40. Be Well, Serve Well

Lars Peter Nissen: 00:11

Welcome to Trumanitarian. I'm your host Lars Peter Nissen. Mental health can be a difficult issue to talk about in general and for humanitarians in particular. I think it's difficult because we're supposed to be the people who help other people who are in trouble and so what is this business of talking about yourself and how you struggled. You're not the main story here. I think there's also a lot of fear about being seen as weak and unable to cope with conditions in the field, and to be seen as a risk who cannot be employed. But to make a long story short, that's a bunch of macho bullshit, quite frankly, and a very unhealthy way of thinking about mental health, and humanitarians. So let's not do that. We're just out of two extreme years where we have all been subjected to stress in one way or another and especially now, when we can see some kind of light at the end of the tunnel, it's important to be really careful, and not just jump back into the hamster wheel on full speed. Personally, I felt like I was approaching some kind of a burnout towards the end of last year, and I had to take a long break over Christmas and I've had to rethink about how, and not least, how much I work. And so it's great to have Imogen Wall on the show this week. Imogen is a humanitarian, the founder of the legendary Facebook group 50 Shades of AIDS, and she's worked extensively with mental health in the aid sector. Imogen's message is simple: Be well, and serve well, you cannot separate the two. And rather than seeing us talking about our own mental health as something detracting from the work we're trying to do, it is the very foundation upon which we should build a healthy workforce, trying to help others. I won't say more because Imogen speaks so much more eloquently about this than I do. But before we jump in, I just want to say that if you're struggling in one way or another, please reach out and get some help. In the shownotes, you will find the link to a couple of resources, including how to get in touch with Imogen. She's happy to talk to you and help you find support. And also, please take care of those around you. We have all been isolated for a long time. And it's been difficult. So take the time to check in with your colleagues. Make sure they're okay. And let them know that you're there for them. Enjoy the conversation.

Imogen Wall, welcome to Trumanitarian.

Imogen Wall: 02:48

Thank you for having me, Lars. I'm delighted to be here.

Lars Peter Nissen: 02:52

Yeah,we only have one problem. That is, I have no clue how actually to introduce you. You're you have so many different sides to you. So I'll just leave it to you. Please tell us who you are.

Imogen Wall: 03:02

It's a very... people keep asking me this at parties. What do you do? And I'm like, well, That's a very good question. So I started out as a journalist, actually, in radio, and then I accidentally became an aid worker. I did frontline humanitarian work for about 15 years, mostly with the UN, and frontline, natural disasters, large scale natural disasters: the classics, tsunami, Haiti, Philippines, that kind of thing. Community engagement was my field, particularly the journalist background, lobbying to try and get agencies to listen better to people affected by crisis and explain what the hell was going on. In the sort of huge operations that descended. I moved back to the UK about seven, eight years ago from New York. I had some family issues, which meant I had to choose between my job and my location and I chose my family. And I've always been very interested in mental health issues, partly from my own personal experiences, experiences in the family. So I retrained as a therapist without really understanding why I was planning to work as a therapist, and a mental health first aid instructor. And I didn't really know what to do with either of those things. I carried on consulting in the UK for all sorts of people. And then COVID hit and the mental health thing has just really taken off. So now I teach a lot online. And in all of that, I also run an online community called 50 Shades of aid, or at least I founded it, I don't really run it anymore. It is very happily exactly where it should be, which is in the hands of the next generation of people with the energy and commitment and vision to take it to new places. Because I started it for me and 15 friends and now it's got 27,000 people in it. So it's been... that's been a bit of a journey. So I do all those things. I quite like not being definable.

Lars Peter Nissen: 04:47

Yeah. So no box for Imogen. We'll just have to live with that I guess, you know. And we have agreed that the main theme for today is around mental health, but I would like you to maybe begin by just explaining a bit about... the 50 shades website has grown to and it's talked about a lot in different circles, so you hear it popping up. So what is the 50 shades? And what's the link to mental health?

