Earlier, psychologist Alessandra Pigni discussed the difference between burnout and PTSD, and explained how burnout has to do with the quality of the work environment, as well as personal tendencies towards perfectionism and workaholism. In this post she explores what aid workers and aid agencies can do to prevent burnout.
The majority of aid organisations fail to prepare and support their employees and volunteers psychologically. What more could they do to prevent staff burnout?
In 2011 I initiated a discussion on LinkedIn among humanitarian professionals on the psychological health of aid workers. I simply put out this reflection/question ‘Aid workers are psychologically unprepared for aid work. Any views from field and HQ staff?’.
The response was overwhelming, with over 200 comments pouring in non-stop. I knew from my work in Palestine that aid workers were at high risk of burnout, and I was hoping to gain a more global understanding. I wanted aid workers to speak up, open a space where they could express their needs, which turned out to be remarkably similar no matter where they worked.
It seemed like the discussion I initiated nailed it. Aid workers offered examples of how their organisations failed to provide adequate psychological preparation and support in the field. From being thrown into the field with no pre-departure briefing, to being at the mercy of managers who lacked emotional intelligence and people skills, from self-medicating with alcohol and pills, to suffering in silence because of the stigma attached to asking for help. One contributor summarised it for us: “It would be great to have proactive measures in place such as adequate pre-deployment preparation, ongoing mentoring and coaching, instead of just relying on reactive counselling.”
Humanitarian professionals also gave examples of how small, everyday acts of support and kindness in the workplace made a huge difference. A story that stayed with me is that of an aid worker who had been working in the Balkans nonstop for months during the war. One day his manager told him she had booked a hotel for him and send him off on a well-deserved break. In his words he was “eternally grateful for this.” “Such simple act” he added “made me much more aware of my own stress and stress being felt by team mates.”
Such acts of attention are what help to prevent burnout. They involve mindfulness, empathy and emotional intelligence, and show how managers with people skills make a significant difference.
Research shows we can learn to care and we adapt to the environment that surrounds us. This brings to mind the famous “broken window theory” which shows that people are less likely to care for a run-down environment than they are for a well attended one. Burnout in organizations is kind of the same: if the dominant tone is disrespectful and toxic, newcomers will follow that trend. Conversely, if it is healthy and caring people will adapt to such culture.
Realistically, there is no recipe to create burnout-proof organisations, but there are some simple ideas that managers can start to implement with the support of headquarters. I find it helpful to remember what Anton Chekhov said: “Any idiot can face a crisis – it’s day-to-day living that wears you out.”
So that’s where we can start: caring for ourselves and each other on a day-to-day basis.
Easier said than done. Where to begin? Here are some practices to keep you sane in the field and build healthy organisations.
In terms of personal self-care consider this:
- Are you overworking in non-emergency situations? Are you thinking about work when you are not working? Do you have a life outside work?
- Are you able to say no to unreasonable work requests and put some healthy boundaries in place? Hard at first, saying no is a sanity factor in aid work.
- Can you unplug? Try and go offline one day a week. As hard as it may seem, this is possible even in the field.
- Are you making time for physical exercise in the field? Consider what Mandela said: “Exercise dissipates tension, and tension is the enemy of serenity.”
- Can you spend time alone? In a highly active job can you practice doing nothing and just being? Exploring guided meditation or yoga can help.
- Are you keeping up with friends and family outside the aid circle? Connecting with people beyond work is essential: sometimes it’s hard in the field but it’s good to remind yourselves that the world does not revolve around your aid project.
In terms of organisational health it can help to reflect on the following:
- How is the “headquarters-capital-field dynamics” in your agency? For aid workers navigating the human interaction between HQ demands, capital requests, and field needs represents one of the biggest sources of stress. Issues of responsibility, trust, power and control come into play. These are the very issues that need to be addressed in order to prevent staff burnout and create healthy work environments.
- Is your agency open to learning? Most learning does not happen in a formal training, but rather it is part of a way of working together where employees are encouraged to share ideas, best practices, and skills in a formal and informal way. At times an informal conversation over a coffee means more than a workshop.
