Shining a spotlight on mental health in the humanitarian sector during COVID-19
by Hitendra Solanki
Mental Health Awareness Week in 2020 has taken on a more pressing and immediate priority in light of the COVID-19 pandemic, given the implications for the mental and physical wellbeing of billions across the globe.
On May 13th, in response to the pandemic, the UN released an urgent policy brief, entitled, ‘COVID-19 and the Need for Action on Mental Health’, warning that it, ‘has the seeds of a major mental health crisis as well, if action is not taken’, and the need to urgently increase investment for mental health services globally. The WHO Director-General, Tedros Adhanom Ghebreyesus, also highlighted these causal factors, stating that, ‘social isolation, fear of contagion, and loss of family members is compounded by the distress caused by loss of income and often employment’. He added, ‘the impact of the pandemic on people’s mental health is already extremely concerning’. The UN brief cited a study from Ethiopia, in April 2020, indicating a ‘3-fold’ increase in symptoms of depression, up to 33%, compared to before the pandemic, and noting a similar trend across many countries.
For humanitarian workers, working with vulnerable communities across the world, this takes on a greater significance. Inherent within humanitarian work, we are an already pre-disposed community to stress, anxiety, depression, and burnout. This is inevitably related to experiencing the suffering and trauma of others via working in environments affected by conflict and disaster, as well as exceptionally high workloads, resource constraints, and deadlines. This deep human and emotional investment in our work, representative of our strengths and our vulnerabilities, are also key to this predisposition.
The mental health of aid workers has been scientifically researched and well documented for nearly 30 years now. Indeed, in researching and preparing the Start Network Humanitarian Wellbeing Survey, published in 2017, I highlighted this alarming exposure to stress at the time also. The survey, for example, stated that, ‘48.5% of staff indicated that they have experienced a distressing or highly challenging deployment’, and that, ‘43% indicated they had experienced a threat to the life and safety of colleagues’.
Sadly, these, and similar statistics, reveal what can be considered as the ‘normal background radiation’ to which we are often exposed, and how we are affected, within this sector. These are variously reflected in rates of depression, anxiety and burnout, that are significantly higher than the general population average. For example, in 2012, research published in Epidemiologic Reviews found that the general population average in Europe for anxiety and depression were 2.5% and 12.8% respectively, whilst for humanitarian workers these measured as high as 29% and 20% respectively.
And now, there is COVID-19
The implications of this new uncertainty are profound, and there are already signs that the pandemic and lockdown may exacerbate an already precarious mental health balance for humanitarian workers. The UN brief states that frontline care workers are at higher risk of psychological distress caused by COVID-19, due to heavy workloads, life and death affecting decisions, and the fear of infection itself. Using data from health care workers in China, it reported that anxiety and depression rates were recorded as being 45% and 50% respectively. In addition, 47% of Canadian health workers also reported the need for mental health support.
Clearly, this has parallels within our sector. For many humanitarian workers under lockdown, the isolation and constant online focus and attention, staring at screens for all of our communications, often across various time zones, and with unchecked working hours, can be highly stressful. With 24/7 news coverage of the pandemic online, our concerns for families separated by the lockdown, and our work now focused almost solely on COVID-19 responses, means that for many, this ‘saving the world from our sofas’, is overwhelming.
For those who are still on the frontline, and redesigning and implementing activities for the COVID-19 response on the ground, the implications are desperately more challenging. Working during lockdown, there may be an acute divide between international and local colleagues, with the latter bearing the brunt in supporting their vulnerable communities, and potentially at greater risk to personal safety. For many, being unable to implement any activity at all, amongst their vulnerable communities, may create a feeling of helplessness, anxiety and distress.
But in this global melee, whether we are locked down at home, or in the field, the need to consider mental health for ourselves is more acutely apparent than ever before. For many, these mental health issues may seem to arise unexpectedly, as underlying and latent issues surface in the face of rapidly changing external circumstances. The changed work-life behaviours, isolation, reduced access to our support networks, job insecurities, separation from loved ones, and a lack of access to the usual activities that nurture wellbeing, are all having an effect.