Imogen Wall: 05:14

Ah, it's such a good question. So 50 Shades of Aid (I can't claim credit for the name, actually. That was a friend of mine) started seven years ago, when I was asked to write a piece for The Guardian and I needed some comedy stories about relationships in the field. And obviously, because it was a newspaper, they gave me a deadline of about 24 hours. So I stuck a thing on my Facebook profile saying, Has anybody got comedy stories about relationships in the field... got inundated. I mean, so many great stories. And I only had like 800 words. So I wrote my piece and I felt really bad that I asked people for content. And they'd given it and it was... it wasn't making it into the piece. So I thought, well, I'll just start a Facebook group, just for all the people I've spoken to, so we can share these stories because they're funny. So I did that. I literally did it about half an hour, it's really easy to set up a Facebook group. And I thought that was it. I was so naive, I thought that was it. So I came back kind of the next day turned it on, and more people were adding comedy stories. And I said, this is great, these are still really funny. And if anybody's got any that they don't, you know, don't want to put their name to just send directly to me, and I'll post on their behalf. And then a couple... it was women, mostly... couple of women started showing some slightly darker stories about you know, relationships gone wrong, or harassment, or a friend of mine who's half Indonesian, you know, about how the guys kind of went for Asian exoticism and really kind of fetishize her. And she found that really hard. And then people started talking about sexual harassment and the whole thing exploded, and at that point, it was an open group, like anybody could join. So I started with 15 friends; The week people started talking about sexual harassment in the aid sector, 800 people joined in a week. And my inbox is suddenly full of people saying, I've never told anybody this, but this is what happened to me. Because I'd said I would post anonymously. So it became overwhelming really fast. There just wasn't any space for anybody to talk about any of kind of the things we face in our professional lives and there's such a taboo in the aid sector about talking about things that impact you. There's such a kind of silencing imperative that the only thing that matters is the welfare of affected populations, which is such a false dichotomy, because you can't look after affected people unless you're actually okay yourself, you just can't so.... So then the whole thing just kind of... thousands of people started using. This is well before Me Too this is 2o15. Well before Aid Too and I have recruited a couple of other people, a colleague called Megan Norbert, who very kindly stepped up to help me because it was becoming impossible to manage on my own. She's a sexual violence specialist. So we became the space where it was okay for people to say things like this happen to me or I... this is happening to me right now and I don't know what to do about it. Mental health is something I feel very strongly about having had my own issues, and having burnt out very badly after Haiti, and have seen the absolute inability to have any conversation in the aid sector without being horrendously judged, if you have any kind of psychological challenges at all. So we started talking about that, and a colleague of mine called Brendan McDonald, he's ex OCHA, who wrote a piece on, here's what happened to his mental health after Iraq, wrote it for The Guardian, and then got told by his organization that if he ever did anything like that again he'd be shut down. He he came on board as an admin for quite early doors. And we started lobbying actually at the World Humanitarian Summit in 2o16 to take aid welfare into account. So once we had this community, we started using it to try and kind of talk about welfare. But over the years, it's gone in so many different directions. We've had conversations about colonialism, we've had really ridiculously funny conversations, we've had people say things that they've never been able to say anywhere before, we sort of became centre stage after the Oxfam scandal. Again, that was a massive leap. We've advised so many people behind the scenes because so many people are too scared even to put stuff anonymously on the page, in case they're identified. I don't think I could have done it, actually, without training as a therapist and how to hold the boundaries. And now we're 27,000 people... It's, you know, you find anything on there from how to find a tax advisor specialising in international aid if you're based in Germany, through to where the best bit for Wi-Fi is in Islamabad airport. I mean, there's all sorts of stuff on there. And there's a whole admin team and now we've got some funding and we're trying to build a website so... And I'm really stepping back. So my little thing that I didn't intend to found sort of turned into this enormous, great, life consuming project, but the space just wasn't there before. And I don't know... There's now things on Instagram, there's now stuff on Twitter, but still the aid sector badly needs, I think, spaces for people to have honest conversations and connect, because the most common thing people say in 50 shades is, I thought it was just me. I thought I was the only one. And then they find out that actually... because we're so scared of talking about the difficult side of our work sometimes.

Lars Peter Nissen: 10:22

It's interesting because I, and I'm going to display my naivety here, it is one of the things I wanted to ask you was, we must have made some progress. When I started to 20 years ago, we had to go to see a therapist once we came home from mission that was part of the standard procedure, there was still a lot of stigma around it and some of the colleagues were very hesitant to... "Nothing's wrong with me, I'm not going to go there" and so on, but I always felt like people my age, which back then was 30, and now it's 50 something, that we understood that the situations we work in are not natural and will twist us in some ways and that having the wrinkles in your head ironed out is a good thing. But are you saying that that's not the case? Have we not made progress over the past 20 years? Or why? I mean, why is that space not there?

