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Q&A from Depression Webinar
13 April 2017
SELF CARE- Questions
- What research and guidance is available for aid workers not just during deployments but during re-entry when they return to their home countries and can be vulnerable to depression but lack support from organisations that understand aid work?
- What is available for staff re prevention of depression?
- I am a victim of depression and know too well how greatly it can ruin a person’s life. Now to my point. I hope that you will touch on 'relapse' and how to tackle it
- Does burn out automatically lead to depression?
- For people seeking to work abroad in a less developed setting long term who have a history of recurrent chronic clinical depression responsive to treatment and which is stable on antidepressants, what advice would you give? How can InterHealth assist?
The InterHealth Worldwide health information sheet “Depression and Anxiety” gives information about depression and ways to support yourself when you are feeling depressed or recovering from low mood. It also has links to a number of resources and organisations working in this area.
We are hoping that one of the key messages that participants gained from the webinar was that having a history of depression does not bar you from taking an international placement or working in the humanitarian sector. Like any other health difficulty, it is a question of monitoring mood and symptoms and taking effective and timely action to manage them. This is a key responsibility for any of us who has experienced depression, but organisations can help if staff members feel they can talk about having had depression and explore options for support with line managers and HR departments. There can be many ways to keep well in the field, but it is key that staff feel able to work contracted hours and take breaks and annual leave rather than being drawn into working very long hours and skipping leave.
Also important is the staff member recognising what helps them and making use of this whether it be exercise, mindfulness meditation, checking in with friends and family who are key sources of support and using whatever strategies for relaxation they have identified. It can be helpful to make a depression management plan so that you have a clear list of things to do if you feel that your mood is becoming lower and you need a structure to trigger more self-care.
SUPPORTING OTHERS IN A TEAM- Questions
- Especially interested in how to cope with team members that undergo a phase of depression and are resistant to any type of support.
- How does presenteeism mask or indicate signs of depression?
- What is the best way to balance work responsibility and family responsibility during the emergency in which our own family has also been affected by the crisis?
If you notice that a team member has changed and is showing signs of depression or burn out, it is important to try and raise this with the person. A key thing is to have specific examples that you can use to show the person what you are noticing (they may not be as aware as you are that they are behaving differently). A compassionate approach that shows that your motivations are caring is important. Once the person is able to hear that you are concerned and recognise why you are concern, then it is helpful to have a clear idea of what the next steps might be (is it a referral to your HR department? Contact with an external OH provider? InterHealth? etc).
Just because a team member is at work every day and is able to function at work to a greater or lesser degree, they may still be experiencing significant symptoms or problems with mood. Again, a compassionate approach that recognises their commitment to work and conscientiousness may be helpful as a way in to talk about tendencies to overwork, high stress levels, emotional distress or other indications that the person may be having difficulties.
It is really important to recognise the particular pressures for people who are working internationally with their families, or are working in their own nation and balancing work and family life. Here the pull to prioritise work that can exist in high pressure emergency settings can cause significant conflict with other responsibilities. It is important to find time to talk about this with staff members and explore the impact of any wider crises on them and their families.
SUPPORT FOR MANAGERS- Questions
- Are there practical ways that managers can be sensitized on how to deal , identify and care for staff who may be slowly but surely lapsing into depression. With the nature of the work in the humanitarian sector which is to get the work done
- What is available for staff I deploy & those they work with re prevention of depression?
- What symptoms should we be looking for to indicate when someone needs:
a. To seek professional help on the field.
b. To leave the field to see professional help?
- Mainly interested in signs & symptoms and what best course of action is when staff are experiencing depression while living/working in an volatile, hostile environment of civil unrest.
- When someone is depressed how do you know when they need expert help?
- Useful to know of techniques, appropriate interview, screening questions to ascertain whether people we are deploying have issues that may go unnoticed otherwise
Again, it is worth taking a look at the InterHealth health information sheet on “Anxiety and Depression” which gives an overview of issues to look out for, as well as links to more specialist websites. Research suggests that cohesive teams and supportive styles of management are the most effective in protecting staff from psychological symptoms of any type.
It is important to recognise the role of the individual in managing their own depression, but also helpful to look at their work context to spot signs of managerial drift or toxic team dynamics that may be also play a role. If there is a sense that actions taken at an organisational level (with individual, team and/or manager) are not bringing about any positive change then it may be worth linking the person with some sort of professional help. An assessment appointment can be arranged with InterHealth or a similar organisation to explore the situation and make recommendations. If there is a sense of significant risk – the person might be a danger to themselves or others – then it is important that this is contained and it may be necessary that they leave an international deployment to return to their home country. This depends very much on what resources are present in the country in which they are working that can help contain the situation (for example local mental health services) and would need to be determined on a case by case basis.
