Introduction
Humanitarian workers living and operating in armed conflict-affected settings face multiple psychological challenges arising not only from their constant exposure to violence, displacement and human suffering, but also from organizational stressors related to the way in which work is structured and delivered. Consequently, numerous studies have reported significantly elevated rates of adverse mental health conditions among this group compared with the general population,Footnote 1 including higher rates of anxiety,Footnote 2 depression,Footnote 3 post-traumatic stress disorder (PTSD),Footnote 4 burn-out,Footnote 5 secondary traumatic stress,Footnote 6 compassion fatigue,Footnote 7 general psychological distressFootnote 8 and suicidal ideation.Footnote 9 The mental health consequences of their work vary and are unequally distributed across different subgroups; younger humanitarians,Footnote 10 for instance, often present higher levels of stress and a reduced capacity for coping (likely due to limited experience in challenging environments), which exposes them to greater risk of burn-out and depression.Footnote 11 Similarly, women workers frequently experience adverse mental health consequencesFootnote 12 compounded by the risk of gender-based violence,Footnote 13 harassment and discrimination in the workplace.Footnote 14 It is not surprising that local workers,Footnote 15 who often share the lived experiences and challenges of the populations they serve, manifest higher levels of psychological distress and are at greater risk of PTSD, depression and anxiety compared with both international staffFootnote 16 and the general population.Footnote 17 Lastly, volunteer workers, who are commonly recruited to carry out humanitarian activities, show a higher risk of negative mental health outcomes compared with paid staff.Footnote 18 While some papers suggest that these higher rates are skewed especially among expats,Footnote 19 the overwhelming majority of studies list humanitarian workers as a population at risk for adverse mental health conditions,Footnote 20 including an increased risk of developing additional morbidities among those with pre-existing mental health diagnoses.Footnote 21
Nevertheless, these mental health consequences can be buffered by personal experiences and factors such as the meaningfulness of one’s work,Footnote 22 older age,Footnote 23 having a religious faith or spirituality,Footnote 24 and the presence of strong social support.Footnote 25 Although many of these factors are personal, and some are non-modifiable, there has been increasing recognition of various organizational factors associated with psychological morbidity within the humanitarian sector. Practices related to poor leadership,Footnote 26 unclear communication and role ambiguityFootnote 27 have consistently been found to predict psychological distress and burn-out; conversely, perceived organizational support,Footnote 28 strong team cohesionFootnote 29 and empowering supervisory practicesFootnote 30 have been shown to mitigate stress, depression and burn-out rates within staff and volunteer populations working for humanitarian organizations.Footnote 31 Unsurprisingly, therefore, having a trust-based relationship with a manager who cares and acts compassionately towards their team is reported as a protective factor by humanitarians,Footnote 32 while the opposite appears harmful.Footnote 33
Corresponding to the concerning prevalence of adverse mental health outcomes among this population, offering psychosocial support interventions to humanitarian aid workers has been an instrumental approach to mitigate these consequences. These interventions generally include individual and group activities. At the individual level, they involve the provision of psychological first aidFootnote 34 after exposure to potentially traumatic situations, and access to individual psychological support,Footnote 35 employee assistance programmes, and external coverage for psychotherapy.Footnote 36 Other offered activities include mindfulness-based interventionsFootnote 37 and resilience training, which have both shown promise in improving stress management and emotional well-being, although evaluations are often small-scale.Footnote 38 At the group level, psycho-educational activitiesFootnote 39 and stress management interventionsFootnote 40 are often offered and have shown some positive results in protecting the mental health of humanitarians. Other suggested programmes include peer support,Footnote 41 with limited evaluation reports of these programmes.