Imogen Wall: 11:22

I can't speak to 20 years, I can speak for the last kind of, five or six, when I've been involved. Certainly that I have seen considerable progress in that time. And CHS has started to take this stuff seriously (they're funding an internal group now), there's a lot more public conversation, but I mean, you're talking about 15 years ago, I can send you links that one of the things that we did quite early on in 50 Shades is collaborated with The Guardian. So if you look at the Secret Aid Worker column in The Guardian, a couple of articles back from 2o15 which I curated, which shed some of the stories of people... what happened to them when they talked about their mental health in their organisations and basically being told to leave. And that's still the greatest fear. And it's very well founded. It's not a phantom fear. That if you talk about or disclose that you've had any kind of psychological struggles in the past that you're going to be thought you... that makes you a bad humanitarian, rather than somebody either who is actually having completely normal and natural reaction, as you said to the circumstances of your mission, or, actually, if you look at the research, what are the six most significant chronic stressors for aid workers (and there has been quite a lot more research in the last few years), you will find actually the most significant stressor for aid workers is the way our organisations are run. And actually that fits in with everything we know about chronic stress: The big threat to us is not trauma. Trauma is... not primary trauma. Anyway, trauma traumatic incident is thankfully, very rare. Secondary trauma, vicarious trauma, is a much more significant risk. But that's a chronic thing. And that's a big... that's a manageable psychological risk that needs to be recognised in the workplace. But that actually has been something that has really only been discussed and identified and driven in the last five years, and primarily through journalism, and through through social media, through content moderators, and what content moderators experience. Vicarious trauma is the consequences of being exposed to the trauma of others. So through being a human rights worker through being a translator through and through content moderator. But that's that discourse is really happening now. But it's been driven by other sectors, I think the aid sector is still very slow to recognise that this is an inherent psychological risk in our work that actually affects people in headquarters as much as possible. Because the problem with the framing you're talking about from when you were... Is that is that psychological risk is something that only exists for field people. And that is absolutely, categorically not the case. Burnout is something you're prone to in headquarters, chronic stress is something you're prone to in headquarters, vicarious trauma, by definition, can affect people literally based anywhere, sitting at your desk in London or New York. So understanding the risk is not actually, if you look at the research, the risk is not actually associated with what happens in the field, the risk is associated with the way organisations are run so actually mental health is not something... in the West, we really individualise it. We talk about it as an individual issue that is for somebody to manage themselves, and to fix themselves in a quite private, secretive way, when there's a problem with it. And actually, mental health is an organisational challenge, because it's the circumstances for poor mental health are organizationally created and the solutions lie in organisational management and structure. They don't lie in sending somebody off to a therapist for four sessions or whatever and expecting them to be fixed and come back fine. That's not how it works. That's the conversation organisations don't want to have. They're very happy to fund you go and deal with yourself and then come back but they're not...

Lars Peter Nissen: 14:54

So I'd like to take... we'll get to the institutional stuff, that's a really, really interesting... but I'd like to take you back to what you talked about with the false dichotomy between aid workers and people in the field and how, "Let's not make ourselves the story, let's talk about the people who are really in need here", And I'd like to ask you, isn't there, isn't there an element of truth in that? I mean, how... aren't we... can we become too self obsessed? isn't it... isn't our job also to advocate on behalf of the people we serve? That whole line of thinking...

Imogen Wall: 15:25

Course it is. But that doesn't.... There's no... the false dichotomie's between thinking that there's... that involves us sacrificing our own psychological well being. And it's... that is what's nonsense. The big, the big shift for me, the kind of the big penny drop moment for me, was when I trained as a therapist. I'm now a professionally qualified therapists (I don't see people one to one at the moment outside of organisational work). But I work to a code of conduct. I have a professional association, BACP, British Association of Psychotherapists and Counsellors, they have a code of conduct. In that code of conduct, self care is my ethical responsibility. As a therapist, that actually ss an aid worker, my job is to be the support system for really, really damaged people, really traumatised people and it's exactly the same profile, taking care of myself is part of my job, because I cannot offer the support service to those people unless I'm alright myself. So I am ethically bound... All the way through therapy training, you have to be in therapy yourself. So you've got this... got an appropriate... that's mandatory. I had to provide evidence at the end of every year of all that I had signed off by my therapist that I've been in the right number of sessions, I have to have a supervisor, so I have to have for every six sessions I have with with clients, I have to have a debrief session with a supervisor: that's mandatory. That's hardwired into my professional ethical code of conduct as a therapist. And the shift sort of mentally from that... from aid world, where self sacrifice and running myself into the ground... You can't advocate on behalf of anybody if you're crying in a corner. And that is what happens to people. And I remember my very, very well respected colleague, Chris Gunness, you may have seen the video, who was the... had the very difficult job of being an HR spokesperson for many years, and who was a extremely articulate ex-BBC journalist, very good at the job, being interviewed at one point, I'm on stage of the Israeli Palestinian conflict, and the camera kept rolling after he'd finished the interview, and he just collapsed in tears. He thought the camera was off. And when that went viral, which it did, so many people said, that is how I feel. You know, you can't do your job if you're not functioning. So when Brandon and I started our campaign to get the World Humanitarian Summit to take this seriously, you know, How is it okay, how are we respecting the needs of affected populations, if we're sending a bunch of people who aren't functional? That's... to me, that's an absolute dereliction of our responsibilities as aid workers. So our campaign was "Be well, serve well". Because you cannot do one without the other. It's like, well, I mean, the thing when I teach you about it go back to the old cliche of the airbag on aeroplanes you put your own on before helping somebody else. It's not a suggestion on an aeroplane, that is a mandatory instruction, because you cannot help other people unless you alright yourself. It's not possible. So how we get to this idea of the opposite in humanitarian sector where unless we're running ourselves into the ground and working 16 hours a day, we're somehow we're somehow not doing our jobs when the absolute opposite is true. I don't know. It drives me absolutely potty.

