Alison Schafer is a provisional psychologist based in Melbourne. She is currently studying for a Doctorate in Clinical Psychology at Swinburne University. Her research is on the influences of basic needs, social support and migration in South Sudan. Still working for World Vision, Alison is employed by the Humanitarian and Emergency Affairs team, which has seen her undertake various overseas missions with considerable time living and working in Sudan. She is also a World Vision technical advisor on a research project for psychological first aid in low to middle income countries with the World Trauma Foundation and the World Health Organisation.

Alison Schafer and friends in Sudan

How did you come to be working with World Vision and what is your role?

I've been working with World Vision Australia for over nine years. I joined the organisation in a marketing/fundraising position, which shortly led on to a role in communications for humanitarian emergencies. Following this I began project management of World Vision Australia funded programs whilst continuing to develop my skills and knowledge in clinical psychology. Today, my position remains in the Humanitarian and Emergency Affairs team with some project management for fragile contexts such as Sudan. However my role as a technical advisor and leader for the World Vision partnership in the area of Mental Health and Psychosocial Support (MHPSS¹) programs in developing countries has now become my prominent role. In this capacity I am currently representing World Vision International as co-chair of the UN Inter-Agency Standing Committee Reference Group for MHPSS (alongside Unicef) and leading a World Vision International working group to develop our organisational responses to MHPSS needs in the field.

What kinds of personal qualities and professional skills have been most valuable to you in this role?

This role with World Vision is extremely life consuming so passion is a primary ingredient. Flexibility and adaptability is necessary since it's not a job with regular hours and requires considerable travel to some very difficult parts of the world; this is not always as exotic as it sounds! Attitude and perception of people's strengths is essential so that we can achieve a balance of being drawn to the needs of the communities we work with, but can do so with a belief in their inherent abilities to cope, particularly within their own cultural frameworks. In our humanitarian work, we see many things that are distressing and it can easily become overwhelming, so being able to find satisfaction on small but meaningful change is also key.

Professionally, this job has required me to understand the basics of psychological intervention, but it has also required me to undertake a personal investment in learning more about how mental health issues are embedded in culture, local beliefs and systems. It further requires a strong ability to establish and build professional relationships. Though I don't claim to be an expert on a range of other topics, it is important for someone in this role to: understand the basics of how the UN operates, International Human Rights Law, and international guidelines and principles for humanitarian aid; be able to analyse situations; and have a foundation of research experience that assists in the design, monitoring and evaluation of programs or interventions. Having said all this, an experiential approach to establishing personal and professional relationships is critical. People in any humanitarian roles need to have some life experience living and working in cultures other than their own, and preferably in developing contexts.

What has the experience meant for you as a person and as a psychologist?

Mental health services in every country in the world seem to struggle to meet the demands of people needing support. This is exacerbated in developing countries and cultures where people living with mental illness are amongst the most vulnerable. There is great personal satisfaction in knowing that you are contributing to making a difference in supporting people to access improved living conditions and services, to be more active and productive in their communities and to be working towards the realisation of their rights. It's a great opportunity to also work at the dual levels of community-based activities, as well as in policy at organisational and international levels. As a psychologist, this work has made me value people's cultural frameworks and the importance of community-based social support even more than individualised approaches to psychological intervention. We regularly see the innate resilience of people once their basic needs are met and their social and cultural supports restored.

How would you advise APS members who might be considering making themselves available to an international aid agency, whether as volunteers or working in a professional role?

The area of MHPSS is growing enormously in the humanitarian and development sector. However, mental health professionals will best serve people when they are directly linked with existing services or agencies operational in the field. This is necessary to work collaboratively with other service providers and to keep them accountable. Interagency collaboration helps to protect affected populations from poor practices or attempts to inappropriately transfer Western approaches to non-Western cultures. It's extremely beneficial for any APS members wishing to engage in this kind of work to have some experience working with cultures other than their own and to be open to alternative intervention practices that are likely to emerge following cultural analyses. Psychologists would also be interested to hear that there are minimal, if any, opportunities to provide direct one-to-one services, such as traditional counselling, including trauma or critical incident stress approaches which are no longer viewed as best practice. Generally, psychologists in humanitarian aid are utilised in the areas of mental health programming, ethnographic research, design and evaluation of programs, or in the training of local service providers.