Although strong links between adverse mental health outcomes and organizational factors have been well documented, there is still a scarcity of literature examining organizational-level interventions in terms of their impact on the well-being of humanitarians.Footnote 42 Nevertheless, several proposals emphasize the importance of training managers and supervisors to improve communication, understanding and their capacity to embody supportive management practices. In their Mental Health at Work policy brief, for example, the World Health Organization (WHO) and International Labour Organization (ILO) have identified manager and supervisor training as one of the essential pillars for protecting and promoting employees’ mental health.Footnote 43 The guidelines contained in the policy brief highlight the crucial role of managers in recognizing psychosocial risk factors related to a team’s work, identifying and responding to emotional distress, practising active listening, and promoting and advocating for mental health activities within the organizational hierarchy. Although the WHO and ILO recommendations were developed within a general context beyond the humanitarian sector, the need for such competences would be more pronounced in that sector, given the importance of their application. In the same vein, as our collective understanding of the need to protect and promote mental health for humanitarians working in emergency settings evolves, much of the current focus remains on responding to psychological needs during and after crises and on individual coping approaches for those who work or volunteer for humanitarian organizations. There is still very little emphasis on comprehensive strategies that address the prevention effort proactively and efficiently, from an organizational perspective, despite the clear impact of mental health in the workplace on productivity,Footnote 44 presenteeism, absenteeism,Footnote 45 and turnover rates.Footnote 46
Based on the arguments above, outlining risks and protective factors for the mental health of humanitarian aid workers, psychosocial support interventions at the individual and group levels alone are not sufficient to protect the mental health of humanitarians, as such interventions often miss the opportunity to address the root causes of the burden.Footnote 47 As an alternative, there is a growing interest in an integrated approach that tackles individual, group and organizational factors, and research has begun to shed light on its potential benefits.Footnote 48 In this article we propose a theoretical framework that corresponds to this approach, and provide examples of practical applications of it within our practice at the International Committee of the Red Cross (ICRC). The proposed framework is grounded in the premise that modifying organizational and contextual psychosocial risks will improve the mental health of humanitarians, advocating a shift from reactive measures to a long-term strategy focused on the prevention and promotion of mental well-being.
Tailoring science to practice: The IGLOO framework for humanitarians’ mental health
Evolving research trends in health and well-being at work have shifted from focusing on individual variables toward a summative approach to explaining occupational stress and well-being, such as the job demands–resources modelFootnote 49 and the effort–reward imbalance model.Footnote 50 The job demands–resources model posits that the extent of imbalance between job demands and resources in the workplace is a salient predictor of adverse mental health outcomes. When demands exceed resources, individuals accumulate stress, putting their well-being at risk, whereas sufficient resources stimulate motivation and engagement. Particularly important for humanitarian workers, resources (e.g., social support, organizational support) can buffer the adverse impact of excessive demands on staff and volunteers’ mental health and well-being;Footnote 51 accordingly, within the demanding nature of this work, a workplace that provides adequate resources can have a profound preventative effect. The conservation of resources (COR) theoryFootnote 52 further explains that people’s resources exist not in isolation but rather in clusters for both individuals and organizations, and thus, the ecological conditions in the workplace either nurture or limit resource maintenance.Footnote 53 In the context of armed conflict response, where humanitarians are exposed to extremely stressful and potentially traumatic events, available resources (such as organizational support) gain a more pronounced value than in normal situations,Footnote 54 making them crucial.
From another angle, the current understanding of psychosocial risk factors in the workplace clearly classifies them as modifiable factors for mental health problems.Footnote 55 Therefore, recognizing and adjusting them plays an important preventive role in maintaining staff and volunteers’ mental health. Particularly in crises, an approach to staff and volunteer care which considers how to recognize and modify these risk factors would arguably reduce the significant resource loss that impacts humanitarians’ mental health.Footnote 56 Matching the WHO and ILO policy brief, which outlines workplace mental health interventions across three interconnected strategies (preventing harm by addressing psychosocial risks, protecting and promoting mental health by raising awareness and fostering resilience, and supporting those negatively affected by ensuring appropriate channels of care),Footnote 57 we sought to mobilize a practical framework to map workplace interventions.Footnote 58 Following the suggested model for practices/resources on the individual, group, leader, organizational and overarching contextual levels, known as the IGLOO model,Footnote 59 we propose the following practices as an integrated approach to care.