Lars Peter: 18:38

But where does the pushback come from?

Imogen Wall: 18:40

Oh, the pushback comes from all sorts of levels, the most pushback... from the World Humanitarian Summit, they were very clear, you know, "We're not talking about us". And bear in mind "us" also includes the what 90% of the aid sector that is national staff, which is a different question? Like, the idea that you can't prioritise someone's psychological well being is also very much a statement of privilege. But they would flat out with, "That's not what we're for. We're about reforming the humanitarian sector, but we're not about considering the actual welfare of the people because..." We don't have a union as aid workers. I mean, my partner is a mental health nurse. And he's... was genuinely shocked that so much of the of the stories that came our way... I got a sister who works in an A&E department. I mean, they... it's understood, you know, that you do got to factor these things in. And yet in the sector, the whole sector said no in 2o16. Organisations found it very hard to get donors to prioritise this or to fund it because of the narrative we've just talked about. But I think the most insidious challenge actually is the internalised stigma between us as individuals. And this is where it gets really toxic. If you have people who are very driven, very committed, very idealistic, who are working for organisations that encourage that and encourage a kind of very tribal sort of loyalty, and that if you criticise the way they work or you criticise anything, especially publicly, that is... these organisations, there's a huge amount of fragility around them and this public narrative, which obviously I'm a former comms person, I understand very well, that if anybody says anything critical, then you're jeopardising funding, you're jeopardising projects, you know, you're... and so I've dealt with many people from 50 Shades from behind the scenes who said, If I speak about this publicly, I will be ostracised by my colleagues.

Lars Peter Nissen: 20:27

So, I mean, you describe very compellingly the way in which, sort of, the toxic intersection between our own, sort of, I don't know whether to call it martyr or hero complex about running yourself into the ground, combined with an institutional requirement to raise funds, to public perception, to somehow institutionalising, "This is not about us": How that runs contrary to best practice. Obviously, you opening 50 Shades of Aid was a channel, serving as an outlet for some of the personal experiences. But how about... what about the institutional level? What can you do in terms of changing the way in which institutions behave and create a more, I don't know whether to call a caring or professional or what, but a more enabling environment for people who are experts at running themselves into the ground?

Imogen Wall: 21:32

Oh, gosh, well, there's all sorts of things you can do. And actually, I think COVID has really opened up a conversation. Because the challenges of lockdowns, of having to work on our own, at home remotely, all of that: they affected everybody. And so they really channelled into this narrative that the people who, you know, need... who's... for whom mental health is a concern... that people in... out in the field, very senior people and very senior headquarters people also found out what it was like to, you know, to live with chronic stress in... and not have the outlets and all of that. And I think, partly because of that, because the universality of that experience, there's been a lot, a lot, a lot more conversations. So I was working at DFID on the COVID response early days when it was still deferred. And they were very consciously bringing stuff in and actually what they did... so one of the single most powerful things you can do in the org... in an organisation, is to have this conversation led by the most senior person available. So in DFID that was the permanent secretary who opened a town hall on subject, talking about how, you know, he was on his own at home, and how he was struggling with isolation and how it was affecting his concentration. Because this is the thing, it very quickly becomes about how you work. I mean, we work in an organisation that fetishize is overwork, that celebrates overwork. I have actually worked in an office, literally, with, I won't name the office or the organisation... and we had... there was one staff member who worked literally 18 hours a day, and she was on her knees with exhaustion. And the head of the office put her in front of the whole staff, most of whom were national staff, and said, this is how hard you should be working, this is what I expect. And she was making herself ill and that was actually explicitly held up as a model to follow. So that's... getting rid of that kind of mentality, and making it okay for people to say, actually, I'm not doing well, I need to step back and understand that actually, recovery is not just possible, it's likely and the people who've been through some of these things, particularly anxiety, actually come... A, you recover, vast majority people we see come out with actually an incredible toolset. You come up with an incredible understanding of yourself, and how you cope in difficult situations and how to cope and where your boundaries are. And those staff are, are invaluable. So starting to see this as an asset, I think helps, having the conversation there by senior people, looking at what we have to learn from thing... from everybody from journalism, to Facebook, to Samaritans (actually, I used to be of Samaritans volunteer, which is a suicide hotline), and how they manage the vicarious trauma risk because these risks are manageable. So with vicarious trauma, you limit the amount of exposure you have, you have regular debriefings, you rotate, and you you monitor people. That's... It's really not very complicated. It's also not very expensive. I mean, Facebook... you know, if you if you let people watch videos, all day long, of awful stuff, abuse and violence and far right content, all of that, and you don't support them in it, they're not going to be very well after a few months of doing that. And the Facebook case, which is a class action lawsuit brought against Facebook, found that one in two content moderators was not very well and Facebook had to pay out over $50 million. So that's where organisations start paying attention is when it's actually making people ill. But that kind of risk is manageable and there's actually lots of guidance on how to manage it. But it's... one of the things when I teach on this, and I teach vicarious trauma, the vast majority of aid workers I'm talking to have never even heard of the concept. So that's basic.

