On World Humanitarian Day 2018, the Overseas Development Institute held an event called Breaking the Silence: Promoting action on aid worker mental health. Two key areas were highlighted as particularly problematic for aid worker well-being; trauma, due to the environments and events they are exposed to, and; stress or burnout, arising from the particular cultures inside many aid organisations.

As a counsellor working with international aid workers, and an ex aid worker myself, I recognised both these issues all too well. But I also noticed that there was a third factor missing from the discussion – loneliness. I would say that loneliness is up there at the top of the list of challenges facing my clients. I recall one of my first aid worker clients describing feeling lost and alone. With multiple missions under her belt she felt exhausted and less motivated to make new friends. She felt she was beginning to withdraw and lose sight of who she was. It was easier to work than socialise. She felt family at home didn’t understand her any more. She didn’t know where she belonged. She felt increasingly anxious, lonely and desperate. Her confidence hit rock bottom. She felt stuck, overwhelmed and uncertain which way to turn. Since then I have heard these same words repeated by many other clients; alone, isolated, lonely, lost, alienated, anxious, desperate, stuck, empty, hopeless.

Aid workers are necessarily an independent, adaptable and resilient lot, signing up to a life of constant challenge and change, and – when necessary – hardship. But this lifestyle has some pretty heavy side effects. Constant transitions between countries mean building relationships, moving on, losing relationships, being left, time and time again. Repeatedly familiarising oneself to a new place, a new culture, new people. This seems to have a direct impact on how people connect and maintain relationships and therefore on their mental health.

In her book “Counselling the Globally Mobile”, Lois Bushong, observes this very phenomenon. Her experience shows that the combination of loss (of people/place/culture) and increasing difficulty in making intimate connections combine to potent effect. Although she is largely describing the Third Culture Kid community, I see strong parallels in both myself and my clients. Over the years, the inevitability of leaving seems to be anticipated earlier and earlier, and less effort is put into building emotionally intimate new relationships. There may be many close friends from previous missions, so why go through the effort and pain of making and losing new ones? The loss of numerous places and people silently grow and is carried within, as a new job and context absorbs all the attention and energy. And so, the emotional boundaries built to protect start to turn into barriers which in turn can cause withdrawal and isolation. Yes, there are old friends, but generally they are now in other countries and it is hard to see them. Social media can help to maintain connections, but the bottom line is that these friends are not present. I notice in my clients that they have become increasingly lonely at a deep emotional level, isolated from people and places they know at a physical level. And while loneliness is not a mental health condition in itself, it is recognised as having a huge impact on well-being, lowering self-esteem and sense of emotional security, and if left, it leads to depression and anxiety. It also reduces our ability to be able to deal with trauma and stress, ever present features of the aid world, and hastens the onset of burnout.

Aid workers can suffer from loneliness at any stage of their career. But I notice it becoming more problematic as the number of missions grows and people get older. The energy and drive that originally got them into the field is ebbing, and the desire for stability and intimate connection has grown. People find themselves increasingly isolated and unsure of where they belong. They seem to feel stuck and unable to find a way forward, holding tight to what is often the one constant in their life – their work. And so, the pattern continues, the loneliness and isolation deepen, and despair can begin to set in.

Being an aid worker is an exciting, interesting, rewarding, worthwhile job, but it is also extremely challenging. Increasing attention is being paid to its impact on mental health and there is a lot of talk about trauma, stress and burnout. Intimate supportive relationships however are crucial to our emotional well-being and the aid sector, unwittingly, conspires to put us and our relationships under serious strain. Given the demands of the job, there is no easy answer to reducing loneliness amongst aid workers, but it does feel important to be able to acknowledge that this has a huge impact on their mental health. Maybe with this awareness we can start to take steps to reduce it.

Helen Arthy, Therapist