratios¶
The PFA provider / beneficiaries ratio determines the viability of the setup. Understaffed, it collapses in a week. Overstaffed, it unnecessarily mobilizes scarce professionals.
| Phase | PFA provider / beneficiaries ratio | Follow-up cadence |
|---|---|---|
| Emergency (D+0 to D+14) | 1 trained provider per 100 at-risk persons | 1 short contact per week |
| Stabilization (D+15 to D+60) | 1 per 50 | 1 visit every 2 weeks |
| Recovery (D+60 to D+180) | 1 per 30 | 1 monthly visit |
Sizing rule: A club of fewer than 50 members cannot provide the PFA team alone. It must identify 2 to 3 pre-disaster partners: volunteer local psychologists, Red Cross teams (PSSM / PFA training), parishes with trained chaplains, victim support associations. MOUs with these partners should be signed before the risk season.
Pillar 2, Community support groups
Organized in gathering places (churches, schools, community centers), facilitated by local professionals. Groups of 8-12 persons. Weekly sessions for 4-8 weeks.
These groups are not group therapies. They are spaces for speech where people share their experience, discover they are not alone, and receive practical information on normal reactions to stress.
Pillar 3, Long-term follow-up
The most vulnerable persons (isolated elderly, persons who lost a loved one, orphaned children) receive prolonged follow-up: D+30, D+90, D+180. This follow-up can be provided by trained Rotarians, in liaison with professionals.
Taking care of Rotarian volunteers¶
This is the blind spot of most disaster operations. Volunteers devote themselves entirely to victims and forget that they themselves are exposed.
Vicarious trauma¶
Vicarious trauma (or compassion fatigue) is the consequence of repeated exposure to others' suffering. It is not a sign of weakness, it is a normal physiological and psychological reaction to an abnormal situation.
Risk factors in Rotarian volunteers:
| Factor | Explanation |
|---|---|
| Prolonged exposure | More than 14 days of continuous deployment without relief |
| Direct contact with distress | Listening to accounts of loss, seeing damage, carrying the injured |
| Sense of helplessness | Needs exceed means, chronic frustration |
| Dual role | The volunteer is themselves a victim but continues to help |
| Lack of recognition | No one asks the volunteer how they are |
| No decompression airlock | No debriefing, no follow-up, abrupt return to normal life |
Specific signs in volunteers¶
| Sign | What it indicates | Team leader action |
|---|---|---|
| Refuses to take their break | Compensatory over-investment | Impose rest. Firmly. |
| Insists on working beyond their hours | Same mechanism | Remove from field |
| Growing irritability with colleagues or beneficiaries | Emotional exhaustion | One-on-one conversation, withdrawal proposal |
| Sudden cynicism ("what's the point") | Advanced burnout | Field withdrawal + psychological referral |
| Unexpected tears or outbursts of anger | Decompensation | Immediate listening + offer of professional support |
| Absenteeism after days of over-investment | Collapse | Phone call, do not judge |
| Increased alcohol consumption | Self-medication | Confidential intervention, referral |
| Sleep disturbances reported by the volunteer | Chronic stress | Workload reduction, referral if persistent |
Club actions to protect its volunteers¶
| Action | When | How |
|---|---|---|
| Group debriefing | Within 72 hours after each mission | 60-90 minute meeting, facilitated by a professional if possible. Not an operational report, a space for speech. |
| Confidential access to a psychologist | From deployment | Phone number communicated individually. The volunteer can call without informing anyone. |
| Right to withdraw without guilt | At all times | "You have the right to say stop. It is not abandonment, it is clarity." |
| Peer monitoring | At all times | Team leaders are trained to spot signs in their members |
| Post-mission follow-up | D+3 and D+30 | See detailed protocol in Chapter 15 |
| Recognition | From the end of the operation | See recognition protocol in Chapter 15 |
Debriefing is not a luxury. Armed forces, firefighters, emergency medical teams systematically practice it after every difficult intervention. Your Rotarian volunteers are no less exposed than these professionals, and they are often less psychologically prepared.
