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Burn-Out: A Culture of Silence? - Part 3

Updated: May 7, 2023

Are We Adequately Recognizing Burn Out in the Aid Sector?

Hopefully you have read Part 1 & 2 of our 3-part blog series. In the first blog, we looked at some key definitions of mental health and burn-out, as well as some surprising statistics in the sector. In Part 2, we considered who or what regulates the international aid sector and what I mean by a culture of silence regarding burn-out. In Part 3, below, we are looking at how to recognize the symptoms of burn-out, how to respond to them and what if any tools exist in the sector to help address it.

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 Do I Need the Most Help?

Agencies from the 2000’s onwards did start to provide psychological counselling for those returning from high-stress relief contexts. It was usually by request but many of us never availed the opportunity. What I realized was that I didn’t need a debrief when I returned home or came out of the field. I needed it when I was actually there – dealing with the day-to-day experiences I encountered!

For those of us on the front line of humanitarian work, we find our own safe place and means of coping with the daily assault on our senses. I feel so sad to see some of my colleagues numb their experiences with excessive drinking or other substances; though I understand the need. For me, I came to a decision early on that I should never let myself become numb to the disasters, the atrocities and the human rights infringements that we experienced every day - as painful as they were to witness. For example, a man was beaten nearly to death because he forgot to take his shoes off in a higher caste village, as he was passing through carrying a heavy load on his back. He was bloodied and bruised and barely breathing – and we were nearby and naturally, our team rushed over to help him. Hard to understand, powerless to do much - but just another day in the life of the aid worker, right? And then we moved on. But how do you move on without unpacking such events? And it leaves us scarred! I know this because the images of these events comes back to my mind often.

Tools and Checklists and more Tools…

Seeking help is important but it can also be very onerous. Like everything in the aid sector – there are guidelines and more guidelines and lots of checklists and questionnaires and various tools available for mental health assessments – and every other type of assessment.

If I were to pick out one that was reasonably close to helpful for me, it was something published in 2011 during the Ebola outbreak: WHO, the Trauma Foundation and World Vision published “Psychological First Aid (PFA) for field workers.

It’s worth picking up a copy if you are thinking of going overseas at some point (click the link above). It covers numerous important areas: Crisis intervention, context adaptation and various disorders resulting from a critical incident. Basically, it’s a manual for humane and supportive (and practical) help for people. But the problem is that it was targeted towards the beneficiaries or stakeholders with whom we were working and not as much for the aid workers themselves – who could very well be experiencing the same emotions.

In regard to other resources, The Red Cross has published some specific ‘breathing exercises.’ The CHS has published Mindfulness-based Stress Reduction methods. I have a colleague I work with who teaches Energy Medicine Techniques - and there are many others. And some of these routines ARE really good if we are trying to cope after an event. In fact, we started outsourcing to 3rd party psycho-social counsellors many years ago in the event of any major incident that affected our staff.

However, as a front-line worker, what I needed when I was out in Afghanistan or Algeria was a ‘preventative response;’ a pro-active and not re-active response to mental health concerns. However, this requires that (a) the aid worker recognizes the need for themselves, that (b) they feel safe to reach out and mostly importantly, (c) that the respective organization establishes a ‘safe environment’ for discussions on the issues.

Listen, Comfort, Connect and Protect

The Psychological First Aid (PFA) manual became a resource available to us. Interestingly, WHO suggested that it was better than the traditional debriefings that NGOs provided through the outsourcing of psycho-social support professionals. And many of us (not all) stopped using the psycho-social approach as a result of that. This method was cheaper and easier - and didn't require we physically talk to a counsellor.

The method actually didn’t require discussing the event – or running psychological tests. In fact, if we look at the advice it offered and then look at this current COVID-19 pandemic and the advice the media gave us for 2 years – it’s almost the same. Let's consider what the messaging was during the lock-down. The media talked about care & support, reaching out, addressing basic needs, listening (not pressuring), comforting (helping people feel calm), connecting people to services and social support and, protecting people from further harm (or hurting themselves).

Look, Listen and Link

What was very interesting during the pandemic lockdown was that we were encouraged to take a PFA-similar approach as a society – which is great news!

The 3 pillars of PFA are Look, Listen, and Link – it sounds a bit like an elementary school principle that many of us learned (drop, roll and cover!). But they adhere to our developmental principles in the field of ensuring safety, dignity and rights and, observing adaptation to the culture and context in which we are working.