• Individual level: Interventions at this level target personal characteristics and needs, including increasing resources available to staff and volunteers. This may include preparing them for the challenges of their work through psycho-education on common psychological reactions, and the development of skills for stress management and emotional regulation. Access to health-care services, including psychological support and specialized mental health care for those in need, is another important intervention.
• Group level: This level involves practices and interventions that aim to mobilize social support in the workplace, including emotional and practical support, as well as strengthening collaboration and cohesion. Examples include group psychological support activities after critical incidents, peer support programmes, reflective spaces to foster solidarity and trust, and activities that facilitate mutual learning and sharing with a focus on shared values.
• Leader level: Recognizing the cardinal protective role that managers and supervisors can play not only with practical considerations such as workload management or role clarity, but also in terms of creating a caring environment, the leaders’ role is highlighted repeatedly. Examples of interventions at this level include equipping managers with the skills for reflective practice, empathetic communication and team workload management, as well as the ability to recognize signs of distress and facilitate access to support.
• Organizational level: This level involves interventions related to both policies and cultural norms within the organization, where protecting the mental health of personnel is a key component of the duty of care policy and practice.Footnote 60 Such interventions include measures to manage internal psychosocial risks such as excessive workload, as well as measures to protect staff from exposure to security risks and inappropriate behaviours, including sexual harassment.Footnote 61 While wider literature highlights the role of autonomy and participation in decision-making,Footnote 62 a special focus in humanitarian-work-adapted practices would also include proactive preparedness, informed consent on security and health risks, and robust insurance coverage.Footnote 63 Tailored human resources (HR) policies such as special leave after exposure to critical incidents,Footnote 64 special protocols for reintegrating those impacted with flexible work arrangements, gradual return-to-work practices and ongoing monitoring of their well-being, and rest and recuperation breaks in high-risk assignments form another important type of intervention. Given the unique demands of humanitarian work, the adaptation of standard HR management practices to accommodate these demands, rather than applying generic HR standards from other sectors, is a key factor without which engagement and trust would be jeopardized.Footnote 65 We strongly advocate for organizational policies that facilitate equity in terms of resources for volunteers and local and international staff, including equivalent insurance schemes and post-exposure support, regardless of contract type.
• Overarching context: As with any programme or intervention in the humanitarian sector, adapting to the specific context in which people operate is a critical element. Recognizing the diverse cultural and geopolitical settings in which organizations function and teams live and work, mental health and well-being interventions should be both context-sensitive and inclusive. Accordingly, interventions at this level should ensure cultural competence for those working in cultures different from their own.Footnote 66 This level also integrates awareness of external factors such as legal frameworks, security conditions, conflict dynamics, specific resources and capacities available within the organization, and community norms into organizational strategies for staff safety and well-being,Footnote 67 helping to ensure that protective systems are grounded in the realities of the operating environment.
Organizational support theoryFootnote 68 explains that the extent to which staff perceive support offered by their organizations, constructed as “perceived organizational support” (POS), has a strong impact on various organizational outcomes, including performance and commitment,Footnote 69 as well as employees’ well-being.Footnote 70 POS has also proven significantly relevant to humanitarian workers’ mental health.Footnote 71 The IGLOO framework presented above provides a practice-based guide for interventions that also contribute to increasing POS among humanitarians, and supports a systematic approach to fostering their mental health and well-being.Footnote 72 This offers a roadmap for an integrated, multilayered staff care approach that moves beyond crisis response to address the modifiable, prevalent psychosocial risk factors in the humanitarian workplace. The following sections offer examples of the practical utilization of these considerations.
Example 1: Managers’ training to promote healthy management practices that support staff well-being, prevent mental illness, and facilitate access to psychological support
In the preceding pages, we have provided a brief explanation of the vital role of managers in mitigating workplace stressors that lead to psychological distress among humanitarian staff and volunteers. This role yields positive results if managers understand staff mental health, are sensitive to the psychological burden of humanitarian work and are equipped with tools to prevent harm and offer support. Managers are often seen as the key representatives of their organization, embodying its values, culture and commitment to staff care. In that sense, managers and leaders are recognized as major contributors to enhancing POS.
