Back in 2016 an article was published (101 Fundraising) regarding the mental wellbeing of professional fundraisers and how they can be exposed to vicarious trauma, compassion fatigue and burnout and yet even today very little support is given to staff in these roles.
It is widely recognised that those on the frontline of caring for others e.g. firefighters, aid workers, paramedics etc are at risk of developing mental health issues, potentially leading to post-traumatic stress disorder (PTSD). There are also so many other roles that could be categorised as high risk due to the level of exposure to traumatic material, such as fundraisers, researchers, and front-of-office staff. While these roles are not on the frontline, pulling bodies from collapsed buildings, medically caring for someone who is severely injured, or supporting a survivor of sexual violence, their role is indeed to help. They are often exposed to listing to traumatic stories of supporters and donors. There is a great deal of research now to show the risk of being effected by traumatic material indirectly, known as vicarious trauma. At FD Consultants we make sure organisations do not overlook the corrosive impact of vicarious trauma, sometimes known as secondary trauma. Research states that by listening to stories of trauma, we can start to be impacted by trauma symptoms, especially if we are empathic or intuitive, as our mirror neurones start to fire in the same way as the person telling us the story. Listening to the media or reading traumatic material can impact us vicariously. We also offer a half-day ‘Trauma and Vicarious Trauma Workshop’. Staff that are identified in ‘high risk’ roles, possibly through the location or intensity of their work, or the risk of being exposed to traumatic material, whether directly or indirectly, would benefit from this workshop. There are many myths and misunderstanding about how to best treat individuals who are traumatised. There is also a great risk of re-traumatising someone, who is suffering from trauma symptoms, without the knowledge from this workshop. Therefore, this workshop is also helpful for managers supporting staff who may be suffering from PTSD or vicarious trauma. Peer support programmes train peers to offer early and good quality support which can prevent an individual’s vicarious trauma developing into post-traumatic stress disorder, or stress developing into burnout. If someone goes off work with stress-related issues they may be off work for a few days, if someone goes off work with burnout, they may be off work for weeks or even months and may never return to the workplace. Additionally, research shows that when an individual receives support early, they will recover quicker, therefore preventing long-term health problems. Please do contact us at [email protected] if you require our psychological support services. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly.
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Encouraging the growing momentum around staff wellbeing in the humanitarian and human rights sectors19/7/2020 Throughout July FD Consultants want to highlight the diverse expertise and professionalism amongst its associates. Arianna Rondos is a UKCP accredited psychotherapist. She specialises in refugees, trauma and psychological wellbeing of humanitarian and human rights workers. In addition to her psychological training she has an MA in Human Rights Law and has worked and lived internationally. Arianna offers psychological and research services for FD Consultants. “I found our session incredibly helpful! I had a post deployment assessment with another service provider back in 2015, and the person I spoke to then had almost no understanding of the type of work I did, and the unique stresses of the humanitarian environment. Your experience and deep engagement with the humanitarian sector is evident and really made the session meaningful to me.” (Humanitarian staff feedback) I joined FD Consultants at the start of 2019 with an academic and professional background in the fields of human rights, international development and gender-based violence (GBV) and with a clinical focus on refugees and trauma. Having lived internationally, in the Middle East, Balkans and in Europe during these years, I also had some knowledge of the aid sector field context. It was this experience which motivated me to broaden my clinical focus to include those who provide support to vulnerable communities and which led me to join FD Consultants as an Associate. I wanted to be involved in and to encourage the growing momentum around staff wellbeing in the humanitarian and human rights sectors. And, to acknowledge the value of my own struggle in appreciating how a desire to address the needs of the most vulnerable can lead one to neglect their own self-care. While my particular experience is not a prerequisite for this work, when significant in some way to the experience of the individual being supported, it can elicit what I have understood as a kind of ‘relief’. A relief, as some have described, in not ‘feeling like I have to spend most of the time explaining the way I live and work rather than what is actually going on for me’. At FD Consultants we attend to each of our clients in this way, with trauma specialist expertise and an understanding of the unique contexts in which humanitarian, human rights staff and first responders work. When meeting a person for the first time I will introduce myself with a little information about my background, which I provide as a way of letting them know that I can, in a way, speak the language of their work/life context. With each consultation I draw upon this