For too long there has been a strong prevailing culture of silence when it comes to mental health. It has been strongly stigmatised, creating feelings of guilt and a sense of shame when discussing these topics on a personal level. This has led to an excess number of unacknowledged and untreated cases, with damaging consequences.
The humanitarian field itself has undergone numerous reconstructions over time, continuously trying to improve and provide the best assistance to target communities in need. However, within this progression a largely yet ignored and overlooked aspect has been the mental health and wellbeing of the aid workers, working to ensure individuals everywhere are being able to exercise their right to live a dignified life. This is especially pronounced with local staff.
While any job may be stressful, humanitarian work can bring an additional mental taxation due to the high daily demands and the potential exposure to direct and secondary traumatisation. Operating in unstable contexts, where the needs and the security conditions are changing daily, can result in highly detrimental effects on the aid worker’s mental wellbeing. Research into the mental health of aid workers began in the early 1990’s, however the implementation of these findings are yet to be sufficiently integrated into organisational structures, with only 20% of aid workers surveyed feeling adequate psychosocial support was being offered.
What is mental health?
When we talk about mental health, we are referring to our emotional, psychological and social well-being, and it affects the way we think, feel and act. While many factors can contribute to our mental well-being such as biological components, life experiences and family history, there is often an interplay between the factors. Within the working environment, the accumulation of acute daily stressors can transform into chronic stressors throughout time, resulting in mental health disorders. The same can happen with the exposure to security or traumatic incidents. Especially relevant in the humanitarian field is the risk of secondary traumatisation, i.e. process of suffering from post-traumatic and other mental health symptoms, due to endured secondary exposure of victims of primary trauma.
Experiences of work-life stressors leading to a multitude of disorders can present itself through physical symptoms (fatigue, diarrhea, constipation, headaches), emotional symptoms (anxiety, frustration, poor concentration), unhealthy behavioral changes (increased intake of alcohol, caffeine, drugs, tobacco) and other symptoms such as strained relationships, , isolation, resentfulness, intolerance of others, burnout, and compassion fatigue. Less discussed symptoms are those such as loss of faith, spirituality, or core belief about God, humans, and life.
Individuals in any settings can develop mental health disorders, but studies have found the risk to be higher for those working in the humanitarian field. To date, there have been too few studies adopting similar measurement standards to significantly be able to compare populations to each other, and thus prevalence rates can often differ between sources. The below values depict statistics assembled by UNHCR on their employees’ risk for different mental health and behavioural outcomes. Values therefore do not refer to diagnoses, but those estimated to be at risk.
| Table 1. Comparison of rates of common mental health disorders experienced by aid workers to the general adult population | ||
| General Adult Population1 | Humanitarian Aid Workers2 | |
| Generalised Anxiety Disorder | 3 – 8 % | 31 % |
| Depression | 12 % | 25 % |
| PTSD | 8 % | 36 % |
| Hazardous alcohol use | 10 – 20 % | 25 % |
1: Life-time prevalence in the general adult population worldwide, 2015 2: UNHCR study respondents at risk, 2014 | ||
Why is it important to talk about?
From an individual perspective, the importance of taking care of your mental health cannot be highlighted enough, with problems and consequences of depression, burnout and anxiety often persisting in individuals even long after field assignments have been completed. Studies have found even 3 – 6 months after the completion of field assignments, rates of depression and burnout had not diminished compared to levels immediately at the post-assignment stage and were significantly higher than pre-deployment levels. However, from the organisational perspective, alongside the duty of care organisations have for their employees, there are also numerous motivators for organisations to support staff mental health. Unmanaged mental health disorders amongst staff working in the field can lead to loss of productivity, high staff turnover, early retirement and the leaving of the humanitarian field work entirely, creating an immense monetary loss for organisations.
Furthermore, it is vital to consider the pure mission of humanitarian organisations, to serve those in need, in their best interest. By failing to take care of the mental wellbeing of their employees, organisations are also as an extension failing on their core missions. To date, as discussed earlier, organisations have taken the step forward at implementing mental health specific programmes across the world and mainstreaming these considerations across the sector at beneficiary orientated activities but have been lagging from the organisational perspective. This disparity is further pronounced in the differences of support given between international and national staff.