Lars Peter Nissen: 25:28

But if you had to... You say them one out of two content moderators in Facebook are not well. What's the number for aid workers?

Imogen Wall: 25:36

Don't know. There's not a great deal of research. There's big, big, big gaps in this. I can go and try and find numbers. I actually... I quote... there's... I quote, when I teach, I talk about Facebook, and I talk about the data from translators in the US in 2o19. It's not aid sector, they're translating for criminal trials in the US, which shows it's [inaudible] of translators. I certainly worked with the translator, in one emergency years ago, who had been listening to stories, essentially persecution and genocide, translating those for six months. She was national staff. She was coming home and cheering for two hours a night to try and get what was in her head out of her head. And she had no idea that it had a name or that she was allowed to be feeling that way or that was actually a normal and natural response to what she'd been put through. She was terrified of saying anything to her organisation because she thought she'd get fired if she did. So we're not talking about kind of complex psychological interventions here. We're talking about basic destigmatisation and education. So we understand that actually, these things are normal and natural reactions, which is the standard working definition of trauma response to abnormal events, to be put in very difficult circumstances and that you're going to you're going to have a reaction. And if you make it okay for people to say that, then actually you're going to improve your organisation. I can give you another example, a friend I know who won't mind... is identifiable from this, I think... but he's a very experienced humanitarian responder who was deployed to a... let's just say, a country in Africa. And after about a month in Africa, in this particular duty station, he realised he was jumping checkpoints. He was driving his national staff around and he wasn't bothering to stop at checkpoints, which is classic chronic stress burnout, because your cognitive capacity goes, your capacity to assess risk goes. And he realised he was doing this, had the self awareness to realise he was doing this and to contact his headquarters and said, I don't think I should be here, because I am taking risks that sooner or later are going to hurt me and hurt my staff. I don't think I should be here and they listened to him and they moved him back to headquarters for a period so he could recover. He'd done too many missions on the bounce. And that is where actually the psychological risk management becomes excellent organisational practice because you've got people who are putting themselves and others at risk, and I do a lot of training, to go back to your question, I've been part of a real movement to try and get psychological risk management and stress management into hostile environment training. So that you get it and staff at that level. And I worked with International Location Services, Security, sorry, Safety, who are one of the organisations who are really starting to take this seriously. And we teach it and then all the staff they will give you chapter and verse of examples of people they've seen create security situations because they were too stressed, too tired, too traumatised to actually make sensible decisions.

Lars Peter Nissen: 28:42

I think what I'm struggling with is to understand the real nature of the the obstacles, right? Because if I think of the organisations I've worked with, they mainly have had counsellors associated to them. And if you raise the flag, if you said that you needed something, you would get it. I've actually not experienced raising an issue around the mental health of a colleague or something and the organisation not reacting. Do you think that's... was I just lucky? Did I work with big organisations? Or is the problem that we... that this self... is the problem that we don't raise it?