For women, the effects on mental health are even more pronounced, with the UN brief highlighting a survey from India, indicating stress levels reported by women were significantly higher, at 66%, compared to men at 34%. The report also highlights that parents of children in Spain and Italy reported feelings of loneliness at 31%, nervousness at 39%, and difficulty in concentrating at 77%.
As part of my mindfulness and wellbeing trainings delivered over the past few years, and more especially, these last few weeks, I have been privileged to speak to, and support, many old and new colleagues globally. Their voices deeply echo concerns regarding their own mental health, and the urgent need to invest in mental health infrastructure within our agencies further.
Whilst major strides have been achieved in placing mental health and wellbeing firmly within our organisations, greater prioritisation and investment is still needed. However, the question remains, will the sector be able to use this time more proactively and mindfully in addressing this mental health crisis that has been known for decades already, and which has now simply been exacerbated and brought to the fore by COVID-19?
Coming full circle, the research on the effects on mental health in the humanitarian sector has been well documented scientifically for nearly three decades, and through dedicated efforts by wellbeing champions within our agencies, this prioritisation of wellbeing has now finally gathered a robust momentum. Sadly, knee-jerk or not, COVID-19 seems to be finally shining a necessary spotlight to address the mental health needs within our sector further.
As it concludes, the UN brief reinforces the need for greater investment in mental health services within our communities, and to ‘build back better’ to support our health, education, and social sectors. It highlights that, on average, countries spend only 2% of their health budgets specifically on mental health.
Lessons for the humanitarian sector
- Can this be the time to proactively seed on how to build back better within our sector too?
- Can we emphasise preventative and preparatory approaches, such as mindfulness to build self-awareness of stress and develop mental resilience, instead of relying mostly on treatment-based approaches?
- Can we create ever more open, accessible, and accepting environments within the workplace, dissolving stigma and taboo?
- Can we develop practical policies, as well as dedicated infrastructures, roles and responsibilities, within our organisations that actively support and ensure mental wellbeing?
- And can we advocate for, and secure, with our donors, a budget line for pragmatically supporting the mental health and wellbeing of our workers, as we implement projects? Perhaps, even, by beginning by mirroring the 2% that already exists within countries health budgets?
As the suffering and uncertainties of COVID-19 continue, so does the extraordinary work of our colleagues. As frontline workers, many with our own personal safety, and even our lives regularly at risk, sadly, this is not an uncommon experience for us. It seems that the pandemic is, simply, just a new and unprecedented one.
So, for Mental Health Awareness Week, as a silver-lining, perhaps we can consider how best to be proactive, for ourselves, our beneficiaries, and our humanitarian endeavour, and to finally invest in mental health and to build back better.
And, inevitably, to make sure we are genuinely prepared and ready, after COVID-19, for ‘the next big thing’.
Hitendra has been active in the development and humanitarian sector for nearly two decades and involved in hunger and health-related programming for over 10 years with Action Against Hunger UK till 2019.
More recently, he led the 3-year Mindfulness & Wellbeing project as part of the Start Network’s Transforming Surge Capacity programme, funded by the UK's Department for International Development (DFID) under their Disasters & Emergencies Preparedness Programme (DEPP) across Thailand, Pakistan, the Philippines, and the UK.
Hitendra is also trained and qualified Mindfulness-Based Stress Reduction (MBSR) trainer, from the Centre for Mindfulness Research & Practice (CMRP), at Bangor University, and presently the Mindfulness & Wellbeing Adviser for Simply Mindful, a mindfulness and wellbeing consultancy offering training and support to humanitarian agencies.
In addition, he has also been teaching at London South Bank University since 2003, and is currently the Senior Lecturer on the MSc Development Studies course.