The PFA speaks to ‘duty of care’ or helping others and taking care of ourselves. This is described as: Getting lots of rest, keeping reasonable hours – not getting too exhausted, scheduling rest times, taking time for reflection with colleagues and limiting drinking alcohol.

These all sound like fairly sensible approaches. Interestingly, we can observe that the Core Humanitarian Standard (CHS) is now talking about yoga, meditation, mindfulness, etc., along those similar themes.

If you're a front-line humanitarian worker – do you think the advice above will work - is it enough?

From personal experience, working in relief operations, I can tell you that there was very little time to get enough rest – given what we are called on to do. Most of us have no control over ‘keeping reasonable hours’ and even if we tried, it would look weak or irresponsible to take some downtime when we were responding to a crisis and trying to save lives. For example, when I wanted to get married, I actually wasn’t authorized to take leave because of the famine response and my responsibilities in the field. My wife and I had to postpone rather than get a few days off of work. And I said nothing to anyone - mostly because I didn't want to upset my managers.

Mental health is a difficult subject for many of us - and even more so to discuss openly. If we keep the topic of stress and mental health focused only on the immediate beneficiaries or stakeholders of our programmes - we’re in pretty comfortable territory. We can sit and talk for hours in meetings about the distress communities are in and what we will do about it. But discomfort jumps significantly higher if someone mentions they are struggling!

It's easier to keep the discussion part of the work, as a 3rd party issue and not let it affect me personally. Have you ever heard the phrase 'Physician, heal thyself?' Well, healing ourselves means uncovering our weaknesses and revealing deeply personal issues. And this would have an even greater gender bias. So many of us just decide to hide our perceived weaknesses out of shame or fear. And yet, revealing our vulnerabilities could actually be our greatest strength and lead to much more productive and capable front-line staff. Agencies need to provide a safe space and a culture to let that discussion be fostered.

Culture of Silence?

Let's re-visit this notion of a 'culture of silence.' I would challenge those of you who are reading this blog to ask yourself or ask a colleague one of these questions: Has s/he ever shared or admitted that they probably started drinking too much because of chronic work-related issues? Do they worry a lot or have a fear of breaking down or having panic attacks? Does their work seem too much for them at times? Have they ever cried themselves to sleep at night - or do they cry more frequently. None of these necessarily implies weakness or that something is wrong with you. However, while they may indicate a need to listen more intently, many of us would not be admitting this to anyone but our closest confidents - most of the time.

These issues might not be affecting you but these are all real struggles for a lot of people in humanitarian work. One of the best books I ever read on this subject was The Idealist's Survival Guide: 75 Simple Ways to Avoid Burn-Out, by Alessandra Pigni. With numerous interviews shared, and honest accounts and personal stories examined, I couldn't put the book down. If you want to start a journey of self-healing for yourself, I highly recommend this book.

Ultimately, how can we expect anything less than an emotional response from real people, with real compassion, who want to make a real difference in the world? For so many people, it is nearly impossible to not be affected by what we see and experience in many complex situations. But it’s not easy to spot the signs amongst your peers and we are usually unable to express it openly. Furthermore, it’s complicated by employees being afraid of being judged by their employers – as being poor performers, unable to cope with the stress or doing something wrong.

So it is not hard to believe that over the decades, a ‘Culture of Silence’ on mental health issues evolved. It was strengthened by our self perception of identify, our idealism and our feelings of guilt and shame if we were to be unable to perform those important tasks that help others in situations of suffering. This slowly evolving culture of silence becomes the perfect condition in which burn-out and many other more acute mental health issues can thrive.

What Can We Do Now?

Most of us know that stress triggers our fight and flight mechanism - or some of us just 'freeze!' It is an automatic physiological reaction to an incident or event that we perceive as a threat or which frightens us. There is no right or wrong response by the way - we are who we are!

Whatever the response, the event activates our sympathetic nervous system. This, in turn, triggers an acute stress response. Without going into the physiology of this reaction, suffice it to say that the brain and body apply the gas pedal and brake to release hormones which keep you on high alert or calm you down.