Similarly, if the person is not able to function at work perhaps because of exhaustion or emotional volatility, it is important to explore with them what they feel would be the most appropriate course of action. Depression leaves one feeling quite powerless and it is important that organisations do not mirror this in taking decisions about individuals without their involvement if at all possible.
STIGMA/SUPPORT ORGANISATIONAL- Questions
- Just wondering how collectively we can tackle the stigma of depression or burn out amongst our peers in NGOs? In addition, many large NGOs do not provide a salary after your time in the field finishes, so if one take time out to work on burn out it starts being stressful financially.
- How can we as individuals help combat this? Often non-profits seem to have poor insurance/benefits to help from the institutional end.
- How do mission organizations handle the issue of confidentiality or privacy? If we say we are confidential, more people might disclose their challenges but we (Member Care) have a duty to share carefully with others (Personnel, field) in order to provide support or make placement decisions. In the US there are very strict laws regarding the use of the term “confidential”.
- Debunking the health questionnaire form pre-assignment - what is the actual impact of disclosing depression on the health form? Many perceive ticking 'yes' to equal no field assignment, or a strong recommendation against deployment. How do Interhealth use that information?
These questions are so important, but not ones that I can really answer as an outsider to your particular organisation. I think we all have a role to play in reducing stigma in the sector, particularly given the commonality of experiences like depression and burn out amongst us all. Similarly, it would be great to work towards a situation in which insurance companies and benefits policies take as seriously difficulties with psychological health as they do medical related difficulties. We are far from this sort of situation at present – I would encourage everyone to raise this with their organisation and would be happy to support initiatives of this kind.
There are particular difficulties related to managing confidentiality in the mission sector, where there can be more of a sense of family relationship between team members, making information more widely shared. This requires quite careful handling given the stigmas that still exist around experiencing psychological health difficulties and seeking help. Making this very clear in a “confidentiality policy” can be helpful as clear directions related to each organisation’s requirements at least allow people to make their own judgements about what they share and with whom. However, it is always better if individuals do find a way to disclose information about health related difficulties (whatever these may be) to managers or HR departments so that reasonable adjustments can be made to their work life to take account of these.
At InterHealth we would always be making assessments based on an individual’s profile relating to risk factors (which might include a past history of depression) and resilience factors (which might include the learning accrued from a past history of depression, current coping strategies and overall resilience). As stated above, we think the difficulty is not experiencing depression, it is having the right strategies in place to manage depression symptoms and having the organisational support to make use of these.
DEPRESSION ON RETURN- Questions
- We have some missionaries who recently retired after 48 years of service overseas and this was their identity. Now coming back to the states, it is not really "home" anymore and I think it is quite an adjustment/transition. It makes them question who am I now? what do I do next? Some leave before they actually see the fruit of the ministry and this also can lead to depression as they may question was my sacrifice/investment worth it? Depression is something that is very real and we would like to be proactive in putting steps in place to help.
- Additionally, experience has been that acute depression/ suicidal thoughts can hit at the point of departure from an intense field assignment. How can we be support colleagues in this transition to help them end their assignment well, rather than either extending their assignment (so delaying dealing with underlying issues) or jumping to an equally intense field assignment?
Research certainly suggests that depression on return from mission is a serious problem (Lovell-Hawker 1997). Different organisations have different processes in place to ease the return of international staff, particularly after long placements elsewhere. These may involve professional debriefing (like the psychological reviews offered at InterHealth) but also things like social events that link former staff members together, involvement in activities with the organisation after return etc. Again, developing a policy around return could help formalise these processes and make sure that they are accessible to all staff.
CULTURAL THOUGHTS- Questions
- Is depression a 'Western' disease? How can organisations factor differing cultural presentations of depression
This is a very interesting question. Some research suggests some commonality of types of symptoms across different cultural contexts but the meaning given to these symptoms may be very different. I am thinking of the time I spent working in Rwanda in which we talked a lot about something experienced by the Rwandans that I worked with that they called “being like a tree”. This had a lot in common with depression (reflecting perhaps a common biological basis) but was more characterised by numbness and social withdrawal rather than low mood. More research is definitely needed in this area but I think the starting point with any group is to explore what behaviours they think indicate a problem. Is this about a person keeping away from others, perhaps “over thinking” and seeming distracted? What would normally help a person like this? I would be very keen to explore this first before offering any solutions based on approaches to depression in Western contexts. That said, just as I really enjoy my acupuncture sessions, cross cultural considerations should not block access to forms of treatment that might be experienced as helpful even if not drawn from the same cultural context. In other words, a careful balance is needed here to avoid disempowering different ways of coping while offering a wide range of options for help and support.