In this context, a workshop for managers at the ICRC was developed to reinforce their skills and commitment to implementing healthy managerial practices within their scope of responsibilities. The workshop was designed with three overlapping objectives: to promote staff well-being through promotive and protective managerial practices, to equip managers to recognize signs of distress among team members and conduct supportive conversations, and to provide tools to help managers maintain their own mental health and well-being. It is delivered in three sessions, each of which lasts three hours and is focused on one of these aims. The workshop is designed for small groups (six to twelve managers), allowing for interactions and mutual reflection among participants, and is delivered either online or in person by a staff psychosocial support specialist. We utilize a variety of interactive learning methods, including brief presentations, small group discussions, polls, role-plays, individual exercises and pair work, to optimize group engagement and learning.
The first session is grounded in prior theoretical work on humanitarian workers’ mental health.Footnote 73 It includes a first section that underpins the role of managers in identifying and managing the psychosocial risks to staff mental health, and a second that explores in practical terms the practices that promote well-being (e.g., offering regular feedback and encouraging group tasks) and address risk factors for staff mental health (e.g., workload and role ambiguity). Managers then reflect on these practices in small groups, bringing their own experiences and sharing the challenges they may face while implementing them, in order to discuss potential solutions for overcoming these challenges collectively.
The second session builds on the first, introducing further competencies for identifying potential signs of distress among team members. It proposes a safe and structured method for carrying out supportive conversations with those who manifest signs of distress. The aim of these conversations is grounded exclusively in the intention to support; therefore, they are made clearly distinct from performance appraisal. Instead, supportive conversations embody a safe and confidential space marked by empathetic, active listening, and non-judgemental attitudes. Ultimately, the aim is to propose and discuss adjustment measures that support improving the situation and encourage seeking psychological support. Managers then discuss this framework in different proposed scenarios, including regular work situations, immediately after a critical incident, and upon returning to work after prolonged sick leave. We chose the scenarios based on our trending experiences of supporting humanitarians, focusing on internal organizational factors rather than conflict-related ones. Participants lastly role-play the situations, and groups end with feedback on each other’s approach.
The last session of the workshop is dedicated to the managers’ own mental health and well-being, including reflective exercises on managing work-related stress, addressing work-life conflicts, understanding and preventing burn-out, and developing and implementing mental health self-care plans.
We implemented multiple tracks of the workshop through our staff psychosocial team, targeting volunteer managers. These were delivered in diverse settings, including mixed organizational structures and both online and offline modalities, with the overarching aim of mobilizing humanitarian managers in a holistic psychosocial model to protect staff mental health and well-being. We also managed to gather feedback from those who participated in order to measure their perceptions and experiences of the participation. Out of the seventy-three responses we have already analyzed, participant satisfaction rate was high (8.82/10), and the participants reported that they would strongly recommended the workshop to other managers (9.21/10). Furthermore, when assessing the perceived knowledge gain across five indicators using a five-point Likert scale (1 = not at all, 5 = very much), results indicated a substantial positive impact, with average scores consistently above 4.20/5 (see Table 1). According to the same feedback, the workshops have served as a very appropriate channel for gaining knowledge and practice reflections; however, many managers pointed out the difficulties they face in scheduling time to attend three different sessions, and the insufficiency of this training for sustained supportive managerial action in the face of organizational complexities and a lack of consistent investment in the matter.
Table 1. Perceived knowledge gain indicators reported by participants of the managers’ workshop (n=73)
Example 2: Mitigating the impact of security incidents – the IGLOO model in action when teams are confronted with threats
In this section we provide two cases to illustrate the utilization of the IGLOO framework in crises, as supportive workplace practices, including social and leadership support, are increasingly recognized as being among the most effective means of facilitating recovery following potentially traumatic and extremely stressful situations in the workplace.Footnote 74 In our experience, minimizing the psychological harm to humanitarian teams in critical situations requires mainstreaming psychosocial considerations into the crisis management response rather than relying on a solo psychological intervention. In the previous sections, we linked resource loss and well-being based on COR principles. Expanding on the same concepts, Hobfoll and colleagues identified the essential psychosocial resources that can mitigate mental health risks for those affected by potentially traumatic and extremely stressful situations.Footnote 75 We have mainstreamed the promotion of these resources of safety, calming, individual and collective efficacy, connectedness, and hope, throughout the security management framework and via all responders. Management, security focal points, human resources, peers and other functions can all contribute to mitigating the impact of workplace trauma by promoting these resources wherever they operate within the IGLOO framework.
