Global Mental Health Briefing. Supporting Humanitarian Staff; Lessons from Research and Practice

1. Making Meaning of Difficult Experiences and Regulating Affect • Global Mental Health Briefing. • Supporting Humanitarian Staff; Lessons from Research and Practice • NGO Forum for Health, March 2012Dr Ros Thomas

2. Changing Nature of Complex Emergencies • Historically - universe simple, line separating good from evil, world of solidarity from world of violence • Today work embedded in changing geo-political-cultural context post-Cold War • Workers in close proximity to the violence of war in climate of fear & mistrust • ‘Wider wrecking power’ of emergency exceeds capacities of affected communities & that of international community • Humanitarian space contested - deteriorating security climate of violence & threat to life.

3. Humanitarian Workers - Not Superhuman - Just Real People • 20th Century – Historical ‘guise of selfless saviours’ - devoted, helpers with an altruistic need make a difference (Brauman,1998). • Symbolized ethos of charity - fuelled by idealism, devotion to cause, motivated by compassion. • those delivering aid - resourceful & strong • those receiving aid - helpless & resource less • Diverse motivations - sometimes romanticized • Professionalization of roles - Degrees in anthropology, history, geography, economics, languages, medicine & business • Political sophistication, humanitarian principles, conflict management & interaction with dilemmas of justice, equality, neutrality & solidarity

4. Modern Day Humanitarian Workers • Diverse motivations - sometimes romanticized • Professionalization of roles - Competencies - degrees in anthropology, history, geography, economics, languages, medicine & business • Political sophistication, humanitarian principles & operational imagination • Manage conflict & interact with dilemmas of justice, equality, neutrality & solidarity

5. Research shows • Humanitarian workers not attracted to secure lives in suburbia -- since early childhood to broader issues of political justice • There are few stressors on the human psyche as extreme as the exposure to combat & seeing what war can do • A need to hold a space for 3 strands: the symbolic, the somatic & the social experience • Give attention to the social construction of a disease category mindset. Suspicious of routinized technical applications of ‘labels’ • Understand the ‘inner life’ &‘symbolic’ meaning of our client’s lives • Need to be aware of dominant & subjugated narrative in political world • Apply cognitive, affective, behavioral or systematic strategies - address wellness, personal growth & then pathology

6. Humanitarian Worker attacks: Global trend analysis Aid Worker Security Report 2011 Humanitarian Outcomes

7. Ethical Stress caused by • Experiences that challenge individual values, ideals, life meaning or vision of humanity • Violence, cruelty, corruption,unethical behaviour in the organisation, bribery, backstabbing, mobbing & unfair dismissal • Experiences lead to disillusionment/ cynicism/depression – leads to burn out….. • ‘Stripped down’ identity means that the internal stigma is often more paralysing than external stigma • Multi-layered readjustment to the disconnect experienced

8. Supporting Humanitarian Workers • Understand - all do not have same experience of mental health issues • Avoid pathologizing difference • Apply mental health, psychological, or human development principles • Look for growth potential & drive to make meaning • Those at HQ for R&R prior to returning to field require therapeutic field proofing (subject/object work) keeping somatic body work to the forefront • Those who return for longer periods or change assignments need symbolic work on their ‘inner life’ (subject/subject)

9. Protective Factors • Identification with organisation mandate • Realism & personal belief instead of altruism • Available pre-departure preparation & briefing • Social support as a buffer - Relationships in organization, with colleagues, managers & kin • Approach-oriented style • Flexibility & humour • Defusing • Love of adventure • No past history - untreated psychiatric problems

10. Case- Individual Meaning “A woman in Somalia was dying. She made me promise that I would find a way to put Ethiopian soil on her body, just a cup, just a sprinkling, if she died. By moving out of my hotel & camping on the office bed I had money to arrange repatriation. I organized for her to die at home. When something like this happens I can’t sleep until I find a solution.”

11. Support enhances resilience, motivation & job satisfaction Friends, Colleagues Community Humanitarian worker

12. Questions and Discussion