5/10/2014 Mental Health | Monthly Developments Magazine

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Mental HealthThe changing approach to humanitarian assistance.

By Alicia Jones, Assistant Director, Don Bosch, Director of Clinical Services, and Rick Williamson, Consulting Psychologist,

Headington Institute

Over the last decade, the humanitarian community has come a long way in understanding the challenges aid work presents

to the mental health of humanitarian staff. It has slowly shifted from a trauma response model—waiting until individuals

exhibit problems before helping them—to a model that embeds aspects of preventative care within agency policies. And it

has gradually shifted from viewing staff crises in the field as strictly a matter of individual vulnerability to recognizing our

collective ethical imperative for staff well-being.

Most mental health crises in the field are normal reactions to highly abnormal situations, and no one is immune from the

toxic psychological effects of these situations. This is pushing employers to become increasingly cognizant of their

responsibilities in this regard. The growing impact of legal liability is certainly adding to this pressure. Many organizations

now provide more predeployment preparation, security training, and some access to mental health or peer support

services. Finally, research has demonstrated the significant role management plays in the ability of humanitarian staff to

cope with challenging environments. A chaotic agency response to crisis or challenge significantly influences the impact of

trauma on staff.

So perhaps now is a good time to evaluate where we stand. What has changed? How are changes in organizations’

structures or the context of aid work impacting aid worker mental health? What are we learning about mental health and aid

work that deserves our attention? Where do we go from here?

What has changed?

The delivery of aid has grown more complex. Increasingly, aid work entails a delicate equilibrium between various political

and religious factions. These negotiated environments are highly changeable and require frequent shifts in operations. Such

constant and often unpredictable change can result in a decreased sense of personal control, a central ingredient in keeping

stress from becoming toxic.

Moreover, aid workers are increasingly the direct targets of intentional violence and threat. Kidnapping, assault and

bombings are becoming more common. As the likelihood of encountering critical incidents increases, organizations need to

be aware of the impact of repeated hits on brain health and be extremely thoughtful about both rest and recovery policies

and also security and how security training is conducted. Preparing workers in advance on how to operate in hostile

environments and how to understand and control their own psychological responses to critical incidents can literally be the

difference between life and serious injury or death.

5/10/2014 Mental Health | Monthly Developments Magazine

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NGO structures are also shifting. Major shifts in organizational leadership and strategy are creating seismic waves of

change that are felt from the very top level of leadership down to the front lines. This unpredictability adds to the strain

national and international staff already encounter as they adjust to these changes and the accordant uncertainty about their

own roles in the future.

As international agencies shift to nationalizing responses it raises questions about who will be responsible for staff care and

how it will be funded. In the midst of budget cuts, such staff support resources are often trimmed and streamlined. A new

staff care approach is needed that fits the emerging humanitarian model.

Finally, team-based models are breaking down, which is also leading to a loss of the emotional support, protection and

camaraderie they once provided. Individuals that are part of a high functioning team are far more psychologically resilient

than individuals operating on their own. This is partly due to the significant stress buffering impact team support provides.

Resilient teams naturally boost the resilience of all the members. Furthermore, in the chaos of disaster response, there is

comfort in clearly defined roles, established lines of communication and familiarity with ways of operating. With the

emergence of new disaster management models, finding new ways to enhance a sense of team and build in these

protective factors will be a worthwhile investment.

What deserves our attention?

The latest findings in neuroscience have important implications for aid worker mental health, both in terms of mental health

impact and recovery, and also in terms of what is needed to remain resilient. Increasingly we are learning how brain

structures are influenced by our environment, our support systems and our own behaviors and activities that either enable

or undermine brain health and function. In other words, aid workers who lack the proper resilience building regimens may

experience emotional challenges and cognitive declines related to structural and physiological changes in their brains. This

understanding highlights the importance of preventative care. As the brain structures change due to repeated exposure to

toxic or traumatic stress, individuals are increasingly prone to anxiety, depression, burnout and impaired functioning.

There is a growing understanding that resilience is not simply a cluster of personality and genetic traits that allow some

people to bounce back while others remain vulnerable. Clearly some individuals do have an advantage or disadvantage due

to their genetics or upbringing, and this needs to be taken into account by individuals accepting various posts and by

organizations in hiring or placement. However, resilience is increasingly seen as a state, not a trait. This means that what

we actively do to promote our own brain health is ultimately more influential than the cards we were dealt in life. The latest

findings from studies by us and our partners provide a better understanding of these behaviors and disciplines.

Organizations need to support activities and policies that build resilience practices in order to offset the impact of high

intensity environments; doing so is clearly beneficial to both individuals and the organization.

These resilience-enhancing practices may look or be implemented differently depending on gender, cultural or faith

practices. This has practical applications and highlights the need to adjust regional staff support programs to take into

account these differences.

Paralleling the complex notion of resilience is the complexity of vulnerability and security: the definition of who is at risk.

Some individuals may be at greater risk for critical incident exposure because of culture, gender, sexual orientation or

religion; stories about aid workers being singled out for assault on the basis of one of these factors are all too common.

Supporting the well-being and mental health of multinational teams will require sensitivity to and evaluation of these risks in

ways that account for varying threat levels among members. It is increasingly important to ensure that training programs

target how to manage these group-specific risks.

Gender assault and harassment remains a significantly underreported, major mental health concern. Those who have

encountered sexual assault are far more likely to develop depression or PTSD than the average population. Combine this

with the other stresses of relief work, legal systems or cultural stigmas that may discourage the reporting of assaults, and

other health complications that may accompany assault, and we have a significant burden that continues to be borne by

untold numbers in the aid community.

Where do we go from here?

Shifts in the humanitarian context can impact aid worker mental health. Yet, clearly not all change is bad. Change is

necessary. There is much we can learn from the field of change management in terms of recognizing that major shifts are

inherently stressful, even when the overall trajectory is a good one. Reflecting on who within the system is hurting and why

is an important process that will help strengthen emerging models for staff support and agency response. Furthermore,

several positive, current trends are creating opportunities to support the mental health of humanitarians.

The widespread movement to professionalize aid and development has generated a number of regional and academic

5/10/2014 Mental Health | Monthly Developments Magazine

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programs, as well as a variety of international certification programs. These programs present an exciting opportunity for

training in stress management techniques, personal security, psychological first aid and other important skills for

humanitarian settings. They may also relieve some of the staff care training burden that NGOs currently carry. In the same

way that self-care and boundary management are included as part of social work or psychology graduate programs,

psychological considerations for aid and disaster settings training may become readily available. Frequently, humanitarians

comment, “I wish I had known this earlier.” Increased access to training is an important step in that direction.

Forewarned is forearmed. Resilience and brain research is growing at a rapid pace, and with it we are learning more

practical ways to build strength that do not rely on the presence of mental health professionals. The existence of these

practical measures is good news as many organizations are looking for ways to improve staff support for all their members,

not simply for those in crises or in regions with higher funding. Although crisis counseling will always be necessary for those

experiencing trauma, organizations can reduce the need for these services through initiatives that help reduce the toxic

stress levels within their organization.

Finally, global standards for mental health are improving. Access to culturally-relevant, qualified mental health professionals

is more readily available, reducing the reliance on expensive, nonlocal providers. Increasingly, global humanitarians are

benefitting from the diverse expertise of global mental health practitioners in humanitarian settings.

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