experience and understanding of the sector to recognise and highlight the unique and meaningful ways a person is supporting their own resilience as well as where they might benefit from attending to themselves with more care. When working with trauma, I seek to convey that, while trained and experienced in this field, I am equally respectful of the uniqueness of their experience. Most recently, as part of the COVID-19 humanitarian response, FD Consultants’ Associates have been carrying out consultations with humanitarian aid staff preparing to deploy, the majority of whom are well seasoned in epidemic emergency settings. Much of their preparation and expectation, which I hear reflected in their calm yet adrenaline infused tone, is relevant to the COVID context. Some have already been on the frontlines at home, ‘facing shortages, infected colleagues, family members and an array of unknowns’, as one staff described. Others are prepared for these realities once on the ground. In support of this, our consultations focus on strengthening innate resilience. And, as I listen and inquire, I encourage the importance of self-care and boundaries by reinforcing responsibility for oneself, including taking breaks, not pushing beyond breaking point, as well as openly voicing concerns with the team leader. Given the global nature of the humanitarian and human rights sectors, our work often involves crossing cultures, ethnicities, religious affiliation, gender, sexuality and, when supporting young volunteers, generations. It also often involves crossing boarders, at the least, and, more often, continents, through video link or audio, and not always with an ideal internet connection. Yet, whether I am asking someone who has never undergone a psychological evaluated to share their experience or I am assessing someone following a traumatic incident, I am regularly struck by the openness with which I am met. And, how, whether speaking to national staff or deployed internationals, they will often describe a sense of personal responsibility, not only towards their work, but towards the wellbeing of their team’s, colleagues, organisations and, most of all, the communities they work in. With each of these interactions, I find myself both exponentially impressed by the work of humanitarian and human rights organisations as well as conscious of the work that still remains in destigmatising and normalising the inherent psychological stresses that accompany their efforts. FD Consultants appreciates the multifaceted nature of this responsibility and understands how organisations, which are increasingly committed to the wellbeing of their staff, can foster healthy working environments, which in turn support the communities they work with. By building relationships with these organisations, providing individual services to their staff and, by providing vital monitoring and evaluation, FD Consultants directly contributes to achieving the goals and objectives of the humanitarian sector through enhancing its duty of care policies. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly. Throughout the coronavirus (Covid-19) crisis much emphasis has been placed on factors that might make individuals physically ‘high risk’ should they contract the virus. NHS UK has published guidelines to help identify and advise people within this category - including, for example, cancer patients, transplant recipients, and those with heart, lung, or kidney conditions – on how to ‘shield’ and prevent themselves from coming into contact with the virus. The reason is that their compromised physical health means a heightened level of vulnerability and the likelihood of becoming gravely ill. What we may have heard less about over recent weeks are factors that might lead those with mental health difficulties to be at higher risk during this crisis. Whilst an individual’s mental health history may not necessarily heighten or reduce their risk of physically contracting coronavirus (Covid-19), or directly influence how seriously they would be affected if they were to fall ill, it can have a profound impact on how they cope with the current situation. It seems universally recognised that the coronavirus (Covid-19) pandemic, and all the measures that have been put in place to halt its spread, are affecting people’s mental health[1]. Who might warrant additional care and consideration from a psychological perspective, though? Here, I present several different categories of mental health difficulty and explore how people living with them may be affected at the current time. Anxiety, Panic Attacks & OCD It’s an anxious and worrying time for most people right now as we wonder, without clear-cut answers, how long the virus will be prevalent for, whether we and the people we love will remain safe, when restrictions to our daily lives will lift, and how our individual and collective livelihoods will be affected longer term. For anyone with anxiety, for whom intense levels of worry and fear are a general and restrictive feature of everyday life, such concerns are likely to be amplified at present. This may lead to feelings of being overwhelmed. Some sufferers of anxiety may also be noticing an increase in panic attacks (intense periods of fear, sometimes accompanied by shortness of breath and shaking), and those with obsessive compulsive disorder (OCD) may find themselves drawn towards compulsive behaviours such as handwashing and cleaning – particularly now these behaviours are being promoted as ways of protecting against the virus. Finding a trusted person to talk to is likely to help anyone experiencing these types of conditions, as struggling with worries and compulsions