What many may not know, however, is that prolonged or chronic exposure to low levels (non-acute) stress responses have the same effect. It can lead to very harmful outcomes for your body and psyche. For young children, it's even worse and has been shown to create significant damage to brain development if living in toxic or high anxiety settings. If you’re like me, you get a dose of anxiety every time you head off to the airport. Sure, I’m excited to be going and for the work that awaits ahead of me – but anxiety creeps in every time; the flight over, where I’ll be staying, who will pick me up, what I should expect, being away from family, and so on. It’s a normal human reaction.

Toilet Paper Syndrome

Anxiety is another form of fear, which is usually a response to a perceived threat – which can be as simple as giving up control of a situation and putting your fate in the hands of those around you.

But these feelings may often trigger a response mechanism in which we want to ‘take action to take control.’

Every human being needs to feel safe and to be in a predictable environment. When that ‘perceived control’ is lost – it triggers the ‘flight, freeze or fight’ mechanism. Just go back over the past 2 ½ years during the pandemic and you will remember this playing out across society. I call it the Toilet Paper Syndrome. When we're faced with an undetermined threat and with little control other than to comply with local legislation, people started buying inordinate amounts of toilet paper and guns (at least in North America)! People made fun of those buyers - but they were simply reacting to a crisis in the only way they knew how - to stock up and hoard. While we laugh, it's not an unusual reaction to that type of threat. We all do it in some ratio of response. It's our mind's way of seizing a modicum of control in an uncontrollable environment.

The problem is that we are not always in the best state of mind to take certain actions and make good decisions when we're faced with crisis - which can lead to odd behaviours. This is no less true of aid workers who are working in front-line humanitarian responses. It is easy to question behaviour after the fact but what is being done to confront the issues they face now - to provide comfort and support?

Insufferable Parasites!

In extreme cases, we have seen many examples of how a lack of control and prolonged (untreated) stress can trigger risky behaviour and negative coping mechanisms.

In many of those cases, they were likely preceded by a lack of sleep, poor eating habits, varying forms of depression and drinking. That can then lead to low productivity, disorganization – even violence (of which we saw spikes in communities around the world during. the pandemic lockdown). Alcohol overuse and lack of sleep have also been a pretty common condition amongst many aid workers over the decades – along with all sorts of minor and major health discomforts because of changes in food and routine - and the insufferable parasites! This can wear down your body and make you susceptible to further chronic stress. This opens the individual to possible trigger events that can push them over the edge to suffer much more serious conditions and to make bad or even self-destructive decisions.

During the pandemic, there were so many questions raised by my colleagues who were repatriated back to their home countries for the lockdown. For example: How is our work going to change, what is the future of daily activities, will we be able to travel again, when can I get back to the field and projects, when will our volunteers be re-deployed, how can we effectively monitor our projects?

We all need an outlet, some certainty and a way of expressing our sense of worth and productivity. Thank goodness for Zoom, Teams and WhatsApp and other technologies because without the connectivity and communications, it would have been much worse.

It was so important that agency staff had clear guidelines on what to do and how to take care of themselves: Routines, check-ins online, setting clear goals, lots of rest, avoiding caffeine and alcohol, meditation and even prayer.

For project managers in the field, it was equally important to provide a context of Control for their staff. This is good advice to a project manager at any time but especially so during a very difficult time like we’ve been in. Giving armies a sense of control and direction is an absolute requirement for military officers in theatres of conflict. For civil society managers, it is no different and could be as simple as: 1. Giving staff tasks to do, 2. Staying disciplined in a schedule, 3. Having clear guidelines, 4. Holding regular check-ins that have meaningful conversations (that’s important!).

Control what you can and let go of the rest

While these principles are important to all aid workers, we should recognize that it affects headquarter and field staff alike. Project Managers, monitors, finance officers, fund-raisers, program officers, communications officers (and the organization as a whole) all ‘seek some kind of control.’ It is a normal human behaviour trait. I remember always telling my teams (in HQ and the field) – “look to control what you can and let go of the rest.” The key is not to look at the whole situation and to feel 'out of control!' Control the parts you can control.

Well, easy to say but hard to put into practice in your own life. But it's a great recipe to start your journey in reducing the burn!

Aid Organizations are Duty-Bearers of Mental Health and Well-Being

As we try to help ourselves, I would argue that organizations that hire aid workers should be held accountable as duty-bearers in their mental health and well-being. Providing a safe space to discuss these issues and building awareness is an incredibly important starting point. Organizational culture should recognize the risks, discuss them openly and provide their staff with a safe environment to bring issues to the foreground. They should then always have regular and credible clinical support services available at all times. Even small efforts can yield huge outcomes in improving staff mental health and well-being. I learned this important lesson from my own daughter.

