At times I kind of feel like I’ve been shouting into the wind over the past five years: who cares about aid workers’ mental health?

How presumptuous of me to try and get beyond a nice conversation with aid agencies on the need for better staff care. How rude to suggest that the day-to-day management of office dynamics and culture (you know conflicts, feedback, appreciation, etc.) could be part of staff care. How annoying to point out that better/different pre-deployment preparation and field support, including a bit more emotional intelligence and a bit less hardcore attitude of the “swim or sink type”, could help. How disrespectful to show that burnout is an institutional problem when we are here trying to change the world.

Maybe things are shifting, or maybe not. Admittedly now we do talk about aid workers’ mental health more openly. With social media we can no longer sweep it under the carpet. But…let’s not rock the boat too much. Let’s neatly fit in some harmless wellness workshop instead of rethinking the way the aid industry has a tendency to use and spit out its own staff. Because let’s face it, your sanity counts as overhead, and we know how much this needs to be kept as low as possible.

This today made me realise that yes, I may be shouting into the wind, but maybe there’s some sense in doing it.

How much has actually changed?

Let me dig out an article on staff care published almost 20 years ago and show how very little has substantially changed:

“Despite mounting anecdotal evidence that stress and its consequences are key occupational health hazards, humanitarian agencies have not moved quickly enough to minimise the risks to the psychological well-being of their staff, whether they are expatriate or local.” (Salama, 1999)

Sounds like 2015. The fact that now it’s ok to talk about staff care doesn’t seem to translate into things being done better. Training is used as the way to build resilience and prevent burnout. But guess what? Unless we give it appropriate time and space, you cannot workshop people into burnout prevention. Plus, as crazy as it may sound, aid workers do need a bit of support along the way too. And when I say aid workers I’m not referring to “expats” only, and when I say support I don’t mean “counselling” only.

So yes, I really think it is time for a better and different conversation around aid agencies’ duty of care. A conversation which has to account for the fact that aid workers are increasingly checking out emotionally: they burnout, use work to numb-out, suffer from depression, experience anxiety and panic attacks, endure traumatic experiences, take to drugs and alcohol as a means of support which can have costly consequences. Conflicts run high in teams because there’s nowhere to let steam off. And aid agencies are partly responsible for this.

The elephant in the room

Forgetting those who remember with nostalgia the good-old times when there was no nonsense about aid workers’ wellbeing, pretty much everyone now agrees that aid agencies do have some kind of duty of care towards their staff. Yet, congratulating yourself for noticing the elephant in the room is not enough. What’s being done about it?

From bad managers to PTSD, here’s what gets in the way of better staff care:

1. Old-school attitudes about mental health. Seriously, there are still people who think that you can be immersed in water without getting wet.

I see little hope of change as long as grit is presented as the “must have” trait among aid workers. Do we really think that humanitarian professionals need to plough through in spite of what they experience? The normal reaction to the exceptional suffering witnessed in the field is to feel something, to be affected by the stories we hear. The normal reaction to some of the absurd demands of the job is to question its practices and sometimes to walk away, not to hang in there no matter what.

2. Stress management. It doesn’t work.

Stress management workshops tend to be a waste of time, money and resources. Why? Because staff care is the byproduct of a learning and caring work environment, not of a two-hour relaxation training. If you want your staff to relax then a good old massage is the way, it’s cheaper and more effective. But if burnout prevention is the aim, then research shows that what helps is an environment that fosters civility, respect and engagement.

3. Self-care is not enough. Here’s more.

Self-care has its benefits, but it is not enough because an individual’s mental health in never sustained in isolation. So by all means do practice meditation as Peter Greste did while in prison in Egypt (here’s how to start). But remember that his spirit was also sustained by the relentless support that he and his colleagues got from Al Jazeera and beyond. Connections are crucial, and hopefully you don’t need to be held in prison to get support from your agency.

4. Lack of soft skills. Emotional intelligence and people skills are not an option.

I’ve seen aid workers suffer more due to bad managers and team conflicts, than to living in a tough political environment. Among the worse I heard of is the one from a poor aid worker whose line manager watched porn during office hours!  A Humanitarian Practice Network paper shows how “aid workers have a pretty good idea of what they are getting into when they enter their career path: dirty clothes, gunshots at night and electricity cut do not surprise them”. Instead, “inter and intra-agency politics, inconsistent management styles, lack of teamwork and unclear or conflicting organisational objectives, […] combine to create a background of chronic stress and pressure that over time wears people down and can lead to burnout or even physical collapse”.

5. Lack of sustainability. Chekhov had a point when he said: “Any idiot can face a crisis; it’s this day-to-day living that wears you out.”

Today we know that the daily grind, combined with an unsupportive work environment leads to burnout. We could almost assert that burnout is one of the unintended consequences of the way the aid sector operates. That’s where I’ve been shouting into the wind a lot! Yes, some aid workers will suffer from post-traumatic stress disorder (and even there it’s time for a paradigm shift), but many more are at risk of burnout. And that’s not simply because of overwork. I apologise if you’ve heard this from me about a million times.

6. Medicalising staff care. Thinking that staff care boils down to counselling, PTSD interventions, or critical incident stress debriefing is reductive.

This is where I tear my hair out. Do we really think that having a counsellor on call will make up for all the challenges that aid workers have to face day in and day out, including the lack of anything that resembles a home, a bit of stability, a supportive work environment? Nevertheless, by all means please do have a staff counsellor available. I will be forever grateful to MSF for providing independent staff care in the field. Such support kept me sane and inspired me along the way.

7. Old-school attitudes in general. I said it before right? Like suggesting that when aid workers need help they are unfit for the job; or when they leave the sector they are just one disillusioned person; or when they question some received wisdom they are just being difficult.

I think we can all pause for a moment and do with a bit of self-reflection here. This will help.

Maybe aid work is no lifetime marriage. Maybe it’s more like a passionate and at times abusive relationship. As such it’s wise to get in prepared, learn, listen, understand, help and get out before you numb-out and burnout.