MASTA Travel Medicine Study Day Psychological Issues in Humanitarian Workers. Ruth Dormandy UKCP registered & BACP (Snr.

Transcription

1 MASTA Travel Medicine Study Day Psychological Issues in Humanitarian Workers Ruth Dormandy UKCP registered & BACP (Snr. Accred) Team Leader, Psychotherapist, Supervisor & Trainer

2 Overview of the work InterHealth Worldwide The Risks and Challenges to Psychological Health of Humanitarian Aid Workers Presentation InterHealth Worldwide 2015

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4 Selection of clients Every year we support over 10,000 individuals working for over 300 organisations.

5 A humanitarian is someone who tries to give voice to the voiceless. Pernille Ironside Gaza with the UN Children s Fund (UNICEF)

6 We look after the health and wellbeing of humanitarian and mission workers through HOLISTIC APPROACH Occupational Psychological Travel Medicine Family Care

7 InterHealth Worldwide is an international health charity preparing sustaining supporting the health and wellbeing of those working around the world, making the world a better, fairer and healthier place

8 World Humanitarian Day - 19 th Aug each year 2003 bombing on UN head quarters in Baghdad, killed 22 people. Humanitarian workers were killed in South Sudan by armed fighters while supporting the mission to reach malnourished children... In Gaza, aid workers have lost their lives in shelling attacks while providing critical care to the sick, the wounded, and the dying, and comforting families of the dead. And in Sierra Leone, Liberia and Guinea, health workers trying desperately to save lives in the Ebola epidemic have succumbed to the deadly virus themselves. Others have been threatened with bodily harm for trying to stop the spread of the disease. Anthony Lake, the Executive Director of the UN Children s Fund (UNICEF)

9 recorded incidents Average 2/mth recorded incidents (within 2 mths) Average 6/mth Low Level Mid Level High Level InterHealth Worldwide 2015

10 RIC incident type MH staff Death of customer/staff Hostage/kidnapping shooting Armed robbery Sexual assault disease epidemic InterHealth Worldwide 2015

11 in 35 years of similar experiences, working with Ebola in the early phase was the hardest thing I ve ever done Senior Leader from NGO

12 Feedback - The Risks High levels of anxiety/high risk of burnout Mistakes being made/patients placed in wrong quarantine Due to demand some less experienced/less resilient individuals being sent (good for career) Trauma/vicarious trauma symptoms Making moral and ethical decisions Overworking Feeling overwhelmed by unmet needs Having to turn away patients

13 Feedback - The Risks Confrontation with massive death and burials The invisible threat & uncertainty Contagiousness of fear Being asked to complete tasks outside the area of training and competence Team dynamics No touch policy 21 day quarantine Stigma family (Xmas)/returning to work

14 My flat mate didn t want me around, my parents didn t ask me anything about my time there, the agency wanted me to work on my replacements and give talks. Yes, Christmas back in the UK was very hard

15 The Challenges The Characteristics The Counselling

16 Case Study Tim, Lab Tech Sierra Leone I don t feel myself, I can t concentrate, I can t enjoy anything like I use to, I feel totally exhausted. One of the patients ran out of the confined area as she was delirious, we had to contain her quickly. Everyone was at risk. What was wrong with me, all I could think about and care about was Ebola, I didn t pay any attention to my relationship with my partner. During the first month I became obsessional about catching Ebola. I was fine until I started working there. The slightest ache or pain made me think I had a death sentence.

17 The Challenges? Frequent travel Cumulative impact of constant change Cross Cultural Differences High intensity work Change in attitudes and values. Cynical see the worst of society Personal relationships Travel-related disease (skin disorders, food poisoning) Psychological disorders (anxiety and adjustment disorders) Trauma/vicarious trauma/burn out Hypervigilant Reintegration on return of assignment

18 The Characteristics? *Responsibility absorbers Martyr/sacrificial/saviour/hero/fixer/carer What are they leaving behind? *Takes a lot to seek help and little to turn them off *Action orientated people, hate confinement Resilient and adaptable *Decisive, assertive, willing to do the job in front of others Emotions get compartmentalised/no room for vulnerability *Solidarity, dependence for survival on colleagues Attachment patterns Adrenalin junkies *Dr. Roger Soloman First responders,police agencies, war veterans (PCIS)

19 Impact on individuals FFFF trauma response. Becomes unaware that they are impacted. Array of trauma symptoms Heightened sense of danger (58%) Anger/Blaming (49%*) argumentative, sense of control Sleep difficulties (46%*) Isolation/withdrawal (45%*) demotivation, no one really cares or understands Flashbacks/intrusive thoughts (44%*) - Preoccupation, all I can think about Emotional numbing (43%*) Fear/anxiety (40%*) - Heightened sensitivity to the reaction of other Trauma narratives can be triggered Social engagement breakdown/attachment figures breakdown Waiting for change some alliance or event will solve everything *Dr. Roger Soloman PCIS

20 The Counselling? Trauma specialist therapists EMDR, TF-CBT, Sensory Motor Trauma Assessment Consultations (TACs) Personal Impact Reviews (PIR) Follow ups *Debriefing Responding in a Crisis (RICs) Training Psychological First Aid (PFA) Stress management/resilience building/trauma awareness Family Liaison awareness Key focal points (peer support)

21 Group dynamics

22 Team members need To feel important and worthwhile To feel understood and heard Belonging and acceptance Clear roles and control (a share in decision-making) A functional sense of meaning Emotional, physical and psychological safety Trust and respect Clear communication

23 Case Study Jane, Operations Manager, Syria the most positive aspect of my role was the relationships I managed to build with my team in spite of the 10mile stretch and border that separated us. Some of my staff were taken for investigation by the controlling entity and detained in a jail for 4 months. I felt responsible and agonised about what might be happening to them. I found myself unable to sleep, heartbroken at the prospect of their suffering. The management and support structure began to break down, I felt I was left at risk. During this time I was involved in a whistle-blowing case against a senior manager as he was abusing some of the local staff. This caused splitting in the team and a lot of cover up. I didn t realise the strain I was under. maintaining and prioritising our own physical and mental health and wellbeing can be difficult when we are surrounded by people with seemingly greater needs.

24 I realised that the psychological support before and after my deployment was really helpful in keeping me going: I recognised this had been missing previously, I will definitely use these services again

25 InterHealth s Approach to Psychological Health Care Psychological equal footing with medical & physical Clinicians with contextual experience Preventative Support for organisation and individual Continuity of Care: Pathways of Support: Prepare, Sustain and Aftercare training, consultations - F2F and remote, responding in a crisis, HR support

26 Thank you Ruth Dormandy InterHealth supports those who make the world a better, fairer and healthier place