alone can feel isolating and also lead to anxiety spiralling as it goes unchecked. Limiting one’s exposure to the news and social media can also be a helpful strategy for dealing with anxiety at this time, as is sticking to reputable sources of news that can be relied upon to be factual rather than sensationalist. Whilst there is a lot about the current situation that none of us can control, anyone with anxiety may benefit from reminding themselves of the things they still can control at the present time – for example, planning how they spend their day and creating a routine that promotes self-care and overall well-being. Bereavement & Loss Anyone who experiences the death of someone close to them during this period, be it due to coronavirus (Covid-19) or any other reason, is likely to have a particularly challenging bereavement. It may be that they were unable to see the person in their life who died due to social distancing, and that they can’t reach out to friends and family after the loss in the way that they usually would. Funerals currently have to be much smaller, scaled-down events than families might wish for, and this can also feel very upsetting. Similarly, anyone who has experienced a bereavement in the past may find that difficult memories of this are stirred up through the constant reminders of death and suffering that we are encountering in the news right now. It is important to remember that grief (the progression and range of emotions we go through as we adjust to losing someone close to us), is a natural process and not something to necessarily be pathologized or viewed as a mental health ‘problem’ – even though it can feel very difficult at the time. If anyone you know is bereaved at this time, then gently acknowledging their loss and offering what support you can over the phone or through video-chat will likely be helpful. Do not push a bereaved person to ‘open up’ or share deeper feelings right now, though. They will be in the early stages of their loss and, given the uncertain and unusual circumstances we’re currently all experiencing, they may not feel safe to connect with more complex emotions for a little while. Depression In its mildest form depression can mean feeling low in mood and finding it hard to muster up the energy to engage in day to day life and the things you once enjoyed. More serious depression can manifest in feeling unable to perform the most basic aspects of self-care, such as eating, bathing and dressing, and can result in sufferers feeling hopeless and sometimes suicidal. Many aspects of the current coronavirus situation might compound the difficulties of a person suffering with depression. Social distancing, for example, might draw a depressed person living alone further into isolation, and working from home might reduce a depressed person’s motivation to get up each day and maintain a reasonable routine. Worries about the future and bleak news stories may particularly impact on someone who is already depressed. Therefore, if someone you know may be experiencing depression at this time, do check in on them to provide social and practical support. If their depression seems more severe (particularly if they have spoken of feeling suicidal or at risk of harming themselves), encourage them to speak to a mental health professional – who should still be able to offer them a consultation remotely. Telephone helplines such as the Samaritans (and other national helplines listed through Befrienders International) can also offer valuable support to anyone in crisis. Trauma Anyone who has directly experienced or witnessed trauma in their past may have a nervous system that’s particularly sensitive to stress. In worrying or uncertain situations, trauma survivors may experience strong physical and psychological reactions such as shaking, sweating and unwanted ‘flashbacks’. They may also feel very ‘activated’ and easily launched back into the ‘fight or flight’ mode we associate with responding to danger. It’s easy to see how the current coronavirus crisis might feel very ‘triggering’ for someone with a history of psychological trauma, and how some of their responses might feel distressing or overwhelming. However, such responses are usually very normal – what we might call a ‘normal reaction to an abnormal situation’. Trauma-informed counselling (which can be delivered remotely) can help individuals in this situation to make sense of their reactions and to learn how to manage them – for example, through learning relaxation and grounding techniques. Summary Those with current or historic mental health difficulties are likely to be at a higher risk of struggling during the coronavirus outbreak - even if their physical health remains unchanged - due to increased levels of worry and a heightening of certain symptoms, as detailed above. ‘Shielding’ and supporting these individuals may not be as straightforward as is the case for those with physical vulnerabilities. Employers, colleagues, friends and family members of those living with mental health difficulties will do well right now to sensitively check in with them and encourage them to seek further professional support if this seems necessary. Below are details of some relevant sources of online information. However, it is worth remembering that GP surgeries and community mental health teams (CMHTs) are still available and able to offer support and guidance at this time in the UK, albeit remotely. The same should be applicable for emergency mental health services overseas. Therefore, if managing staff abroad, now may be the time to check relevant details and make your team aware of how such services can be accessed if needed.
