World Humanitarian Day: Experts speak out about mental health

LONDON — With more people in need of humanitarian assistance than ever before — increasingly in protracted crises — and as attacks against aid workers continuing to climb, aid agencies and donors need to do more to ensure the well-being of their staff and volunteers, starting with simple and cost-effective measures to help look after their mental health, experts said.

Exposure to traumatic events and danger, long working hours, stress, and frequent, often back-to-back deployments abroad, mean that humanitarians are at high risk of developing depression, burnout, and anxiety. A survey run by the Guardian in 2015 found that 79 percent of respondents had experienced mental health issues, and 93 percent said they were related to work. A separate study found that only 20 percent of aid workers felt their organizations were supporting them.

Speaking at a session on Thursday at the Overseas Development Institute in London to mark World Humanitarian Day on Aug. 19, experts and former aid workers said aid organizations are paying more attention to mental health but that there is a long way to go. They also said a “machismo” culture meant many workers didn’t feel they could speak out about mental health issues, and warned that volunteers and national staff often get less help than international staff.

A healthy workforce

Christine Williamson, founding director of Duty of Care International, said most organizations now understand that they have a “duty of care and an obligation to be equally concerned with the psychological health and physical health of their workers,” and that not doing so puts the organization’s health at risk. Groups are increasingly providing more services and support — and more quickly — than in previous years, and have also improved their prevention strategies.

However, aid groups need to do more, Williamson said, describing current approaches to mental health risks as “minimalist,” and called on organizations to go beyond offering counseling services, instead putting more “holistic” strategies in place to create a “healthy workforce.”

“In order to really address mental health issues, I would approach it from the other side and ask what does our workforce look like when it has good mental health, and take a more optimal and ethical approach,” she said.

Volunteers and national staff at risk

Michael Bociurkiw, global affairs analyst and former aid worker, said that national staff and volunteers are often the last to receive treatment and generally get fewer perks, including access to mental health resources, compared to international staff.

He said during his time working for United Nations Children's Fund in Gaza, he saw first-hand how national staff often had more to deal with. “The death and destruction was one thing … [but] we also faced a lot of delays, rough treatment, and humiliation going through Israeli checkpoints … and this was especially bad for national staff,” he said.

Cecile Dinesen, who works as an adviser in the International Federation of Red Cross and Red Crescent Societies psychosocial support center, said local volunteers have a higher risk of experiencing mental health issues since they are often members of the communities affected by crisis, and so experience personal loss while also having to navigate the “tricky situation of wanting to help everyone but also being under pressure to help their friends and family.”

However, volunteers are often overlooked when it comes to receiving support, she said. They tend to have more limited supervision, and lack defined job descriptions compared with full-time or international staff, which can contribute to their stress.

Humanitarian bosses also need to be aware that it is not always the most obvious employees who experience the most trauma, the IFRC adviser said. For example, when IFRC surveyed staff working on the Ebola outbreak in West Africa, the drivers showed more symptoms of post-traumatic stress disorder than staff involved in what appeared to be riskier roles, such as burying diseased bodies. This surprised Dinesen, who said it could be down to the fact that burial workers had better protective clothing, so were perceived as being safer — they also got more recognition and acknowledgment than the drivers, which could also have been a contributing factor, she said.

“We need to take organizational matters seriously … [It’s about] how we organize the work, not just the role itself,” Dinesen concluded.

Cultural challenges

Bociurkiw also pointed to a “machismo” culture within some aid organizations, which made it hard for staff to acknowledge when they were overworked or take steps to do anything about it.

“I’ve seen very close colleagues approach burnout ... and it’s difficult even as a close colleague to say ‘you need time off’ … There’s this organizational culture and machismo which makes it difficult for people to … acknowledge it and take time off,” he said.

One easy solution would be for aid agencies to make staff take time off between deployments. He said he knew of instances where organizations had policies promoting leave between postings, but in practice didn’t encourage staff to take it.

Technology is also creating new pressures, which are harming humanitarian workers’ mental health, according to Bociurkiw. While working for an NGO in Ukraine doing election monitoring, Bociurkiw said he witnessed what he described as harassment by Russian “trolls” who would pick out an individual election observer, find their social media profiles, and start harassing them online. This is a fairly new phenomenon that caused a lot of stress, he said.

Additionally, communication technology can cause stress and burnout among staff due to the pressure to answer emails immediately. Bociurkiw said that fellow aid workers had confided that the backlog of emails, and the speed with which they were expected to answer them, meant taking time off was not always restful.

Simple solutions

There is a range of “simple and cost-effective things” that aid organizations can do to promote well-being of staff, both before, during and after a deployment, and to prevent staff from experiencing burn out, Dinesen said. These can range from “small acts of recognition” and holding regular meetings, to training for managers to identify early signs of stress among their staff and having a good referral system for severe cases to get specialized care.  

However, management buy-in is key and well-being needs to be allocated the necessary resources and time, she said.

“Staff well-being needs to be in budgets and strategic plans and [to] be prioritized in the middle of humanitarian crises, and that’s a challenge ... We have a long way to go,” she said.

For Williamson, improving training and support for managers to help them “spot signs of mental health issues [and] to ... provide a supportive environment” is key. However, too often managers are given the same training as their staff which puts the emphasis on the individual manager to figure out how best to apply it.

“A much better solution would be to work in community, as a team together, facing the ‘battle’ [of mental health] together. Not hiding it, covering it up, or even displaying an image of ‘all is well’ — which is often the go-to survival behavior,” she said.

More data

Finally, more data is needed to get a better picture of the humanitarian sector’s current state of health, and to know what support and training is needed and when, according to Williamson. She noted that currently, most of the data being collected is on statistics such as accidents and turnover but not on the effects of this on the mental health of the affected individual and their team or organization.

Williamson proposed collecting more data in order to understand the “true cost and time spent on psychological health matters,” which she suggests will mean organization’s “wouldn’t think twice about investing more in health and well-being practices.”