Imogen Wall: 29:24

I can answer from my own experience? I mean, I have a history of depression, runs in the family. I am enormously privileged, you know, I'm good at my job, I am... I don't have kids, no one depends on me, I can say what the hell I want because I'm independent now. I remember going to work for one organisation and I did the medical, and it was frontline response organisation, and the medical said Do you... you know, part one there was a box: Have you ever suffered from any mental health disorders? And I really hesitated over ticking Yes, because I thought if I tick Yes, are they not going to deploy me? Are they are they... going to decide I'm uninsurable? Are they just going to think I'm too risky? And I had that moment, really, myself, of, you know, as a mental health advocate going, Oh, I don't know, should I fess up to this? And I can tell you it 50 shades. I don't, I mean, by definition, there's no data on this. But the number of people we've had writing to us over the years saying, "I really need a therapist, but I can't ask publicly on the page because my organisation will see it." Because a lot of organisations won't fund you. Or, you know, "I need medi..." Somebody was like, "I need medication. I'm on deployment. Are there any doctors that can prescribe? Again, can you ask this question anonymously, because..." for things that they'd been living with, for years, things like ADHD that they had completely under control that they were living with for years very successfully, but still worried if any of their colleagues found out, they would be professionally judged. And, as said, if you go look at some of the stories on the that we published in The Guardian, five, six years ago, you will see that it's a very real assessment that people make that once if I tell anybody I've... you know, I live with PTSD, that I'll never get employed again. That... and that's... because there's a lot of people have been told that. They've been told You're too risky, or If you can't handle it, that makes you a bad humanitarian. That's the worst. If you cannot handle what you're going through, then you must... this whole macho thing in the aid sector, you know, the Suck it up, or or You're bad at your job, or your vocation isn't real. It's... that's so manipulative, but it's really common. And as I said, I know that anecdotally, because people write and tell us so and they asked to be posted anonymously, because they're too worried about judgement.

Lars Peter Nissen: 31:33

But would you also agree that quite a lot of organisations have mechanisms in place so that if you actually go out and ask then the help is there? Or is that not so common, either?

Imogen Wall: 31:43

Up to a point. In big organisations, yes, they're getting better. But therapy is a very specific model. It's fundamentally reactive. So it's what, as I said, it doesn't address the problem of creating... you know, getting somebody to the point of breakdown in the first place. And also, it's a very odd model is a very, very Western model. The idea you'd go and talk to a stranger for an hour about your problems once a week. It's very... yeah, it's very Western. I mean, that's the whole therapy tradition. It's very European, very European-American tradition. So for a lot of people from other cultural backgrounds, it simply doesn't wash. I mean, it's just odd. So I've seen, you know, I've seen it fail in Indonesia, for example. People just like, "That's weird! Why would I do that?" It's also often only available in English, or it's... you know, the internal therapists are English. It's often not covered in medical insurance. You'll recall the Steve Dennis case from 2o15, when he was kidnapped, and when he sued NRC, who an organisation with an excellent reputation, [inaudible] at the forefront of the aid sector, you know, he sued them for failing to prevent the kidnap, but he also sued them for completely failing to provide him with appropriate support afterwards. Because, you know, even if you do have it in house, it's likely kind of six sessions and you're done. And unless your medical insurance covers more, which is something most people don't bother to check, and particularly national staff, medical insurance doesn't tend to cover it, then you're then you know, you've got to pay for it yourself. And that's an awful lot if especially if you're not working. And Steve Dennis is one. Steve Dennis is one. The court agreed the NRC had completely failed to provide appropriate psychological support to him after an incident. And that... you said... I don't know how much change has happened. I thought that ruling would really make the aid sector sit up because once money is involved, organisations tend to jump.

Lars Peter Nissen: 33:47

Yeah, that is a strong motivator. I was wondering, let's say that you became the secretary general of one of the big operational NGOs, one of the... Bah! You pick one in your head, don't tell us which one you pick. What are you going to do to put in place the perfect support system, creating a better work environment for the people that now work for you?