Author: Felicity Runchman, Associate, FD Consultants Date: May 2020 References [1] Roxby, P. Coronavirus: ‘Profound’ Mental Health Impact Prompts Calls For Urgent Research. BBC News [Internet]. 2020 April 16 [cited 2020 May 1]. Available from https://www.bbc.co.uk/news/health-52295894. What we see is a new type of war veteran, the international humanitarian worker, returning from the battlefields unable to escape the horrors there. It is obviously very important that aid organisations begin considering seriously the factors affecting their project personnel. Someone must be able to spot the danger signals at an early stage, and help exposed personnel in dealing with their situation (Smith et al, 1996). Relief workers today are faced with situations which generate more stress than straightforward natural disasters. This happens in a context in which the usual support mechanisms of family, partner or close friends are absent. Furthermore, the culture in the humanitarian community, which may be one of bravado and competition in emergency situations, does often not allow the space for discussing issues such as psychological stress. 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,. Some common problems Some of the common stress-related problems seen in relief workers include burnout, psychosomatic disorders, and risk-taking behaviour such as alcohol abuse. Unlike domestic rescue workers who are periodically exposed to short stressful events, relief workers may suffer exposure to chronic low levels of stress by, for example, residing in insecure environments for many years. It is in this setting that stress may be cumulative. Burnout is probably the most commonly used lay term associated with cumulative stress. It is a process that is usually gradual in onset. Symptoms can be grouped into five categories (Kahill, 1988):
Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are more formal diagnoses related to exposure to severe traumatic stressors such as a direct assault or abduction (primary traumatisation) or witnessing the death or abduction of a colleague (secondary traumatisation). The phenomenon of tertiary traumatisation is also increasingly recognised (Jensen, 1999). Examples include being witness to mass violence or listening to first-hand accounts of traumatised people. ASD appears relatively quickly after exposure to a particular stressor and, by definition, resolves within a month. It includes a spectrum of emotional reactions, cognitive changes such as confusion, and symptoms of mental and physical hyperactivity. PTSD symptoms appear from one month to three months after a given event. Symptoms usually involve flashbacks to the events and a state of being hyper-alert. Symptoms may become chronic and extremely debilitating. In their attempt to find a new internal equilibrium, relief workers may also respond to unresolved stress with more subtle behavioural changes. One such reaction has been termed “enmeshment” and is akin to survivor guilt with an over identification with the beneficiary population (Smith et al, 1996). This reaction may be more common in the younger, more idealistic relief worker. By contrast, avoidance reactions of distancing, withdrawal and denial may be more common among experienced personnel. Finally, relief workers may exhibit self-destructive behaviours such as working to the point of exhaustion, consuming excessive amounts of alcohol, or engaging in unprotected sexual encounters. Problems exacerbated by the humanitarian sector Many of these problems may be exacerbated by factors particular to the humanitarian sector. For example, relief workers do not usually benefit from being in a well-trained, tightly knit unit with a clear command structure. In addition, training and briefing, particularly with regard to psychological issues, is generally inadequate. This is particularly pertinent for those organisations which deploy a high proportion of first assignment volunteers. Third, aid workers are often called upon to perform duties outside their realm of professional competency and experience. Finally, there is the pressure when the drive to ensure the visibility of their own organisation may over-ride questions of the appropriateness or quality of interventions. Two other issues deserve mention because they are relatively modern sources of tension in the humanitarian sector. First, is the pressure of discovering that one’s internal mandate in terms of personal ethics and preferred approach does not match the mandate of a particular organisation. Second, is the changing culture of humanitarian work. Organisations are more self-critical than previously and are increasingly putting resources towards evaluating their activities. Inevitably external criticism, even if constructive, leads to a re-assessment of an individual’s perception of his/her own effectiveness. The latter is particularly true if individuals have an unrealistic expectation of what they may achieve under any given circumstance. Recommendations An individual has three levels of