- How do you give each other feedback? Are employees encouraged to learn from their mistakes? Try and introduce appreciative feedback in the workplace. When used skilfully this practice opens up a whole new way of communicating, allowing people to discuss what works and what doesn’t.
- How does your organisation show appreciation and reward staff? Treating people with fairness when it comes for example to salaries, career progression, and job stability/flexibility is a way to improve staff retention. Aid workers’ intrinsic motivation to do good is simply not enough, people need to be rewarded and appreciated.
- As a manager, how do you model self-care and leadership? Spending time with your colleagues informally, over lunch for example, helps to create a supportive work environment. Many aid agencies are based in countries where the society values sharing a meal together. We can learn from that instead of exporting the bad habit of eating alone in front of our computer!
- How does your organisation take stock? Making time for periodical retreats or reflecting time to pause and explore how to move forward makes individuals and organisations more effective and resilient. No one can drive on an empty tank, no matter how powerful the engine is.
I guess you could say that more than a recipe for success, this is an anti-recipe because its course cannot be charted with a one-size-fits-all intervention. Creating “learning and caring organisations” is certainly not an easy task, but some social purpose organisations are exploring it with promising results, and I think that aid agencies can learn by looking beyond their sector. There’s a certain hubris that needs to be overcome: we can learn from others even if they do not work in war-zones.
A manager with over 20 years of experience working in Palestine shared this powerful thought during a staff meeting: “institutional change and community empowerment can only happen when staff needs and priorities are properly attended to.”
In other words, personal and organisational wellbeing are linked to global wellbeing. By taking care of ourselves and creating healthier organisations, we can better affect change – the reason most of us got into this field in the first place.
Burnout is a problem many aid workers face. In this post, psychologist and organisational consultant Alessandra Pigni discusses the causes of burnout and how it differs from stress or PTSD. A follow-up post will appear next week and will look at what (aid) organisations can do to prevent burnout.
Why does burnout, rather than PTSD, seem to be more common among aid workers?
We need to make a clear distinction between the psychological conditions aid workers may experience following traumatic events, and the distress they experience in their day-to-day work. Both can lead to psycho-somatic suffering, but the causes and remedies are different. Aid workers do not experience burnout following the exposure to a traumatic event, but they may experience trauma-related conditions including (but not exclusively) post-traumatic stress disorder (PTSD). Instead burnout is related to a way of working and to a particular type of organisational culture that I shall describe.
Research suggests that 5% to 10% of aid workers suffer from PTSD. Between 30% and 50% suffer from moderate to severe levels of emotional distress, and 40% are at high risk of burnout. What we need to understand is that given adequate support, most people have the strength and resilience to overcome a traumatic episode without developing PTSD.
This means that aid organisations need to provide tailored support to those professionals who may need it, offering a range of options and not exclusively trauma counselling. The work of trauma therapist Babette Rothschild is excellent if we want to understand PTSD: the author warns us about avoiding the common mistake of thinking that exposure to a traumatic event equals PTSD, and consequently rushing people into counselling.
Burnout is a different issue and unlike PTSD it is a widespread problem across the aid sector. Burnout is a “man-made” condition over which individuals and mostly organisations have a high degree of control. As burnout experts Prof Maslach and Leiter illustrate, burnout is a condition caused by being exposed to an unhealthy work environment, meaning the internal organisational environment.
So while people need to figure out what they can do on an individual level to prevent burnout and, for example, keep their perfectionism and workaholism in check, change will be limited without a shift in organisational thinking.
Aid workers have a pretty good idea of the challenges that they will face in a humanitarian/developing context: power cuts, at times violent and insecure surroundings, gunshots, checkpoints, etc. Place a group of aid workers around a table and you can almost feel that there is a sort of pride in how much they have endured, they always have a story to tell about showering out of a bucket and having to negotiate with the rebels the access to remote areas!
While these though conditions are far from easy, aid workers make an informed career choice. They know that these ‘rough edges’ come with a job that they expect to be meaningful, and full of action, a job that will allow them to experience the world, while being part of a community of people driven by common values. This is where burnout comes in because often these idealised expectations are betrayed by reality.
In order to understand how burnout is not simply a stress problem over which a single individual can have full control, let me go back to the research by Maslach and Leiter who clarify that “while most people think job burnout is just a matter of working too hard, that’s not necessarily true.”