Letter to a Health Worker

A few months back, my youngest daughter wrote a letter to a healthcare worker, through her school. Her letter was a beautiful thank-you note and described "the health worker" as a hero and an inspiration. And so they are! It was so inspiring and I imagine it meant a lot to the worker who received it.

At the same time, I also couldn’t help but remember the two big plaques that are secured to the reception wall at CARE Canada, when you walk in the office at Gurdwara Road, Ottawa - a stark memorial to all of the fallen CARE relief & development workers over the years.

I was reminded every morning that this work should not be taken for granted.

There is also a memorial to slain Canadian Aid Workers at Rideau Falls Park, in Ottawa; some of them are my friends.

People may not consider it very much but idealistic humanitarians lay down their lives for their work too. USAID supports a database that tracks the number of incidents every year. Over 100 aid workers die in the line of work each year and over 200 are injured. If you have the fortitude to look, (but I caution that it can be very distressing) more details can be found here:

When my daughter wrote her letter, I thought how amazing it would have been to have received THAT kind of letter from someone I didn’t know - when I was in Afghanistan, East Timor or Sudan.

We're only human

How often do our organizations put aside 'the employment contract' and consider the human factor of their primary resources - people? When do we put aside the expectations of a job description and think about the mental health of our ranks - and simply ‘remember and thank’ our local and international staff for the risks that they take every day – to their bodies and to their minds? I know - activities have to be implemented and the report has to be submitted on time. But let’s not forget that we are still human, with emotions and weaknesses and a need to be supported - and appreciated.

I’m not suggesting that every aid worker needs this reinforcement or appreciation - the work can speak for itself. But there is no doubt that by becoming a front-line worker in any country – whether it's fire response, ambulatory services, or international aid, you will be exposed to situations that are outside of your normal environmental experiences. It will call on you to make a quick decision for yourself and for those around you. Every action you take impacts others – and the decisions of your teammates and your organization impact you too.

Take a moment to consider this: Who was that one team leader that you have worked with who remembered an important aspect of your work. I hope you can - but it isn't every leader who can inspire and make you feel valued.

Help, Indiana Jones!

Burn-out is real and it is a slow fuse for many. As you become part of a management team or a relief operation or a grants proposal design team, I hope that you will keep this important mental health challenge in mind and be part of the solution in our sector. Look for the early signs of stress and burn-out in yourself and your teams and value the importance of dealing with it early. And remember that we are not all going to be like "Indiana Jones," from the movies, travelling to exotic countries and dealing with all kinds of crises without any visible trauma.

Remember that if you have had feelings of anxiety and burn-out - it is not a weakness! In many cases, it is simply the slow wear and tear that erodes our zeal and idealism over time and reduces that original bright spark that we brought to the job! It can manifest as disappointment, rejection, loss, grief, frustration, hurt, abandonment, and so many other emotions. Interestingly, I have found that millennials seem to be having a lot less trouble talking about mental health. My eldest daughter saw me preparing this blog and mentioned that her employer (a retailer) provides mental health leave and encourages its staff to take it. To her, dealing with and talking about that sort of issue in the workplace is, as she describes it - "A no-brainer, Dad!"

So why is it so hard for our international development sector to talk about and deal with this issue of burn-out? Is it fear of failure, rejection, or feeling less than capable?

As we contemplate Mental Health Week, let's remember that in many corners of society, mental health is still viewed very negatively. However, our staff are the most valuable resources and assets we have in the international aid sector. We depreciate the value of our computers and our cars for tax purposes - but unfortunately, that doesn't work for our staff! Yet, as humans, we do depreciate if we cannot spot the signs of burn-out and other mental health issues. And with it, our productivity, teamwork and dedication can decline as well - sometimes without us even realizing it!

Message from The Grants House!
Grant proposal; Grant writing; Writing a grant proposal; grant writer; grants strategy
Philip Tanner, Grants Coach and Trainer. Founder of The Grants House

This concludes our 3-part series on Burn-Out: A Culture of Silence?

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; Logo for The Grants House. Grants Acquisition. How to write a proposal. Grant proposal. Grant Writer.

@The Grants House, 2023


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