What are some immediate and/or longer-term implications of natural disasters like the earthquake in Haiti?

Following crises like the Haiti earthquake, conflict or displacement, the first thing people need to both survive and to support their mental or emotional recovery is safety and access to basic needs. They need safe shelter, water, food and emergency medical assistance. At this base level of emergency response, the role of MHPSS workers is not necessarily working with the affected people, but with the first responders. Our role is to ensure social and psychological considerations are addressed in the provision of those basic services, acknowledging that when humanitarian aid is provided, the way in which it is carried out can either promote or hinder wellbeing. For example, if food distribution is delivered in a chaotic way, this will intensify stress or anxiety as opposed to a distribution that is well organised and with staff that are empathic and encouraging of community participation. Information to communities has also been shown to reduce stress and anxiety amongst affected groups. Community messages to inform people about where to go for basic provisions, services or details about their loved ones is essential. Other community messages MHPSS workers facilitate include information about expected emotional reactions and positive coping strategies.

At some point during the initial response phase, MHPSS programmers will usually form an interagency working group and begin mapping services, referral processes and analysing gaps. This may include MHPSS needs assessments, with a particular focus on highly vulnerable groups such as women, the elderly, people living with disability, unaccompanied children or people living with severe mental illness. The first programs set up are those designed to facilitate improved community-based social supports and participation. This might include women's groups, child-friendly play spaces, various committees (such as water, food, protection committees), youth groups etc. MHPSS workers will also play an active role in training, such as assisting teachers or parents to manage difficult child behaviours, psychological first aid for primary health care workers, or even nutrition providers for encouraging greater parent-child interaction. Standalone mental health services are not common and generally reserved for more severe cases managed through health services. Over time, more severe cases sometimes evolve amongst a small percentage of people and they may require more focused programs, such as group therapy activities in churches, community centres or health services. This often sees MHPSS workers training or supervising local lay service providers. MHPSS in emergencies is now viewed as a mainstreamed approach, meaning interventions cut across many aspects of a response and with a focus on sustainable community-based interventions. This approach has become more recognised since the establishment of the Inter-Agency Standing Committee Guidelines on Mental Health and Psychosocial Support in Emergency Settings (IASC, 2007).

When crises occur and media coverage is prominent in Australia, psychologists can still play an active and important role locally. Of particular concern, diaspora communities may seek support and certainly one of the most important interventions is to try to find a way for them to reach their loved ones in the affected country. As well, people often feel a deep need to try to help in some way. This can be difficult if they are not directly linked with responding organisations, but financial support to agencies like World Vision remains crucial. Put simply, we are sometimes unable to respond in emergencies if public donations are not forthcoming. So despite feeling that making a small donation can seem inadequate, it is often one of the best ways people can assist.

Is there a take-home message for us as psychologists here in Australia, and as global citizens?

As previously mentioned, we cannot underestimate the importance of culture and tradition as a way to assist people to cope, or the enormous value of connecting them socially. This is a fundamental message for people working with culturally diverse groups whether that is in Australia or in a humanitarian context. The other message I believe warrants much greater attention is that mental health needs are just as great in developing countries as they are here in Australia, yet it remains one of the least researched areas of health in the world; and mental health services are one of the least resourced areas in developing countries. Psychologists in Australia have skills, knowledge and resources that can contribute to filling these gaps. The work is not always profitable, rigorously scientific and certainly not easy, but I believe as a nation of plenty we can take a worldly perspective to our work and find a way to serve people with mental health and psychosocial support needs both locally and internationally.

Thanks to Heather Gridley for conducting the interview.

¹ In the humanitarian sector, the composite term ‘mental health and psychosocial support' (MHPSS) is used to describe any type of local or outside support that aims to protect or promote psychosocial wellbeing and/or prevent or treat mental disorder. Although the terms mental health and psychosocial support are closely related and overlap, for many aid workers (and other professionals) they reflect different, yet complementary, approaches.

InPsych April 2010

InPsych April 2010

Table of contents

Vol 32 | Issue 2