Stress is to burnout what feeling a little blue is to clinical depression. “Burnout is when you feel overwhelming exhaustion, frustration, cynicism and a sense of ineffectiveness and failure.” The authors list six areas that can result in burnout:
- work overload;
- lack of control over the work;
- insufficient rewards;
- workplace community problems, such as incivility and a lack of support among co-workers;
- a lack of fairness, such as inequality of pay, promotions or workload;
- and a conflict between one’s personal values and the requirements of a job.
Do you recognise any of these traits in your organisation?
This evidence-based understanding of burnout and of its key features is essential to appreciate how this condition is an organisational challenge. Most aid workers do not simply overwork, they may also be immersed in an organisational culture that resembles the points highlighted by Leiter and Maslach. It is not unusual for aid workers to experience a sort of ‘cognitive dissonance’ between what they thought it was going to be and what it is.
This gap between expectations and reality, the mismatch between official mission statements and work on the ground, a defensive culture of overwork and sacrifice, and the lack of rewards and fairness is what leads aid workers to burnout. Burnout feels like falling out of love with your job.
If you are just tired, a break and some self-care will do. Burnout requires a different kind of approach, and the best approach is preventing it at the organisational level by strengthening a supportive and respectful work environment.
[Ed. note – participants in WhyDev’s pilot peer coaching program indicated a range of benefits to participating in the program, including feeling less stressed and isolated. We’re currently fundraising to launch DevPeers, the next iteration of this program.
For more information and to support our campaign, visit http://www.startsomegood.com/devpeers.]
White Paper Series by Alessandra Pigni
“The idea that psychological well-being is a luxury is right at the root of the problem. The mental health of field staff is every bit as important as their physical health. Proper preparation for the psychological stresses of field life should be taken as seriously as pre-mission medical assessments and associated measures to prevent/treat illness in the field.”
(Robyn Kerrison – human rights/protection advisor, currently working in Haiti)
Over the last months I have been collecting stories, reflections and suggestions from humanitarian professionals on the importance of staff-care, pre-deployment psychological preparation, burnout prevention training, field support, coaching and mentoring and post-deployment care. HQ and field-staff have lent their voice to this white paper series, which provides an analysis of the needs in the field, as well as the types of interventions that could be of help, including mindfulness training.
Encouraged by my dear friend Jennifer Lentfer at how-matters.org the first chapter of the White Paper Series on the psychological health of the precious people who work in aid is now out! It provides the background and purpose of the whole series. I have chosen to release the twelve papers over several weeks, in order to give readers the time and space to process the material and reflect upon it.
Below is an overview of the series:
- Provides the background and purpose of the white paper series.
- Offers an overview of the issues in psychological health faced by aid workers before, during, and after field deployment.
- Gives an overview of the concepts of mindfulness and how they may apply to aid work.
- Focuses on the recruitment and hiring processes of aid workers.
- Focuses on the pre-deployment phase, and the type of psychological preparation required.
- Focuses on the importance of personal awareness in the field.
- Explores the role of teams and team conflicts in staffʼs psychological well-being.
- Examines the organisational culture that permeates humanitarian agencies.
- Focuses on burnout and reaching ʻa breaking pointʼ.
- Examines practices that support aid workers while in the field.
- Provides an open conclusion with recommendations for action.
- Offers a list of useful resources on staff care, psychological support and mindfulness-based interventions.
In each of the papers, the voices of aid workers in the field are included (always in italics), along with their personal stories. They discuss the staff-care needs that arise during a mission, often describing the predominantly tough “humanitarian culture” that permeates agencies. But these papers do not only collect, describe and analyse the evidence offered by frontline professionals and volunteers. Each paper also provides conclusions and suggested interventions: action points, priorities and policy changes, highlighting how the lack of training and staff-care in humanitarian programmes can turn into an occupational hazard for employees and their agencies.
In particular, the concepts and practices of mindfulness are introduced in their relevance to the problems that may arise in the field, highlighting the significant difference that they can make to standard NGO training, procedures and management. Recommendations for developing psychological awareness, better staff retention, care and support before, during and after the mission, as well as a list of useful resources can also be found in a separate section of the white paper series.