The first of the two cases examined in this section was an incident that took place during an aid activity resulting in serious casualties. In the second case, a team was confronted and detained by an armed group for several hours, during which a commander showed unpredictable and humiliating behaviour, threatening the team with a longer detention, kidnapping or even a fatal outcome. In both situations, staff felt that their humanitarian mission and organization were severely disrespected.
As is well recognized, preparednessFootnote 76 is critical because mitigating the impact starts long before an incident takes place, and is a key organizational responsibility. In the first case, the management team and the other support functions that had to respond to the death of staff who came under shelling had recently participated in a crisis management exercise. They felt prepared and were able to respond swiftly and with mastery, which reduced their own stress. Key support functions, including staff health doctors, the psychosocial support team, trained family liaison officers and the human resource manager, were ready to be deployed to the site where the affected team and families were gathered. The staff psychosocial support team was included in the response discussions and actions, aiming to integrate the Hobfoll essential elements into its actions; this resulted in the response being perceived as very supportive by the wider affected team in a subsequent evaluation. The efficient and swift response in managing the aftermath of the crisis increased the sense of safety and collective efficacy for the affected teams. This integration was highlighted as very caring and supportive.
Another key organizational practice in this case was the application of a special leave policy, allowing the affected staff to take days off to rest and recover in acknowledgement of their difficult experiences.Footnote 77 This policy was applied following the logic of circles of impact, recognizing that it is not only those directly affected by the violent event who are affected, but also those who have to manage the aftermath.Footnote 78
Group support was highlighted as a key element in the recovery of the teams affected, as groups play a key role in providing social support and hope.Footnote 79 Injured staff members received messages and visits of support from their peers, and teams appreciated the care and support provided to the families of their deceased colleagues – staff positively highlighted the commemoration initiatives carried out by the management team and the logistical support provided to those who wanted to attend the funerals, allowing for collective moments of bereavement and support, which increased the sense of community. Similarly, in the second case, the team recovering from detention by an armed group was received by their colleagues, who had organized a welcoming breakfast the day after their arrival, accompanied by warm messages displayed on a board. This peer support reinforced a sense of belonging and connectedness in the workplace.Footnote 80 It was also instrumental in building bonds between teams, sharing the fear and frustration they had experienced, and exchanging knowledge of the job and the context. This opportunity for sharing is not something that everyone dares to have even in family or more intimate circles in such difficult situations, and was therefore invaluable.
Leaders and managers play a critical role, as we have highlighted above. In the first case, the rapid, regular and transparent communication about the circumstances and how the ICRC was responding to support the affected staff and their families contributed to re-establishing the feeling of safety and the perceived support in teams present in the country, not only in the affected site. Likewise, in the second case, staff who had been detained highlighted the importance of their manager on their return to the base; informed by his previous training in the managers’ workshop discussed in our first example, his welcoming attitude, marked by a listening and observant approach towards their immediate needs, was crucial. The manager’s willingness to schedule an operational and supportive space intended for sharing emotional experiences the following day, the invitation to the staff psychosocial team to be involved, and the manager’s openness during these spaces to listen and provide clarifications on the decision-making criteria all contributed positively to the team regaining a sense of safety and trust.Footnote 81 Team members felt that the difficulties they had faced were recognized, and they gained a better understanding of their manager’s challenges as well. They valued the way their manager encouraged them to take care of themselves and activated the special leave for all to recover, endorsed by the organization’s policy. With this thorough management approach, the psychosocial risk factors associated with the situation were carefully identified and addressed.