resources, personal, social and organisational, at his/her disposal with which to tackle demands. Organisations should seek to strengthen these resources wherever possible. The personal level: Selection and training are key areas where organisations could better support their personnel. In the past the key qualities organisations have looked for when selecting personnel are flexibility, maturity, adaptability, ability to work in a team and past experience in emergency situations (McCall & Salama, 1999). While experience is crucial, this must be tempered by the knowledge that stress can be cumulative, especially in the setting of aid workers going directly from one emergency to the next. Individuals who have a past psychiatric history including that of alcohol abuse or those with a recent significant life event such as a relationship break up should be regarded as being at higher risk of psychological distress. More effort needs to be made to ensure that an individual understands and is comfortable with the mandate of the organisation and has a realistic expectation of living conditions, security conditions, potential risks including to psychological health and what can be achieved in the circumstances. Some examples of best practice in this setting include being interviewed by the person directly responsible for the project by telephone or in person, and in-depth discussion of hypothetical field scenarios that illustrate some of the complex trade-offs inherent in humanitarian work. Studies in various settings have shown that untrained, poorly briefed staff suffer most from stress-related illness (Ursano & McCarroll, 1994). Briefing and debriefing should be mandatory and in person. It should cover an individual’s personal and emotional reaction to their work environment, not merely the programmatic or administrative issues encountered. A briefing and debriefing by a psychotherapist should represent the standard for all emergency assignments. Mental health professionals working in this role should themselves ideally have experience of humanitarian emergencies. Training courses should cover stress management techniques (types of stress, coping strategies, how to access help within the organisation), cross-cultural issues, team building/conflict resolution strategies, as well as the ethical frameworks and moral dilemmas of humanitarian relief. Courses should also help to prepare recruits for the task of adapting their professional skills to an environment which may demand a very different orientation. The social level: Organisations should be more willing to accommodate couples on assignment, particularly if both have relevant skills. Unless situations pose extreme risk, couples themselves should be given the autonomy to weigh the benefits and risks of the presence of an accompanying partner. Managers should consider flexibility in breaks so as to maximise, wherever possible, couples’ time together. It is also important that those responsible for recruiting understand the team dynamic in each particular field and attempt to match new recruits to a field that will potentially suit them. The organisational level: Formal policies on the prevention of stress in the humanitarian sector are frequently non-existent or incomplete and vary significantly from one organisation to the next (McCall & Salama, 1999). Strategies for improving briefing, training and debriefing need to take place in the context of organisations developing clear, written and comprehensive policies on the psychological health of their employees. Within the framework of institutional policies, mechanisms to support relief workers in the field need more detailed elaboration. A formal mentoring system for new personnel or the designation of a particular individual chosen by his peers in the field to act as the support person for that particular area are two examples of current practice. Policies on the use of critical incident stress debriefing (CISD) also need to be put in place. CISD may be a useful technique particularly in acutely traumatic events such as a line-of-duty death. Furthermore, organisations should come to a consensus on the most appropriate methods for psycho-social follow-up of employees so that they are able to determine what happens to their workers after leaving the organisation; the success with which they negotiate the difficult transition back into their former environments, as well as the proportion that suffer psychological distress. Anonymous cross-sectional surveys at regular intervals are one possibility. Finally, there must be a recognition of the effects on empathetic field managers of coping with the stress of numerous employees. In effect this is a form of tertiary traumatisation and they too must be able to recognise the symptoms of stress in themselves and call in re-enforcements if necessary. Peer support networks of regional managers often occur on an ad hoc basis but this could be made more formal. Conclusion Unfortunately, humanitarian emergencies are becoming more common. Concurrently