1. 5/10/2014 Mental Health | MonthlyDevelopments Magazine
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Mental Health
The 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.
2. 5/10/2014 Mental Health | MonthlyDevelopments 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
