We Are Failing To Care For Our Aid Workers’ Mental Health: Evidence For A Poor Mental Health Culture Within Aid Organisations

AJ Jones (DEP 2017-18) writes:

“I’ve had many discussions with fellow aid workers who really feel this humanitarian response has not been very humanitarian to them” – Participant F

Photo by Maranatha Pizarras on Unsplash

Did you know, that as an aid worker today you are more likely than not to experience a mental health disorder as a result of your work? Burnout, primary and secondary trauma, depression and anxiety disorders are fast becoming the norm, and mental health problems are increasingly being seen as an occupational hazard. What is worse is that numerous studies show that when these disorders are not addressed they can lead to negative coping strategies, such as absenteeism, alcohol and drug abuse, and suicide.

This needs to change. But most organisations have been slow to respond to their staffs’ mental health needs despite the fact that everything we do for our beneficiaries is planned, monitored and evaluated through a psychosocial lens. Why is this, and why are we failing to care for our aid workers’ mental health?

To answer this I conducted an exploratory study into the mental health culture within some aid organisations by interviewing a range of aid staff. The study’s participants either worked, or had worked, for agencies in conflict and non-conflict settings all over the world, in a field or office-based role. Their responsibilities ranged from delivery level volunteer to country director. My research found that unhelpful donor and management attitudes were significant contributors in creating a poor mental health culture in most organisations, and that this culture acted as a powerful barrier to staff seeking help. 

The problems with poor donor and management attitudes

“One of the hindering points for having staff mental health services… is that they [the donors and management] focus on the beneficiaries overlooking the needs of the staff” – Participant A

In most aid agencies I observed a poor mental health culture. Specifically, I found that managers and donors had little-to-no understanding, or awareness, of mental health issues and their impacts on staff, and in most agencies I found a complete absence of any support or services for aid workers at all, especially among national staff and volunteers. Moreover, I found that most staff felt replaceable and this generated fears of discrimination in their roles or careers if they divulged a mental health issue. And in some aid agencies I found a worrying lack of mental health awareness in general, alongside the absence of any published information or studies about aid worker mental health to help inform and raise awareness.

Poor donor and management attitudes towards mental health were largely to blame for creating this culture. Many donors and managers either did not know enough about aid worker mental health to tackle it effectively, or had not considered it an area that needs addressing, or were not incentivised or interested in confronting it – this was especially the case in the Middle East where mental health is still widely perceived as a Western construct.

But it’s not all bad…

“My employers are very understanding… we have a very good director… he knows how to put our needs first” – Participant A

I was pleasantly surprised to see a positive culture in some organisations, and where staff mental health care is taken seriously it can have positive effects. When managers were supportive, understanding and proactive in addressing staff mental health care I observed positive outcomes. This ranged from informal and formal team bonding, to beliefs that aid work can be a positive experience, to reports of personal growth and recovery after suffering from a mental health illness. Some consequences of this positive culture were that services and support were made available, which staff could, and did, access; employees were more productive and loyal; and staff felt valued and rewarded for their hard work. This should, logically speaking, improve the organisation’s performance.

However, a positive mental health culture appears to be the exception rather than the rule, and this needs to change. If we want the aid we deliver is to be as effective as possible then we need to be doing more to address aid workers’ mental health. This starts with rigorous research informing positive action.

There is an urgent need for further research

First, we need to better understand why some donors and managers hold these attitudes towards staff mental health care. Second, we need to understand in what ways staff mental health care initiatives impact on overall organisational performance. Third, we need to conduct a larger longitudinal study. This research would provide valuable academic contributions to the wider debate on aid staff mental health, and raise awareness across all levels to help deconstruct poor mental health cultures across the sector.

We cannot continue as we are

It is no longer enough for organisations to have policies and services in place to react to disorders as they emerge; donors and managers need to create and maintain a proactive mental health environment in which mental health issues are understood and taken seriously by everyone, and help seeking is encouraged. This means fundamentally changing how some donors and managers understand and respond to staff mental health care, and this needs to happen soon. We cannot continue as we are, otherwise our beneficiaries, the aid we deliver, and the people who deliver it will all suffer a great deal more.