the humanitarian sector is becoming larger and more professional, and we are seeing a new type of professional: the career relief worker. These environments, however, are not ordinary work places; they expose individuals and organisations to new dilemmas and new challenges. Staff turnover is high and burnout is common. Perhaps the crucial element in the achievement of the humanitarian goal today is the development of a stable and experienced workforce whose energies are effectively harnessed through more enlightened organisational policies. When seen in this light, the psychological support of relief workers is simply part of the employer’s duty and responsibility. It is not an optional extra. Humanitarian aid workers are routinely exposed to traumatic events linked to the cause of mental health issues including depression, burnout and anxiety. But increasingly, work stress including extremely heavy workloads, long hours and limited time for self-care are being highlighted as major causes. Among volunteers, mental health issues can be even higher. Often from affected communities, volunteers experience the same loss and grief as those they are working to support but without the same training, support or structure as professional workers. At the global level, there is now increasing recognition of the importance of ensuring the well-being and safety of humanitarian workers and volunteers. However, too often the appropriate support and care systems are not in place, especially for national or local staff. A recent study found that only 20% of aid workers surveyed felt adequate psychosocial support was being offered (Dunkley, 2018). The prevailing culture of silence, feelings of guilt and perceived stigma around mental health, leads many to continue working without seeking treatment. To reduce stress, burnout and to promote the well-being of workers and volunteers, simple and cost-effective initiatives can be put in place before, during and after deployment. Where are we going wrong? Dr Idit Albert, a clinical psychologist specialising in anxiety disorders and trauma, believes that one of the problems is the stigma of mental health in this sector. She points out that, “you wouldn’t send firemen into a fire without the right equipment or training, it’s like in any other profession of care; we’re not talking about providing people with lavish lifestyles but what they need to be able to carry out their work, cope with the situations and be able to resume their lives when they return home.” The problem it seems in the humanitarian sector is the difficulty of transforming that raw compassion into the practical skills necessary, which in turn puts those who may not be fully prepared in a vulnerable situation. The culture of silence Despite NGOs recognising the mental health issues plaguing humanitarian workers, speaking up can sometimes be hard. Self-care is a very easy to say, but very hard in practice. Michael McHugh, a nurse and child protection officer who was one of the first to volunteer in the camps in Calais, feels his training as a nurse gave him those “professional boundaries” necessary that some younger volunteers without training couldn’t seem to grasp, from fear of not being a “true humanitarian”. Mandatory breaks became an actual thing. People were struggling to look after themselves because their focus was outwards, but when people burnout, they can become destructive, which can affect those in their care. This feeling of compassion is what drives aid workers and volunteers, but if the worker becomes unbalanced, they can be a danger to themselves and those they are trying to help. It can even lead to “compassion fatigue”, where even the most compassionate can “lose sight of their end goals or become cynical and detached”. A need to rethink the humanitarian sector and its actions At the 2016 World Humanitarian Summit, Brendan McDonald, along with other colleagues, attempted to petition the summit, calling on the UN to “prioritise staff well-being”. “I was told by UNOCHA senior management not to pursue the matter; it was basically not seen as an issue.” While this interaction has left McDonald with “zero faith in the system”, Amjad Saleem, manager for the Volunteer section of the IFRC believes this summit was an attempt to rethink the humanitarian sector and its actions and open a dialogue on mental health. For McDonald, working in countries where there is often no rule of law, aid workers struggle to find someone to turn to, and in one of the world’s largest unregulated sectors, “the bullying, the harassment, the poor leadership, the arbitrary dismissal of staff, the inherent racism, misogyny and sexual harassment are very present”. Here at FD Consultants we take this subject seriously and offer support for organisations and individuals both before a humanitarian assignment, during and after. For our full list of services, or to talk to us about how we can support you, or your volunteer staff, click here |
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