Imogen Wall: 34:14

Oh, my gosh, it's such a good question. I do think the most important thing is... it's actually what we're... legally, if I say if I'm British, I put to UK organisation, my legal duty of care requires me to provide itself [inaudible] workplace, and that includes psychological welfare. And that's also in the CHS commitment as well. So that includes making sure that people don't work ludicrous hours, that they don't work weekends, that they get appropriate access to sick pay, that they are... put a lot of emphasis on team building and on people spending social time together and getting to know each other. I would use my own personal experience to open a conversation about the importance of being open about mental health. The thing about... you understand when you get into kind of mental health work and the stuff that I do, the Mental Health First Aid training: You know, everything you're talking about (therapists, whatever) it's fundamental, it's reactive, it's post, you know, once there's a problem. And with everything to do with mental health you're looking at prevention. That's where you really need the interventions, because the earlier you pick things up, or the more you sort of manage situations correctly, that you don't get an issue arising at all. So a lot of it comes down to make sure people get paid on time. If you look at what actually makes people happy and successful in workplace, make sure people can develop themselves professionally. I would say this because I'm a Mental Health First Aid instructor, but I would make sure that there was... the objective is one in 10 of staff who are actually trained in not just how to spot the early signs and symptoms, but what to do, how to talk to people how to have a conversation, how to onward refer, all of that, and create an environment in which people can thrive and make sure that everybody who was working for us knew that, you know, had access to predeployment, postdeployment, but also this was applied in headquarters as well. I think it's particularly important to equip managers. I've worked with a lot of managers over the last year, senior managers, who feel they get a lot of stick, managers, particularly headquarters, they get a lot of criticism, and actually, a lot of them feel the emotional responsibility [inaudible] very, very acutely. But they don't know what to do. They panic, like someone's just broken into tears. How do I have that... What do I? Their so worried about making it worse... and no one trains them, no one equips them to actually have those conversations. So there's a lot of mystique around mental health and psychological risk and actually, when you really start to unpack it, and have a stigma-free conversation. It's really, it's really open. And as I said, I would try and instil a culture where you understand that people who have gone through incidences and experiences, as I'm sure you have, actually come away from that with extremely valuable knowledge and skills, which then makes them better at their job, ultimately. So that's, that, I think, is where I would start. And what I would hope to see out of it is not just, kind of, people feeling better, but also lower... greater staff retention, lower levels of sickness, the return on investment, from a financial point of view (heart knows this is private sector research for supporting mental health in the workplace) is one in five. So for every pound in the UK, you spend, you get five pounds in benefit in terms of reduced sick time, reduced turnover, retention of staff, and better quality work. So the... it's a very hard nosed thing, this. It's not kind of a, you know, let's sit around and sing Kumbaya together. It's this is how you actually run an effective organisation.

Lars Peter Nissen: 37:58

So I agree with that. And as you were talking, I was trying to figure out, Would this work if she really had this position... but she and she did these things would it work? And I think my reflection is that you focus a lot on the sort of policy side of things (I put this in place, this in place, this in place) and actually, you talk, for me, surprisingly little about the cultural side of it. I really liked the bit about you using yourself as an example and having the courage to stand up and say, you know, "This is this is what it's like", I like the bit about working with your managers. But I guess in my head, I thought it was more cultural. But you really... in the way you describe the solution, describe the problem, is predominantly one of policy and systems and getting paid on time. Is that right?

Yeah, it's structural. Absolutely. And this is a lot of the way we think about mental health. It all tends to be quite kind of fluffy and go do some yoga or... (you know, not to criticise people who do yoga. I know a lot of people who get out of it. it's not my thing, but there we go), but no, I mean, I'm speaking... actually, it's interesting reflection from you because I think what I'm speaking from after two years now of doing this professionally, of teaching and having people come to me and say what can you do for us, and we explain that, rather than being just an advocate as I was to 50 shades where we were talking much more about, kind of, personal experiences. So now, you know, organisations want to [inaudible]... you know, they're going to invest in the stuff that I do they need bang for buck. They need to see... And I'm like, Look, I can double... In a single mental health first aid course I can double your staff's knowledge, but I can also double their confidence. I can see their self assess confidence go from four out of 10 speaking about mental health to nine out of 10 and I can do that in five sessions. So the people want... You know, it's like any other area of aid, people do want data, but also the more you look at the this research, there's a huge amount of mystique around mental health and it's part of the stigma. That whole kind of, you know, "Oh it's all very wooly and vague" and actually, it really isn't. And that's, and that's not a... you know... that's now we see... that there's clinical data around this. So one of the things that I would definitely do if I was running this organisation is make sure that people had time in their day to get outside in daylight once a day, for example. Because the clinical data shows that is as effective as antidepressants for mild to moderate depression, half an hour's exercise outdoors, because you need to manufacture serotonin. And stress also, look at stress management, stress happens in your body, it's biological. It's not, it's kind of mystery, mental health, sort of phantom weird, sort of floaty round thing. It's very, you know, there's... the data is there. So, yeah, you're right, I have come to talk about it in a much less culture, in a much more kind of this is.... these are the practical, simple things you can do, because it's... the data is there that that's what ultimately drives change.

Yeah, I think the thing that keeps on bouncing in my head is this saying, you know, culture eats strategy for breakfast. And I wonder whether what you put in place here, what you talk about, is enough to change that very ingrained culture that we have spoken about in this conversation, that stigma associated with it that hero complex, or whatever you want to call it, that whole crunch that a lot of people find themselves in. Do you think that sunlight and getting paid on time will help change that?