While the practices above showed a greater effect of mitigating the impact on the individuals affected, nonetheless, due to various factors such as personal circumstances, levels of exposure and previous history,Footnote 82 some affected staff were in need of and benefited from individual psychological support. An initial intervention by a mental health specialist provided an opportunity to assess their specific needs, risk factors and immediate reactions. In both of the cases detailed above, this led to several referrals for specialized mental health support. The availability of quality-checked services before the incidents and the financial coverage needed for treatment were key factors in avoiding unnecessary delay. Access to safe and confidentialFootnote 83 psychological support remains a minimum essential response to mitigate the impact of violence on staff, as in our post-feedback analysis of support perceptions, this access was strongly highlighted as useful not only for those who used it but also for others, who felt relieved that their affected colleagues had this opportunity available to them. Managers and crisis responders also appreciated the guidance received from the staff psychosocial team in the response to these situations; the extended availability of individual psychological support to cover them was highlighted as extremely helpful.
Lastly, the overarching context required the response to be adapted to the labour laws of each setting. In one of the cases, the incident had to be declared to the national labour risk insurance office, and a medical assessment was carried out for the local staff, ensuring compliance with national law. In both cases, the community norms around support during such situations (e.g., commemoration and gathering practices) were carefully considered and utilized, allowing staff to express and process their experiences within their native cultural frameworks.Footnote 84
Integrated psychosocial approach: Stitching real wounds versus creating cuts to practice stitching!
Everyone would appreciate a doctor who stitches a wound resulting from an accident – but consider the same situation when the wounds are caused by the “doctor” for the sole sake of practising stitching. This would clearly be a harmful practice. Similarly, while offering psychosocial support interventions to humanitarian workers is imperative, providing such support without integration into organizational culture and practices may lead to several negative outcomes, including reduced effectiveness of the support, low service uptake, and increased stigma.Footnote 85 Stand-alone psychosocial support without proper integration can also result in a fundamental misrecognition of psychosocial risk factors within an institution, leaving humanitarian staff and volunteers repeatedly struggling with the same challenges despite existing support mechanisms. We therefore offer the following comparison between stand-alone and integrated approaches to highlight those that best protect and promote the mental health of humanitarian workers.
Integration versus isolation
A holistic, integrated approach mainstreams staff psychosocial well-being into the very fabric of organizational life. Recognizing that humanitarians are a population at risk for mental health conditions due to their profession indicates that protecting their mental health should be part of their profession, including its design, environment and available resources. This requires a multilayered approach involving individuals, managers, peers, institutions and mental health professionals (IGLOO). By contrast, stand-alone interventions such as group sessions, workshops, counselling, psychotherapy or awareness campaigns are often time-bound, one-off services – they won’t create intended outcomes when operating in isolation from the organization’s core practices, despite their importance.Footnote 86
Addressing root causes versus managing consequences
An integrated approach to staff mental health and well-being means identifying and reducing the underlying organizational psychosocial stressors rather than solely offering means to manage the resulting strain. The systematic assessment of potential psychosocial risks (e.g., security risks, workload, unclear roles) and the implementation of measures to address them, in addition to promoting a supportive working environment, would undoubtedly bring more value to both organizations and humanitarian staff and volunteers.Footnote 87 By contrast, stand-alone psychosocial interventions that focus on helping individuals to cope with distress once it has already occurred might not address the conditions that caused it. Such a siloed approach can also create further unintended vulnerabilities for individuals, such as when cause factors are related to harassment or racism in the workplace,Footnote 88 and may ultimately result in additional unfavourable outcomes like decline in staff motivation, productivity and commitment.
Shared ownership versus departmental responsibility
When psychosocial support for humanitarians is integrated, it becomes part of the shared organizational culture and is therefore reflected in the institution’s values. Everyone, from senior and middle leaders to front-line responders, has a role in maintaining it (IGLOO). This approach creates a sense of accountability and commitment across different institutional levels. A stand-alone psychosocial approach, on the contrary, would be owned by a specific department or even an outsourced provider. This external ownership leads to fragmentation of accountability, resulting in situations where the service is treated as a “tick-the-box”, an “employment benefit” or “not my business”.
