Updated: May 1
Are we adequately Recognizing Burn Out in the Aid Sector?
During 1-7 May 2023, countries around the world are recognizing mental health week. In Canada, we shine a spotlight on community-based mental health care champions, programs and communities. In England, 'anxiety' is featured, affecting so many people who live with mental health concerns. It is such an important topic and
The Grants House is proud to share in that conversation as we consider the less talked about mental health issue of 'Burn-Out.' And I ask the question, "is this the next big crisis to affect the International Aid Sector? Stay with us as we release 3 blogs this week, on the subject of mental health and burn-out. This blog is for discussion and awareness only and The Grants House always encourages those suffering with mental health concerns to seek clinical help. No clinical help is offered or intended to be offered in this blog series.
Whether you are one of the privileged cadre of aid workers roaming the world or are contemplating joining the sector, I think you will find this topic relevant. It might seem controversial to some - but often, controversy can raise awareness. The perspective in this blog emerges from 30+ years of experience and I include it in my University courses as an important pre-departure consideration for young people preparing to deploy overseas. But it applies to all of us. Unfortunately, I only became aware of the issue later in life but I truly wish someone had discussed this with me when I was in the field.
Our 3-part blog relates to a very important mental health consideration in the Humanitarian sector and I hope it will contribute to the detection of early warning signs that could have potential impacts in the workplace: affecting your performance, your enjoyment of the job, being alert to the possible negative impacts on your team and organizational culture and, even safety and security of your teams. Most importantly, I hope it will encourage readers to consider ways of openly discussing their concerns and worries - which we all have!
Please remember that this blog is an opinion piece and is for discussion and awareness only. The Grants House always encourages those suffering with mental health concerns to seek clinical help. No clinical help is offered or intended to be offered in this blog series.
When you consider the nature of work that international aid workers do, in some of the poorest, most dangerous and hardest hit regions of the world, it is only natural that they will be confronted by some harsh realities that can be traumatic and earth-shaking. It can take the notion of 'culture shock' to a whole new level. Many of us are just not well prepared for that experience. We often do not know how to handle it when we are confronted by it or when it impacts someone that’s working close to us. The recent conflicts in the Ukraine and North Sudan continues to reinforce the need for attention to this important subject.
I speak from personal experience because, like many of you reading this blog, I’ve worked in war-zones for over 16 years, including Afghanistan, Algeria, South Sudan, East Timor, Rwanda, Burundi, and many other countries in fragile context or conflict. I also grew up in regions with war and disaster and totalitarian regimes, where I experienced very traumatic events. I've been evacuated from several countries, and am deeply sympathetic to what is happening in North Sudan presently. Our thoughts and prayers go out to them.
Through all of that experience, it made sense to me that I should go on to a career in relief and development work, responding to disasters like the Burundi post-genocide (1997), South Sudan War & Famine (1998), Banda Aceh Tsunami (2004), the Tōhoku Japan earthquake (2011), the Pakistan (Kashmir, 2005) and Nepal earthquakes (2015), to name a few.
But like many of my colleagues and friends, I was forged and shaped in these environments over many years of work. I became used to it and even good at responding quickly to emergency situations. But the reality is for so many of us - that prolonged work in difficult contexts becomes Normalized.
I suspect that most do not take a breath and a moment to consider what they have observed and experienced before moving on to the next job - I know I didn't. I either left a job for another agency or I transferred to a new country - but it was not common practice to be asked, "how are you doing? Do you need a break?" And that is not a criticism of any agency - it was just not in the regular practice to identify these potential problem areas.
I'm sure that we can all name the one caring person that took an interest in our mental health and condition. I hope so anyway. In my 30 years of work, I had only 1 HR representative that took special interest in staff mental health. He once interrupted my deployment to Angola - on the evening before my departure - because I seemed agitated and worried. We discussed it and he said, "If it is doesn't feel right, Phil, you shouldn't do it!" You'll find that I never name names in my blogs - but I will this time because he was extraordinary. His name was Paul Prosser, at World Vision. A sensitive and kind many who is no longer with us - but he cared about his teams and put mental health high on his priority list. He became one of my biggest supporters when I first joined the ranks of the INGO sector. I say a big, "Thank you, Paul!"
In hindsight, I would say that some of my best experiences with humanity were in countries that were facing their darkest moments. It was where I felt I could best contribute and where I forged the strongest friendships. It was a moment to experience real honesty and transparency between those helping and those being helped. But it was also in regions where the growing threat of physical and mental danger were on the rise and the experience of bodily threat was quite real and a clear and present danger every day.