Unknown Speaker: 41:35

I certainly... I saw... I mean, the being paid on time or, you know, I worked in Indonesia after the tsunami and our accounts department thought it was fine to pay national staff two weeks later, but some of them were my colleagues and I saw the stress when you have 30 people depending on your salary and it's not okay when it comes two weeks late. That's, that's gonna mess with you. Never mind the fact you've just survived an emergency, you know, you've got 80... you've got 30 people hanging on payments. Yeah, so the practical side of it is, you know, I've seen that in practice very much. The cultural side... and I still have organisations say to me that, this is a private sector, this isn't an aid sector organisation, I teach Mental Health First Aid, literally in one company come back to me and say, "We think we need it, we like it. Can we call it something other than mental health? Because we're scared of that language." And I work with them. The problem is that they the younger generation, I think are much, much more open, but I work with at least one organisation on a regular basis, who I won't name, and then the person I'm working with who's relatively young, her main challenge is that the board are made up of, you know, people who stuck it out in the mud for 30 years and think that anybody who's struggling is basically weak. And so they don't want to talk about it and they don't want to, they don't see the need for it, they're not interested in those people, their turnover is insane, because people are burning out. But people leave for all sorts of other reasons. They won't say, "Oh, I'm burnt out". They quit for other organisations. So the problem remains invisible. So I have certainly found that if you're those are the people you're trying to convince to invest in, what is going to actually deliver for an organisation, you have to be quite hard nosed about it. And you can't you know, the whole kind of this is, you know, this is just going to make everybody a bit happier doesn't really wash, especially when you got people who won't even use the words mental health. So I call it psychological risk management, I call it well being, you know, I've learned to change... It's another learned behaviour of mine over the last two years, change the language. But I've got more and more aid agencies coming to me and coming to my colleagues coming to others in the aid sector saying that, we now see that actually, we... this is... we need this for our organisation, this is not going away. And COVID has really driven that. I mean, it's not probably a little bit less extreme, it's not probably entirely dissimilar to, in the UK, the history of research into trauma is very much been driven by conflict, take trauma, specifically, and it was it was driven during the First World War by literally there were so many soldiers struggling, that they couldn't run an army properly. So suddenly, people got interested in trauma and understanding what was going on. And that, sadly, that kind of very pragmatic thing, I think, now is driving a lot of the conversation now, that you... we've got so many staff who are really struggling, who are burnt out, we're gonna lose them, can't replace them fast, we're gonna lose a lot of expertise, we're gonna need a lot of institutional memory. And because senior people have also struggled over the last two years, they see actually they... if I'm struggling, maybe I'm wrong in my assumption that only people who are weak or damaged or not really able to cope can't handle this. That's the most insidious cultural thing that needs to go. And it's a super internalised aspect of that, that makes it that makes it very difficult challenge, why, you know, public conversations are so important. But one of the things we do as Mental Health First Aiders, and I do very much, is bring hope, you know? and the conversations about mental health are so fraught because people don't want to talk about this because they think it's all very scary. You know, particularly you get appropriate treatment early on, almost everybody recovers, you're going to be fine. It's, you know, it's treatable, it's manageable. PTSD, your chances of recovering from PTSD are hugely increased with a diagnosis and with appropriate treatment. That's just fact. So that kind of prevention... and look, it's, you do start to struggle, it's just because you, you're having a reaction to something, your brain is trying to tell you something's wrong. So let's do something about it.

Lars Peter Nissen: 45:37

I think that's an excellent note to end on. And I think we should say that, to anybody listening who is struggling, in one way or another stuck somewhere in a situation that's not good, Join 50 Shades of aid and there's a space where you can talk about these things and figure out how other people are dealing with them and potentially get some help.

Imogen Wall: 45:59

Yeah, come find me, come find us. Find me, I got a website, you can ping me on Facebook. I'm very happy to chat. And I really understand that for a lot of people, it's very hard, it's still a very hard thing to talk about, publicly. And the other thing I should say culturally, particularly for people who aren't, you know, from countries where this discourse is open, is that the cultural implications, the implications of shame and stigma for their entire families for their communities can be enormous. It's a bit like sexual violence in that respect. So I totally respect the need for people to talk anonymously, because the social and personal consequences for them could also be very, very significant in places for example where attempting suicide is still illegal. Where you'll get a large fine or put in prison, which is still 25 countries in the world. So yeah. So come find me. And if you want to, you want to drop me a line to my website, or come to 50 shades we know we'll be happy to chat.

Lars Peter: 46:53

Great. Imogen, thank you for your work. Thank you for opening these spaces for an extremely necessary conversation and thank you for your courage and speaking up in this way.

Imogen Wall: 47:04

You're more than welcome. I'm very lucky to be able to do so. It's a pleasure to be here. Thank you.