The Disparity Between Local and International Staff
The burden of mental health is a pressing issue within the humanitarian sector for all practitioners, but disproportionately affects national/local staff. The Antares Foundation has found international staff rates of depression and anxiety to be 20% and 12% respectively, however the rates for national staff to be 50-60% and 50%. They did not find significant levels of PTSD amongst international staff, but for national staff this was 20-25%.
There are many reasons behind this disparity, including national staff are being paid less and offered less security guarantees. When a humanitarian mission pulls out of a location or are evacuated, national staff are left behind to manage themselves, often without a guaranteed financial source of income. The level of benefits and trainings differ greatly between the groups as well, all creating additional stressors to the work-life of national staff. Large international organisations may be on paper following the localisation call, increasingly utilising the capacity of the local populations to deliver their missions, however, are sometimes failing to do so in a dignified manner. The current practices are not meeting the diverse mental health needs of all staff members. Action must be taken to include national staff within organisational policies. A shocking 59% of national staff reported tensions in disparity of treatment between international and national staff, to be one of their most frequent stressors affecting their lives.
“It is an unsustainable organisational practice to continue hiring an increased number of national aid workers, when their care and overall mental and physical wellbeing is not ensured” – Erin Mercado
What can we do?
An important component of tackling and addressing mental health issues are the actions taken by the individual themselves. However, it is very difficult to do so, without adequate tools and resources, or the support from others. More comprehensive trainings must be integrated into the organisational culture, to attempt to break the silence and stigma of mental health issues. Trainings should include all staff members, to enable them to better understand, identify and manage arising issues; but there must also be specialised training for managers to provide support and identify symptoms within their teams.
A substantial barrier to the increased attention of the wellbeing and mental health of employees however come from the donors. Within the humanitarian field, donors have the biggest influence on the decisions made, and they often prefer seeing funds targeted directly at beneficiaries. This results in less capacity to develop training materials and offer counselling support to staff members across the organisation. It is therefore vital to raise awareness of the issue, highlighting the dire importance of supporting employee mental health and its eventual cost-efficiency.
The Reference Centre for Psychosocial Support of the IFRC offers many resources and training material to address these issues, which organisations can utilise. The Antares Foundation has produced guidelines for best practices, offering organisations practical steps with measurable indicators. For additional insight and discussion into this topic for personal interest, ODI has hosted an in-depth panel discussion.
The Idealist’s Survival Kit: 75 Simple Ways to Avoid Burnout, a critically acclaimed book by humanitarian psychologist Alessandra Pigni offers those in the field with new perspectives and concrete tips on managing burnout.
About the Author
Enja Vaario is a Junior Officer in the Business Development department at Trust. She is currently studying a masters degree in International Humanitarian Action (Erasmus Mundus Joint Masters Degree Programme, NOHA) specialising in protection. With a background in psychology, she is keen on contributing to the mental health discussion within the humanitarian field.
Sources:
Antares Foundation (2012). Managing stress in humanitarian workers, Amsterdam: Antares Foundation.
Cardozo, B. L., Crawford, C. G., Eriksson, C., Zhu, J., Sabin, M., Ager, A., … & Olff, M. (2012). Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study. PloS one, 7(9), e44948.
Mercado, E. (2017). Managing Health in All the Helpers: A Survey of Mental Health Services for Humanitarian Aid Workers.
ODI (2018). Breaking the silence: promoting action on aid worker mental health. [Online]
Available at: https://www.odi.org/events/4574-breaking-silence-promoting-action-aid-worker-mental-health
[Accessed Sep 2020].
UNHCR (2016). Staff Well-Being and Mental Health in UNHCR, Geneva: United Nations High Commissioner for Refugees.
Welton-Mitchell (2013). UNHCR’s Mental Health and Psychosocial Support, Geneva: United Nations High Commissioner for Refugees.