Many of you reading this may be in the exact same position right now - and I have a quiet reflection daily for all those who are.
Humanitarian Aid Workers are Front Line Workers?
Over the past 2 years, the COVID Pandemic raised people's awareness on the work that our brave health workers do in our communities - our public support workers, nurses and doctors. If you live in Canada, you may have seen the signs on lawns and windows and in the media. And yet over the last few decades, how many of us have considered that "Humanitarian Aid Workers (aid and development) are front-line workers, too!” This includes our National and International teams of brave men and women who risk their lives to help others every day. They face illnesses, exposure to diseases, unfamiliar and harmful practices and daily security risks.
Aid Workers do much the same type of activities as our own service workers in Canada, often in highly complex contexts, and are faced with every imaginable human suffering! They have the same experiences (sometimes much worse or extreme), all of the baggage and all of the grief and pain that comes with that tremendous commitment and passion. And sometimes, all of the guilt for not being able to do more!!! Sometimes there is guilt from leaving and not having completed the task or leaving friends and colleagues behind. I frequently point out to people I meet that Aid Workers are NOT just employment contracts. They are people - with feelings, with relationships, with goals, ambition and passion – and on top of that, most have a unique attribute that makes them stand out. It's a simple attribute that many people forget to consider. That is - Idealism! An ideal that they can make a difference in the world. That’s why most people join this cadre of development professionals. And they’re usually in it for the long-haul.
When Realism Collides with Idealism
If you’re like me, as an aid worker, you don’t see your work as a 9-5 job! There is endless amounts of work to be accomplished and it is often woven into our self-identity – it defines us and we never stop doing our work.
Most aid workers that I’ve come across in my career have gone into the profession with a very unique world view. In many ways, they are similar to frontline workers in our communities - like paramedics, firefighters, police, or public health workers. They don't join for fame, it's definitely not the safest profession in the world (with over 300 aid workers affected by violence or killed every year) and you often give up a lot of personal support and comfort by accepting a position in aid work. I was very glad to see the Canadian Red Cross add a webpage to their site asking, "Are you Ready to be an International Aid Worker?" There are a set of comprehensive questions that prospective candidates can go through. However, how many of us are properly equipped to assess our real state of being when we are keen to find a job and put our newly minted undergraduate degree to the test.
Believe me - our ability to self-diagnose our mental health state does not improve with experience in the field.
Trauma and stress is a slow-creep and when realism collides with idealism, we experience emotional exhaustion. Sometimes we feel that we can’t give of ourselves as much as before. And that’s a terrible feeling for an idealist – and can bring on feelings of guilt and self-criticism.
Physician! Heal Thyself
I believe we often also misread our symptoms. We’re not good self-healers and we are even worse at self-diagnosing.
I was happy to see the Canadian Red Cross ask the question: Is my personal motivation for working overseas healthy? Am I trying to escape from issues and problems that may be better dealt with by staying in Canada?
The trouble is that we often don't know the answer to that and may indeed think that international work is the solution to our immediate issues. Once you are in the aid sector, the experience is so intense that it may certainly mask or diminish some of those issues. However, it is also possible to compound the challenges with new and oftentimes traumatic experiences.
I don't have enough fingers and toes to count how many times I’ve seen colleagues turn their frustration outwards to blame their organization, their colleagues or their managers for something. Then, they start looking for another posting or mission as the solution to their problems. In a previous blog, I mentioned that organizational issues or a supervisor are the most common reasons given by staff for feelings of anxiety or for leaving their post. Aid workers are no different in that regard.
But I will be bold and say that, in most instances, an idealistic aid worker will be challenged by the reality of aid work - every time. They will encounter the day-to-day administrative demands, complex personnel relationships, communications with supervisors and, the increasing bureaucracy that stifles creativity and flexibility. Does any of that sound familiar?
And that does not even take into account the cross-cultural experience for those posted overseas or living in a different region of their own country. One has to take into account being away from family and friends and, the complex nature of the work that the individual is trying to accomplish. This is fraught with its own personal and professional demands.
That wasn't what I signed up for at the beginning! And no one prepared me for that stark reality check before I was deployed to my first post.
If you are a passionate, idealistic person (desiring to see a change in our world), then I'm afraid that you are at more risk of being disillusioned when you encounter all of the hurdles and challenges that have to be faced. Being aware of the coming "reality check" is one of the first steps to confronting anxiety and burn-out.