Donors and HQ staff may be particularly interested in following this white paper series. Frontline professionals who know all about burnout, stress, trauma, loneliness, isolation and depression in the field, and the urgent need of doing something about it, may recognise their voices in it. I am convinced that “changing the world starts from within”, and that successful projects on the ground derive not only from professionally competent, but also psychologically healthy staff. How we feel within ourselves has an impact on how we engage with the world. This is no small matter.
Much is to be discussed, changed and improved in our aid community around staff-care. Starting from ourselves I feel is a good place of enquiry. Feedback and comments are most welcome, and so is your participation in the Frontline Burnout Prevention Group on LinkedIn.
To download the first paper of the series please click below (the bibliography is available for download as well so you can refer back to the various sources)
The remainder of the series will be updated section by section and downloadable from Mindfulness for NGOs.
“Learning to live the paradox of action as reflection, and reflection as action”
– Westley et al., Getting to Maybe. How the World is Changed.
Supposedly carved into the temple of Apollo in Delphi was the phrase ’Know Thyself”. I often wondered if in itself self-knowledge holds the risk of turning into self-obsession. And whereas the risk is there, knowing oneself – understood as cultivating self-awareness – holds immense possibilities of change: within, and outside in the world. No effective change is brought about without a degree of self-reflection and self-awareness. Great leaders and social innovators from Nelson Mandela, to Aung San Suu Kyi, Thich Nhat Han, the Dalai Lama, Mother Theresa, Martin Luther King, all have held together the paradox of action and reflection, they all seem to have started their engagement in/with the world as an inside out process. This because we cannot just expect others to change: ‘wanting to change others means accepting a profound change in oneself. Self-reflection and self-revelation are necessary’. To me there seems to be a link between psychological/personal awareness and social/political awareness. Jon Kabat-Zinn himself, the founder of the mindfulness-based stress reduction programme, emphasises how a reflective practice such as mindfulness has wide effects in the body-politic (see ‘Healing the body politic’ from the his book Coming to Our Senses). So it comes as no surprise that for social innovators ‘there is gold in a reflective practice’, and ‘it is essential to understand that there is a connection between self-knowledge and worldly knowledge’. Self-knowledge as self-awareness requires us to get out of the constant ‘doing mode’, to cultivate who we are. Which, in my opinion, is what makes all the difference when it comes to serving as an aid worker, a volunteer or an NGO manager. Nevertheless what prompts many into aid work is activism, the desire to make a difference, ‘to do’ things that matter. It is somehow a quest for a meaningful life. Here reflection should not be understood as a state of passivity, but as moment of ‘being’, where we nurture those qualities that will inform our ‘doing’. Reflection becomes important because the way we think about the world, and how we understand it frames our actions. So it is of no secondary importance to learn the art of standing still, seeing that the world is not simply acted upon, but rather it interacts with us, with who we are. To paraphrase the work of my friend and colleague Jennifer Lentfer‘it is not what we do, but HOW we do it’ that matters. Engaging in personal enquiry and reflection is therefore part of the action, it becomes an essential component of how we do things and who we are. Learning to standstill helps us to take stock and move forward effectively.
The story of the woodcutter from The Barefoot Guide to working with Organisations and Social Change (a wonderful, inspiring guide) conveys the message of why learning to pause is crucial:
‘Once upon a time an old woman was walking through the forest near her home when she came across a man chopping down a tree. They exchanged brief greetings but he continued chopping. He was working very hard, determined to complete the job and see results before sundown. She watched him a while and then disappeared. A little later she returned, bearing a stone and a small bucket of water. When he paused in his work to wipe his brow she handed these to him and said, “Sir, I see that you are very busy. But, to put it bluntly, it looks to me like you need to pause a while, take a breath and sharpen your axe.” “Go away, woman, I am too busy I don’t have time for this!”’
When do we sharpen our own axes? Do we take the time to standstill, take a breath, reflect? How many of us are just too busy for that? For further reading, check out: The Barefoot Guide to working with Organisations and Social Change (free download); Kabat-Zinn, Coming to Our Senses: Healing Ourselves and the World Through Mindfulness