4343 Managing Stress In Humanitarian Aid Workers

Managing Stress in Humanitarian Aid Workers: The Role of the Organization John Ehrenreich State University of New York ([email protected])

USAID OFDA, Washington, D.C. July 27, 2004 1

I. Assumptions 1. Humanitarian aid work is inherently stressful. 2. Stress takes a toll on humanitarian aid workers. 3. Staff stress adversely affects the organization and its mission. 4. Stress and its adverse effects can be lessened.

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1. Humanitarian aid work is inherently stressful • • • • • • • • • •

Separation from family Physically demanding working and living conditions Lack of privacy and personal space Long hours, heavy work loads, chronic fatigue Lack of time, resources, support to do job Conflicts within work team Conflicts with local authorities Chronic danger Repeated exposure to tales of horrific experiences Direct exposure to gruesome scenes and terrifying experiences • Moral anguish over choices, triaging, limits to effectiveness

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2. Stress takes a toll on humanitarian aid workers One-third or more of staff show clinically significant sign of emotional distress at end of assignment

• Post

traumatic stress syndromes • Vicarious (secondary) traumatization • Burnout and compassion fatigue • Depression • Pathological grief • Anxiety • Multiple psychosomatic complaints 4

3. Staff stress adversely affects the organization and its ability to carry out its mission • Less commitment to agency and higher rates of turnover • Higher accident rates and higher rates of illness; increased absenteeism and greater health care utilization • Poor decision making; behaviors that place team members and recipients at risk • Lowered efficiency and effectiveness in carrying out assigned tasks • Increased legal liability

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4. Stress and its adverse effects can be lessened Mitigating stress is cost effective. It benefits the organization and recipients as well as the aid worker. Strategies • Reduce exposure to stressors • Lessen impact of stressors that do occur on individuals • Increase capacity of individuals to deal with stress

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Levels of action to reduce adverse impact of stress • Individual level • Organizational level Central organization Team 7

II. Effective Organizational Responses to Staff Stress 1. Create a general organizational commitment to creating a culture of stress management 2. Provide effective leadership and efficient management at all levels of the organization 3. Promote team cohesion 4. Develop specific organizational policies and practices that reduce stress and its effects

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1. Develop a general organizational commitment to creating a culture of stress management • Develop systematic organizational effort to address the problem of stress • Review policies, programs, and practices with respect to effect on stress experienced by staff • A tool: The “stress impact statement” – “What will the effects of this policy or practice be on the stress experience of staff?” 9

2. Provide effective leadership and efficient management at all levels of the organization

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Assumptions Leadership is a key variable in determining the impact of stressful events on staff Bad leadership creates stress on staff. Good leadership helps protect staff from stress originating outside the organization itself.

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Elements of leadership Leadership style: • How does leader treat staff? • How are decisions are made and communicated? • How are staff motivated, assisted, and rewarded? Management skill • How does the leader carry out the practical abilities needed to organize and carry out programs, policies, and activities Moral leadership • How does the leader act, inspire staff, create sense of vision, transmit own personality and vision and values?

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Leadership style: “Democratic/consultative” vs. “authoritarian/hierarchical:”

• If information is widely shared and time pressures are not enormous (as is usually the case), the “democratic” style is generally the most effective

A good leader: • seeks staff input and feedback • keeps staff informed and keeps informed about staffs • is concerned with human needs of staff as well as task performance • is a good role model 13

Management skill: Good management skills reduce staff stress • • • • • • • • •

Well run meetings Clear job descriptions Clear prioritizing of tasks Clear lines of authority Needed supplies obtained Competent budget preparation and management Consistent supervision Appropriate hiring of local staff 14

Moral leadership The leader inspires staff, creates a sense of vision, transmits organizations vision and values In crisis, leader helps restore sense of control: “We can handle this”

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Implications Leadership ability should be a major factor in agency hiring and promotion decisions (at all levels of management) Leadership abilities can be taught; organizations should provide managers with training in leadership/managerial skills 16

3. Promote team cohesion Team cohesion and the availability of other forms of social support are key variables in determining the impact of stressful events

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Team Building: The Team Leader’s Responsibility A good team leader • fosters communication among team members • seeks to build bonds among team members (work together, meet together, get to know each other) • creates positive environment for collective problem solving and support; creates atmosphere in which differing opinions are valued but in which clear decisions can be reached • is alert to cliques, bickering, scape-goating, etc. and acts to address them; maintains atmosphere in which sexual, racial, ethnic, national or other harassment is not acceptable • monitors individual staff members for signs of stress and provides basic support • models good individual stress management practices • seeks to base expatriate/national staff interactions on mutual respect, transparency, and partnership 18

Team building: The Organizational Responsibility • The agency identifies team-building skills as an essential qualification for prospective managers • The agency trains staff and managers in team work skills (e.g., conflict management) • The agency helps build team cohesion (e.g., through common experiences such as safety and security training) • The agency regularly reviews team functioning and has policies for addressing the problems of dysfunctional teams and of staff members who have difficulty functioning in their team

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4. Develop specific organizational policies and practices that reduce stress and its effects

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Organizational policies and practices The organization’s human resources policies and practices conform to industry standards: •InterAction (1997) Private Voluntary Organization (PVO) Standards •People in Aid (2003) Code of Good Practice 21

Specific organizational policies and practices I • The agency has a clear structure (e.g., lines of authority, job descriptions • The agency periodically scrutinizes its “bureaucratic” procedures with respect to their impact on staff stress • Recruitment, hiring and assignment seek to match skills to task demands and take assignment stress/stress tolerance into account • The agency provides staff members with a full operational orientation before deployment, including stress management training • The agency undertakes to provide staff with adequate facilities and services, and maintains appropriate policies and practices with respect to safety and security 22

Specific organizational policies and practices II • The agency supports individual activities to reduce stress (e.g., limits to hours of work; periodic breaks mandatory; facilitates maintenance of communication with family) • The agency has arrangements in place for outside support for staff on “as needed” basis (e.g., after “critical incident”) • The agency has clear policies with respect to potential evacuation • The agency has clear policies forbidding harassment (sexual, racial, ethnic, national, or other) and mechanisms in place to enforce these • The agency provides staff with both an operational debriefing and a personal stress debriefing at the end of an assignment 23

Some Additional Resources •

Action Without Borders/Idealist.org (forthcoming, Fall 2004). Website on stress management for aid workers, managers, families) . Http://www.Psychosocial.org

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Antares Foundation (forthcoming, Fall 2004) Guidelines for Good Practice in Managing Stress in Humanitarian Workers. Amsterdam, Antares Foundation (http://www.antaresfoundation.org)

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Centre for Humanitarian Psychology (forthcoming, 2004). Management of extreme stress and of crisis in humanitarian work. Interactive CD-ROM. Geneva: Centre for Humanitarian Psychology. (http://www.humanitarian-psy.org).

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Ehrenreich, J. (forthcoming, Fall 2004). The Humanitarian Companion: A Guide for Staff of Humanitarian Aid, Development, and Human Rights Projects. London: ITDG Publishing.

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Ehrenreich, J.H. (forthcoming, 2005). Managing stress in humanitarian aid workers: The role of the agency. In G. Reyes and G. Jacobs, Eds., Handbook of Disaster Psychology. Wilton, CT: Greenwood/Praeger

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Fawcett, J. (2003). Stress and Trauma Handbook. Monrovia, CA: World Vision 24