Professional psychologists say that Burn-out occurs when passionate, committed people become deeply disillusioned with a job or career from which they’ve previously derived much of their identity and meaning.
Baptism by Fire - first deployments
Part of my professional work, currently, is teaching international development to 3rd and 4th year undergrads and overseeing the internship program for a Canadian University. I'm privileged to help prepare young Canadians for their first overseas deployment.
I take this matter very seriously in order to build their awareness of the realities of field work. In addition to the joys, rewards and adventure of working in the humanitarian sector, there are also emotional challenges from being away from home and in unfamiliar settings: homesickness, personal/physical safety & security and caring for one's mental health being a few.
For some of the younger readers, preparing to go overseas, you may learn that when you are starting out in relief and development work you do not always get to pick your first few postings. This is true for any aid workers, regardless of their country of origin. Many first time jobs might be referred to as a ‘baptism by fire;’ being thrown into the work with minimum preparation. Myself, I wore that initial experience like a badge for many years. Dealing with drunk soldiers at traffic stops, haggling in the markets, negotiating with less than above-board customs officials, organizing distributions of food items for people on the verge of starvation, or just trying to get from place to place - and many other things for which I was poorly prepared. I even hitched rides in the local beer trucks, and disguised myself in local taxis in some countries because the risk of car-jacking and kidnapping was just too high where I was going. I often had to sink or swim by myself, far from home, clinging to the limited support network around me - but making sure that I produced results for my agency and the donors. No pressure, right!?!
More Training Please
I jumped from job posting to job posting, with very little formal training offered. After awhile, I was highly experienced and qualified…but I was not invulnerable!
With my new found skills came an ever increasing offer of new postings to complex emergencies and throughout those experiences, I can't ever remember having the time or the inclination to describe myself as having PTSD or ‘burn-out.’ I had to get the job done. And quite honestly, my situation was nothing compared to those people with whom I was tasked to help. So what was I complaining about?
Oh wait, though - come to think of it - I was often fatigued, sometimes on edge, restless at night, had stomach problems. But isn't that just the normal situation of being in a high intensity job? Maybe - but it's also often the warning signs of a bigger mental health situation, which I'll get back to in a moment.
Early Warning Signs
In international aid work, our project planning demands that we do a significant Risk Analysis and produce mitigation tables to ensure our projects stay healthy.
How many aid agencies have actually thought to do this type of planning for their most precious resource - their staff? Mental health is a very complex issue and there will be varying levels of illness that may need to be diagnosed and addressed through professional services. However, we can strengthen our awareness of mental health through detection of early warning signs - just the way we do with project development. And we can create a safe space for staff to talk about the issues in order to build awareness as an organization but most importantly, our own self-awareness of how we are doing - a self check-in! There are many obvious triggers for stress and PTSD - what we call acute onset. There are also the less obvious series of triggers that turn into a chronic anxiety. Let's first consider the acute triggers.
Slow-onset, Primary and Secondary Trauma
When aid workers are tackling very difficult and complex challenges - whether in Haiti, Afghanistan, Somalia, Chad or the Congo (DRC) - agencies have a responsibility to be alert to the underlying root causes of stress and anxiety. Various chronic stressors may lead to persistent worrying and difficulties in functioning that may or may not be tied to a specific event. It is a slow-onset trauma tied to repeated and undiagnosed events.
Additionally, there may be some people who are reading this blog that have directly experienced very unsettling or traumatic situations. You may also know someone who has gone through an experience like that. I know I have. Thus, you may already be aware that there will be times that the survivor did not talk about their experiences but it resulted in a post traumatic stress disorder (PTSD) - a real condition that affects many aid workers. Perhaps you or your colleagues were afraid – of being belittled, told to get over it, ignored, afraid of losing their job, afraid of looking weak, intimidated by an authoritative leader, and so on. In my case, I was convinced to 'suck it up,' get over it and move on. Life is tough and we're here to try and make it a bit better. It's not about you!
In other instances, you may have had an experience that didn't affect you directly but you observed it. This is a very common form of trauma amongst aid workers caused by exposure to an event that evokes an extreme emotional response - such as fear, shock or sadness. In that case, you could be suffering a post-crisis or what is called a Secondary Trauma Experience. There are likely to be a larger percentage of aid workers who have had this experience. However, again, you will rarely see aid-workers listed on the mental health sites as being 'prone to secondary trauma.'
