Humanitarians provide a glimpse of the best of humanity in an often violent and distorted world. Yet despite their strength, studies suggest they experience more mental health issues than the average individual. So what accounts for this disparity? And what can be done about it?

The difficulty and risk faced by aid workers in the field are now well-known and many are simply experiencing normal reactions to these abnormal situations. Neuroscience research has helped us understand the consequences of continued exposure to toxic stress. Stress becomes toxic in situations that are novel and unexpected, where we have little control, where available internal and external resources are limited, and where we experience harmful intent.

These circumstances, especially if they become chronic, cause a breakdown of both physical and mental processes. So how do we recognise the signs that the stress of aid work is becoming an issue in ourselves or our colleagues?

Here are a few well-known signs:

• Emotional agitation: short temper, anxiety, depression.
• Being prone to conflict or withdrawing from social situations.
• A feeling that there is no room inside to deal with shock and that everything affects us.
• Being unable to think clearly: everything is important and nothing is important.
• Self-medicating with alcohol, tobacco, drugs or sex.
• Being prone to flashbacks and intrusive thoughts.
• Feeling mistrustful and paranoid.
• Memory problems or visual spatial confusion.
• A growing sense of futility.
• A lack of interest or engagement in our usual activities.

This partial list of typical indications that our mental “knees” are beginning to buckle under toxic stress should not be ignored. Given the “can-do” attitude of many aid workers, the tendency is to toughen up and push ourselves through these symptoms. This often results in making the problem worse and exacerbating symptoms.

A better approach is to honestly acknowledge the symptoms and begin to make changes in our situation and behaviour that will help bring the toxic stress under more control. While this will look different for each individual, there are some common recommended resilience practices developed out of the neuroscience research that should be implemented by all humanitarians.

Advice on staying healthy

Actively promote more social connection during and off deployment. This may look a bit different if one is introverted or extroverted, but it is essential for wellbeing. While always a challenge for humanitarians to stay connected to friends and family at home, it is worth the effort to keep in regular contact. With today’s technology this is increasingly possible even in remote areas.

Remind yourself of the reasons you do this work. Having a sense of purpose, whether religious or humanistic, has been shown to confer mental protection against some of the demoralising and traumatic experiences encountered in aid work.

Continue to develop your technical skills and expertise. Having a sense of confidence in your abilities increases your self-efficacy and reduces feeling out of control.

Learn to manage your emotional responses in more healthy ways. Train yourself to recognise your emotions as helpful information and communicate them to others involved in a way they can hear. Yelling at someone disengages their thinking brain and yours – never really useful.

Get enough sleep. Adult brains require 7 to 8.5 hours of sleep a night to function. The research is becoming clear on this and the consequences both in performance and health are quite sobering.

Get physical exercise. While difficult to do in higher risk environments, physical exercise actually grows new brain cells in a critical area of the brain necessary to process stress. This same area is damaged by toxic stress. 20 minutes a day, 4 to 5 times a week is a good regimen to follow. If it is too dangerous to jog or there is no local gym, do exercises in the office or team house. Any and all exercise counts as long as you sweat.

Finally, if you find that you have checked off many or most of the signs of the impact of toxic stress, reach out and get help. The field of psychology and psychiatry has advanced significantly in being able to help individuals with PTSD and other mental issues, but it is always easier to help when the early signs appear. Like any physical or mental symptom, the sooner we address the issue, the more likely we can successfully move beyond it.

Donald is a psychologist and has focused almost exclusively on humanitarian aid workers experiencing mental health issues for the past decade.

You can explore more coverage on the issue of mental health and wellbeing in the aid sector here. Get in touch on globaldevpros@theguardian.com if you would like to comment on the topic.

• If you have been affected by the stories in this article, the Samaritans can be contacted on 116 123 in the UK. If you live outside the UK, a list of organisations providing support internationally can be found here. The Headington Institute provides online resources as well as information about counselling, training consulting and referrals. Additional peer to peer resources may be found on sites such as Globalaidworker.org

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