Mental health and psychosocial support: who cares for the volunteers?

Every day, volunteers around the world respond to humanitarian emergencies. In Syria, volunteers deliver food, water and medical supplies to families fleeing Eastern Ghouta. In Bangladesh, volunteers provide shelter, food and psychosocial support to unaccompanied children separated from their families as they fled Myanmar. During the Ebola response in West Africa, volunteers ensured safe and dignified burials and conducted contact tracing in affected villages.

The central role of volunteers in humanitarian responses is increasingly recognised. The 2015 UN Resolution ‘Integrating volunteering into peace and development: the plan of action for the next decade and beyond’ (Resolution 70/129) underlines the role that volunteers can and should play in the implementation of the 2030 Sustainable Development Goals, including in humanitarian action, peace building and conflict prevention. The Resolution also requests Member States and the United Nations system to work together with volunteer-based organisations to enhance the protection, security and well-being of volunteers. Although this indicates an increasing recognition of the duty of care towards humanitarian volunteers, their mental health and psychosocial needs are all too often neglected. Simple and cost-effective initiatives and interventions can be put in place before, during and after humanitarian responses to promote the well-being of volunteers and reduce symptoms of distress and burnout.

What do we know about volunteer wellbeing?

Millions of people volunteer in humanitarian emergencies. They work in difficult, complex and sometimes dangerous environments. They help people during and after crises, providing them with practical help, understanding and social and emotional support. They may find themselves comforting survivors in the initial phases of shock and grief, and they often work long hours in challenging conditions. Volunteers are also likely to be members of affected communities; they often work close to home, and may experience the same loss and grief as the people they are supporting. Operational experience shows that, in addition to direct exposure to traumatic events, organisational issues and working conditions have a large impact on the stress levels and well-being of volunteers. This includes unclear or nonexistent job descriptions, poor preparation and briefing and inconsistent or inadequate supervision. IFRC Reference Centre for Psychosocial Support, Caring for Volunteers: A Psychosocial Support Toolkit (http://pscentre.org/wp-content/uploads/volunteers_EN.pdf).

There is limited research available on the mental health and psychosocial well-being of disaster volunteers, but what research does exist backs up operational experiences. A review of the literature shows that humanitarian volunteers tend to have higher levels of mental health complaints than professional workers, but may be more resilient than other members of affected communities. Sigridur B. Thormar et al., ‘The Mental Health Impact of Volunteering in a Disaster Setting: A Review’, Journal of Nervous and Mental Disease 198(8), 2010; Sigridur B. Thormar et al., ‘The Impact of Disaster Work on Community Volunteers: The Role of Peri-Traumatic Distress, Level of Personal Affectedness, Sleep Quality and Resource Loss, on Post-Traumatic Stress Disorder Symptoms and Subjective Health’, Journal of Anxiety Disorders 28(8), 2014. Research conducted after a large earthquake in Indonesia indicated that mental health issues for volunteers may persist for many months following the event. Sigridur B. Thormar et al., ‘The Impact of Disaster Work on Community Volunteers: The Role of Peri-Traumatic Distress, Level of Personal Affectedness, Sleep Quality and Resource Loss, on Post-Traumatic Stress Disorder Symptoms and Subjective Health’, Journal of Anxiety Disorders 28(8), 2014. The research also showed that volunteers providing psychosocial support, distributing goods and handling administrative and logistical tasks were particularly affected. This is backed up by findings from the West Africa Ebola response, where volunteers providing psychosocial support and contact tracing and drivers reported more mental health distress than, for example, burial teams. IFRC, The Psychological Strain of Responding to West Africa’s Ebola Outbreak: Findings from Guinea, Liberia and Sierra Leone (Geneva: IFRC, 2015). This suggests that it is not necessarily frontline volunteers who are most vulnerable, and that efforts to support and care for volunteers should target the broader group of volunteers.

Organisations should consider, not only the mental health and psychosocial needs of their core volunteers, but also the needs of the spontaneous volunteers who often join humanitarian responses. Volunteers with a long organisational affiliation are usually trained and prepared for their tasks, but spontaneous volunteers often have little or no prior experience and training before joining the response. This make them more vulnerable to mental health issues after the response. Sigridur B. Thormar et al., ‘PTSD Symptom Trajectories in Disaster Volunteers: The Role of Self-Efficacy, Social Acknowledgement, and Tasks Carried Out’, Journal of Traumatic Stress 29(1), 2016; IFRC, The Psychological Strain of Responding to West Africa’s Ebola Outbreak.

How do we support and care for volunteers?

Many of the challenges facing volunteers can be managed by addressing organisational and structural issues before, during and after a response, and through the provision of basic psychosocial support. Relevant psychosocial support for volunteers ranges from small acts of recognition and informal gatherings to more structured peer support systems and psychological first aid for volunteers – either individually or in groups. These are all simple and cost-effective interventions and initiatives that can be implemented with no or limited resources. However, there is currently very limited research on the effectiveness of these interventions, and this is urgently needed in order to support and scale up these interventions. An added benefit of providing support and recognition to volunteers is that it often leads to increased recruitment and retention. Better care inspires and motivates, and ultimately leads to better performance.

Before a response, it is important to address the known organisational factors that can cause distress later on, and to ensure that volunteers are properly recruited and trained and have clear job descriptions. Contingency planning can help prepare the volunteers for a response.

During a response, the well-being of volunteers should be monitored and supported. A simple yet powerful way of supporting a team is to show appreciation and recognition of their efforts and hard work. This can be done through informal gatherings, where the manager calls volunteers together for refreshments and makes a short speech of appreciation and gives others the opportunity to say a few words. This can be combined with more formal components, such as handing out letters of appreciation. As indicated by the research from Indonesia and West Africa, it is important to include the broader group of volunteers in such events, not just those involved in the frontline response. Another way of supporting volunteers during a response is through a peer support system. This provides a network of support and strengthens the resilience of volunteers.

After a response, it is important to follow up with the volunteers and provide support to those who need it. If the team has been involved in a very stressful or dramatic response, or if some team members show signs or symptoms of distress, the manager may decide to arrange a psychological first aid session for the entire group. This is a safe space where participants can talk about their experiences in a supportive environment, where others listen without judgement and where reactions to crisis events are normalised through the provision of psychoeducation, peer support is encouraged and information about available support systems is shared. Managers should follow up with their volunteers in the weeks and months after a response to check if anyone is in need of additional support or referral to more specialised mental health and psychosocial services. This is particularly challenging with spontaneous volunteers, but it is an important part of the duty of care.

Conclusion: what next for volunteer care?

There is increasing recognition of the importance of ensuring safety and well-being of humanitarian volunteers at the global level, but too often support and care systems for volunteers are not in place on the ground. Barriers include limited understanding of the issue, lack of acknowledgement from management and organisational and structural barriers. In order to address these gaps, simple, cost-effective initiatives and interventions can be put in place before, during and after humanitarian responses to reduce symptoms of stress and burnout and promote the wellbeing of volunteers. This includes addressing organisational and structural issues and the provision of basic psychosocial support to volunteers. Volunteer care initiatives should be included in strategic plans and budgets, and managers at all levels should recognise the role of volunteers and support initiatives for their protection and well-being. Research on the effectiveness of interventions and initiatives for volunteer care is urgently needed in order to support activities on the ground and promote wider advocacy efforts to put volunteer care on the agenda of volunteer managers, organisations, stakeholders, donors and policy-makers.

Cecilie Dinesen is an Advisor at the IFRC Reference Centre for Psychosocial Support.