While Secondary Trauma is a high risk for aid workers, either witnessing our colleagues suffering or seeing the suffering of our project stakeholders, we do not classify it as importantly as the Primary Trauma incident that affects people directly. The body and mind's reaction, however, is often the same.
Consider the last time you saw or heard about something disturbing happening in the world (like an earthquake or the North Sudan mass evacuation) and think about how you felt. Now multiply that by a hundred for those who are called to respond to that critical event in person and to witness the human suffering first hand. They cannot change the channel or turn it off at night. It is engrained 24/7 and there is little time to process what is being witnessed. For those working in the field, do you remember the last time you went into a village to help build a school or a water well? What was the condition of that village and how were people coping? That can be secondary trauma if the conditions are bad enough - and we're all prone to varying levels of that depending on 'how thick our skin is!'
I personally don't like that term - having thin or thick skin. In fact, it has nothing to do with the skin - and everything to do with empathy. But remember, aid workers are shameless idealists - and so we will be prone to being hurt and feeling the pain of others.
Because of this 'feeling for others,' aid workers may also be prone to experiencing chronic anxiety and stress. As a result, we may be subjected to one of the most prevalent mental health illnesses that is frequently overlooked - Burn-out! And yet - burn-out is not considered a clinical illness.
Instead, we demote burn-out to a mild form of fatigue and suggest a holiday or a few days off as the salve for this mild problem. But how many of us return from holidays - needing a holiday!?! If you've ever had that situation, keep reading.
I would hypothesize that burn-out is probably the most prevalent condition afflicting international aid workers worldwide and some recent studies will back this up. Burn-out can impact leadership styles, can affect the performance of your staff, create conflict amongst teams, lead to poor decisions or raise the general level of toxicity that exists within an organization. It is - to put it simply - insidious!
Burn-Out! An insidious mental health condition
First – let’s understand the term Mental health more generally, because it’s often not something people want to talk about freely. And this is one of the first problems or challenges the sector faces.
Simply, Mental Health is defined as:
a state of ‘well-being’ (which is physical, mental & social) where every person can realize their potential and can cope with ‘normal’ stresses of life – can work productively/ fruitfully – and is able to make a contribution to their community.
In studies conducted by the CHS Alliance on Well-Being (prior to the pandemic), 79% of surveyed humanitarian workers reported some type of mental health concern. 33% reported a post-trauma stress disorder, according to an Antares Foundation study. 44% had depression and many reported turning to alcohol more frequently (Mindfulness & Wellbeing Project, 2016; CHS January 2020; Young, (2015) The Guardian Research: mental health crisis among aid workers). 84% of respondents said that they have continued working with "untreated mental health issues."
Almost all of the respondents in the studies reported it was due to their work - and described a lack of structure and support in our sector and the ‘normalizing’ of excessive workloads – which can be just as dangerous as the hazardous contexts in which we work. For any organization, that should be a serious ‘wake-up call.’ Compare that to 20-24% of Canadian veterans that were found to be suffering from some form of mental illness sometime in their life. On the positive side for serving military, there is a body responsible for responding to those needs (Veteran Affairs). For Aid Workers, who are non-combatant but are still often working in theatres of war and conflict, there isn't.
Message from The Grants House
Look for A Culture of Silence - Part 2 in the next blog.
One thing this COVID pandemic has taught us - mental health and burn-out are real and it’s becoming more common to talk about it - and it's ok to talk about it! It doesn't mean that we aren't 'fit for purpose!' And as those 84% of aid workers who have continued working with untreated mental health issues begin to talk more freely about their experiences, will the Aid Sector be prepared to respond?
We are starting to realize that being able to discuss mental health openly means we are fitter than most! I've seen so much burn-out affect staff in the field and in headquarters, and I often see it amongst my Grants Acquisition colleagues - working long hours and on recurring deadlines, travelling to difficult and complex places, and often with program designs that impact the most marginalized people. My hope is that this blog may provide an opportunity, as a sector, to reflect deeply on the matter and to better support our most valuable resource - our committed aid workers!
I'm Dr. Phil Tanner, founder of The Grants House. I've been working in international development and humanitarian relief work for over 30 years and now I'm excited to pass along my experience to you in The Grants House proprietary training courses!
Don't forget to give us a thumbs up after you read this blog and let us know if you want to hear more about identifying and mitigating mental health risks and concerns within the international aid sector.
@The Grants House, 2023