I just landed in the beautiful and crazy land of Israel and Palestine, home of hundreds of NGOs and IGOs, and hot from the press a longitudinal study confirms that aid workers are affected by high levels of psychological distress, depression, anxiety, and burnout.

Inspired by this research, below are some personal reflections.

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Who cares about staff care?

 ‘Despite intense efforts, the majority of agencies contacted from the initial list of possible organizations declined participation or did not respond to the inquiry’.

88 international agencies were invited to take part in the scientific study:

• 18 didn’t respond
• 22 did not provide enough information to qualify for inclusion
• 21 declined to take part in the research

Out of 88 INGOs, the final number of participating organisations was 19. This lack of engagement struck me more than the actual results of the research. Could it highlight the little concern that many organisations have for the psychological health of their staff?

The researchers themselves recognise that such (low) participation in the study means that the results are based on the data from organisations ‘with adequate resources and/or a particular interest in the research topic’. In other words the agencies that are represented in the study are on average better at staff care, which given the results leaves me rather baffled.

Stiff upper lip culture

The outcome of this study is hardly surprising given the little psychological preparation and support that most aid workers receive. In theory the importance of staff care is now acknowledged in humanitarian circles. Nevertheless, in actual fact, there is still a tendency to sneer upon anything remotely emotional, maintaining a ‘stiff upper lip culture’, whereby the idea that an aid worker could actually have psychological needs is still frowned upon and seen as selfish or indulging.

Scientific evidence and common sense  

Over the past 15 years several academic and non-academic papers have been discussing the occupational hazards of aid work. Though this new piece of research represents an important scientific study, which hopefully will strengthen the case for need of better staff care in the eyes of HR managers, the fact that aid workers burnout and suffer much psychological distress is not exactly breaking news.

As trauma therapist Babette Rothschild reminds us, we should never leave our common sense behind. Same here: there may be limited research on the efficacy of staff care and its economic benefits in building resilience and preventing burnout. Nevertheless common sense and direct experience all point in the same direction: most of us need support to be touched, but not crushed by life in the field. One could mention ethics too, a good enough reason for investing in staff care, as highlighted during the People in Aid 2012 HHR conference.

Personal stories from aid workers

The lively ongoing discussion launched over a year ago in the Humanitarian Professionals Group on LinkedIn on the psychological health of humanitarian professionals has seen hundreds of contributions by field staff. Their stories and reflections reveal the lack of psychological preparation in the pre-deployment phase, the limited support in the field, as well as the sense of isolation following a mission. The discussion gives a rather sad picture of the personal cost of aid work, and of the many ideals that are shattered, posting after posting. On a mission to ‘healing others’, we find that we ourselves are in much need of healing.

Typewriter or iPad?

In my experience field professionals have been responsive to the idea of burnout prevention and psychological awareness and support – I believe this to be the case because when the tide gets tough, they are the ones who suffer.

Academics from important institutions have reached out to discuss the ethical implications of staff care, and the importance of looking after (and within) ourselves, in a field where the agenda is that of alleviating the suffering of others. To what extend benefitting others is feasible when we are drowning in our own psychological suffering, as the scientific study illustrates?

Organisations. Now, organisations seem to be slow when it comes to exploring different ways of implementing staff care. In analysing the resistance to change in the non-profit sector Seth Godin writes:

‘These organizations exist solely to make change. That’s why you joined, isn’t it? The problem facing your group, ironically, is the resistance to the very thing you are setting out to do. Non-profits, in my experience, abhor change’.

So it’s not surprising that when the idea of ‘duty of care’ is at all on the agenda, NGOs tend to have an approach that I compare to insisting on using a typewriter in the iPad era. Such approach includes:

• stress management workshops (what is the scientific evidence that relaxation techniques such as progressive muscle relaxation can help to reduce stress, prevent burnout and deal with challenging situations – e.g. poor team dynamics – in the field?),
• critical incident stress debriefing (scientific evidence says it may do more harm than good),
• and, post-deployment counselling (yes, it has its place, but prevention and field support need to be priorities)

Staff care is not stress management

Imagine being a daring and creative soul at work, asking professionals and volunteers what kind of support might help them in the field, and doing away with relying solely on standard procedures.

How about exploring evidence-based approaches such as MBCT/MBSR, remote staff support via phone or Skype, independent consultants in the field, peer-coaching and mentoring?

How about starting with prevention and developing a culture of ‘humanity’ within organisations, where aid workers are allowed to have their needs met, before plunging into helping others? The old metaphor of wearing our own oxygen mask before helping others applies to aid workers too.

The study concludes that some of the above ought to be priorities if we want healthy staff in the field.

Going beyond the stigma

The research also suggests that in the pre-deployment phase agencies may want to screen candidates for a history of mental illness and family risk factors. Though it is wise to enquire into people’s motivations and personal issues that may drive one towards a career in aid, ‘mental health screening’ may end up creating further stigma around the psychological health of aid workers. The fear of being cast aside from field missions is so strong, that it is not unusual for aid workers with a history of psychological conditions – who may for instance be on medication for depression or for anxiety disorders – not to disclose such information to the HR team.

Creating a ‘humane’ working culture, where both informal and formal support are easily accessible, and where requests for help are not stigmatised, is generally the way forward towards a healthier work environment.

Let’s talk. Then what?

From field to HQ, staff’s psychological health is a popular discussion topic, but when it comes to providing psychological pre-deployment training and/or field support, it is never a priority. This in spite of the fact that the mental health of aid workers does have an impact on the quality of the humanitarian and development interventions that are implemented in the field (to put it bluntly ‘burnt-out staff’, often deliver ‘burnt-out projects’).

I’m happy to see that my tweets on the Antares scientific study are creating some debate among aid workers, but I wonder if once again it will only be a debate, or whether it will be taken beyond the sphere of discussion into some concrete action for better staff preparation and field support.

Raising awareness on this issue through dialogue and debate is essential, nevertheless I don’t think that this is the kind of ‘talking cure’ that humanitarian professionals need. It’s time to move from reflection to action, without making staff care into yet another soulless set of guidelines and bureaucratic practices.

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Full academic article

Light version summary

More reflections and the need for action in my interview with People in Aid on burnout, mindfulness and the need to be ‘human humanitarians’.