Financing psychological support¶
Psychological support has a cost. But Rotary has several mechanisms to finance it, they are too often ignored.
| Mechanism | Use | Amount | Timeframe |
|---|---|---|---|
| Club own funds | PFA, children's materials, group activities | Variable | Immediate |
| Disaster Response Grant (DRG) | Emergency psychological support integrated into the overall response | Included in max 25,000 USD | 24-48h after approval |
| Global Grant | Structured mental health program with a professional partner | 30,000 - 400,000 USD | 2-3 months (standard procedure) |
| Local pro bono partnerships | Psychologists who are Rotary members or network offering their services | Free | Immediate |
| NGO partnerships | MSF, Red Cross, local mental health organizations | Free (if coordination) | Variable |
How to integrate the psychological component in a DRG application¶
The DRG covers psychological support if it is presented as a component of the emergency response. Acceptable budget lines:
| Line item | Example | Indicative cost |
|---|---|---|
| Children's activity materials | Notebooks, pencils, games, balls | 200-500 USD |
| PFA training for volunteers | Trainer fees (1 day) | 300-800 USD |
| Emergency psychologist sessions | 10 days × half-day | 1,000-3,000 USD |
| Quiet space in the shelter | Tent, rug, soft lighting, soundproofing | 300-600 USD |
| Post-operation follow-up | Individual sessions for identified cases | 500-1,500 USD |
| Total psychological component | 2,300-6,400 USD |
This amount represents 10-25% of a 25,000 USD DRG. It is an investment, not an expense. Clubs that integrate the psychological component in their DRG application have stronger files because they demonstrate a holistic response approach.
The Global Grant for a structured program¶
For major disasters requiring a prolonged mental health program (6-12 months), the Global Grant is the appropriate tool. It requires:
- An international partner club (sponsor club)
- A local implementing partner (university, NGO, hospital)
- A monitoring and evaluation plan with measurable indicators
- A detailed budget and sustainability plan
Measurable indicators for a mental health program:
| Indicator | Target | Measurement method |
|---|---|---|
| Number of persons who received psychological support | [X] persons | Consultation register |
| Number of group sessions held | [X] sessions | Session register |
| Reduction of PTSD symptoms in beneficiaries | Decrease of [X]% on the PCL-5 scale | Pre/post questionnaire |
| Beneficiary satisfaction | > 80% | Satisfaction survey |
| Number of professionals trained in PFA | [X] professionals | Training register |
| Number of volunteers trained in PFA | [X] volunteers | Training register |
Resources and contacts¶
Build this list BEFORE the disaster. Print it. Put it in your emergency kit.
| Resource | Type | Contact / access |
|---|---|---|
| National hotline | Phone | [To complete by country] |
| Medical-psychological emergency unit | Emergency | [To complete] |
| Club-member psychologists | Pro bono | [Names and phones] |
| Rotary network psychologists (district) | Pro bono or reduced rate | [DRO contact] |
| Local Red Cross / Red Crescent | PFA and psychosocial support | [Local contact] |
| MSF (if present) | Emergency mental health | [Contact if applicable] |
| WHO, PFA Guide | Free online training | https://www.who.int/publications/i/item/9789241548205 |
| IASC, Emergency mental health guidelines | Reference | https://interagencystandingcommittee.org |
Takeaways¶
Psychological support in a disaster comes down to three convictions:
First conviction: Psychological suffering is as real and as urgent as physical suffering. It is not always visible, but it destroys lives.
Second conviction: You do not need to be a therapist to help. Looking, listening, linking, these three simple gestures change trajectories.
Third conviction: Your volunteers are not invulnerable. Take care of them with the same attention you give victims. A volunteer who burns out rarely returns to the next operation; one who feels supported usually does, trains the next ones, and strengthens the chain.
What your club would do without prior training¶
Without prior training, a well-meaning club tends to make three typical mistakes. The first: confusing support with advice, giving "solutions" to someone in shock, saying "don't cry," promising that "everything will be fine." These phrases, spoken in good faith, deepen the distress rather than ease it. The second: over-exposing the same volunteer to traumatic stories without a relay discipline, a single Rotarian listening all day to disaster survivors with no break, no debrief, no rotation, deteriorates without realising it. The third: missing the warning signs in their own members, simply because nobody taught them how to recognise them.
A single day of Psychological First Aid (PFA) training is enough to correct these three mistakes. It is the highest-yield training your club can schedule in peacetime. The Red Cross runs it free of charge in most countries, and the WHO publishes a freely available PFA guide (referenced at the end of this chapter).
The threshold at which you must hand over¶
There is a clear limit beyond which a Rotarian, even one trained in PFA, is no longer the right interlocutor: signs of acute psychosis, explicit suicidal ideation, total break with reality, behaviours that endanger oneself or others. In those situations, your role is to relay, not to take charge. The national psychiatric emergency line, the medical-psychological emergency unit, the nearest hospital, those contacts must be pre-printed in the club kit, not searched for at the moment someone collapses.
The following chapter (Part IV) will address long-term recovery. But before rebuilding houses, you must rebuild people. And that starts now.