Position on stigma
A holistic, integrated approach reflects an organizational culture that recognizes aid workers as being equally exposed to adversity as the populations they serve, thereby normalizing the narrative around mental health consequences as a common experience among humanitarians operating in armed conflict settings. In this approach, mental health consequences are not treated as a “lack of competence”, “personal failure” or “lack of strength”, statements usually used to reinforce stigma.Footnote 89 A stand-alone psychosocial approach might be stigma-free for those practising and using it, but if not integrated into the culture and norms of the organization, particularly within the long-standing heroic culture of the humanitarian sector, it can feed loops of stigma for those experiencing adverse mental health consequences.Footnote 90
When responding to crises
Responding to crises is complex and requires coordinated organizational action. In our examples above, if psychosocial aspects had not been considered by managers, responders and the organization, impacted staff could have been unrecognized, a negative perception of organizational support could have developed within the institution, or affected individuals might have experienced additional emotional harm, thereby increasing their vulnerability despite the availability of stand-alone psychological interventions.
Based on our experience, stand-alone psychological interventions for humanitarian staff and volunteers exposed to potentially traumatic events should be embedded within a wider organizational support framework to strengthen their value. While the effectivenessFootnote 91 of stand-alone psychological interventions in the aftermath of traumatic experiences remains debatable in the literature,Footnote 92 a holistic and integrated psychosocial approach ensures both (1) the fulfilment of the physical and psychosocial needs of those affected and (2) the mobilization of intra-organizational support, both of which have been identified as protective factors against adverse mental health outcomes.
Wider considerations and challenges
While the arguments above might appear straightforward in practice, we recognize the complexity and challenges that many practitioners and policy-makers might encounter when trying to adapt them. The first challenge is obviously related to the rapid demands within humanitarian organizations, which often do not allow for thorough staff preparedness and managers’ training. We recommend that humanitarian organizations incorporate staff mental health and well-being considerations in the multilayered IGLOO model as early as possible and build on their expertise as it develops, rather than dismissing this call. The second challenge is related to evaluating these complex integrated approaches, which makes it difficult to spotlight their impact on staff and volunteers’ mental health. Mainstreaming managers’ training on staff and volunteers’ mental health and well-being aspects, as well as offering systematic follow-up on their practices, remains a significant third challenge. In our experience with the managers’ workshop discussed above, we often receive questions from those who participated on how to engage leaders who do not prioritize staff mental health. We share this concern. The wider International Red Cross Red Crescent Movement has developed an online module on the International Federation of Red Cross and Red Crescent Societies (IFRC) Learning Platform that could be a good way to start.Footnote 93
The fourth challenge concerns the extremely difficult moment for humanitarian funding in which we currently find ourselves, forcing humanitarian organizations to reduce operations and cut jobs and services available for staff. We strongly call on decision-makers to include staff mental well-being considerations while making these decisions, as recent trendsFootnote 94 have marked mental health support, including for staff, as particularly prone to being cut.Footnote 95 The last point worth recording is that building such a holistic system requires expertise encompassing mental health, organizational psychology and implementation science. We strongly recommend retaining these areas of expertise when moving toward an integrated approach.
Conclusions
In light of the current understanding of the mental health consequences of humanitarian work for staff and volunteers, this article has presented arguments in favour of integrated mental health and psychosocial support approaches over stand-alone ones. We have outlined a roadmap for an integrated, multi-layered staff care approach that incorporates individual, group, leader, organizational, and overarching context considerations (IGLOO), moving beyond crisis response to address root causes, mitigate risks and sustain both well-being and performance over time. We have provided examples of this approach in action, including training managers and responding to crises affecting staff. In conclusion, we urge humanitarian organizations to adopt a holistic approach to the duty of care, prioritizing not only the treatment but also the prevention and mitigation of psychological harm among staff and volunteers operating in armed conflict zones, as such approaches fulfil the moral and legal duty of care and at the same time strengthen operational effectiveness.
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