The Role of Psychology in Medical Volunteering: A Personal Reflection
There is already a literature on volunteering and the benefits of volunteering, both to communities being served and the personal or psychological benefits accruing to the volunteer. There is a literature which reports on the benefits to the community served, enhancing social trust, and also the benefits to the volunteers themselves, including less loneliness, increased optimism, a more robust sense of purpose in life, less helplessness, and fewer depressive symptoms (Berglund xxx). The role of clinical psychology in facilitating mental health through medical volunteering is less well described. In this blog I wish to draw upon my experience as a psychologist volunteering through the Tshemba Foundation and describe the potential benefits which psychologists may bring to medical volunteering.
I am currently volunteering with the Tshemba Foundation South Africa and have previously had the opportunity to undertake a program organised by the Mandala Foundation https://mandalastaffsupport.org/wordpress/. The Tshemba Foundation was established for the purpose of enhancing health within the Mpumalanga region of South Africa.
Clinical psychologists have training in the assessment and treatment of mental, emotional and behavioural disorders against a background of broader training in psychology. They can draw upon the science of psychology to address complex human problems and promote adaptive change. They may also bring skills in understanding organisations and promoting human development more broadly.
With this background, an obvious role for clinical psychologist is the provision of mental health services addressing the psychological needs of individuals or groups. However, there are significant limitations to traditional individual-focussed models of psychotherapy. Psychologists are able to draw upon far more skills relevant to medical volunteering then may first be evident. I wish to outline five areas in which psychologists may make a meaningful contribution to medical volunteering.
Ways in Which Psychologists may Contribute to Medical Volunteering.
1. Psychosocial support for patients. The most obvious area for psychologists with relevant qualifications is the provision of support to people who present with mental health issues. However, there are several constraints related to differences in context, culture, and language issues.
Very recently, a woman presented herself to my office. She shared with me in broken English that she had lost a 4-day old baby and had lost her mother a few months prior. Observing tears running down her cheeks I attempted to convey some understanding of her plight, and to convey that such experiences are hard to bear. Understanding by another is often the first step in providing healing.
Whether one is working in a rural hospital or in a refugee camp or some other context, the capacity to work with the other and to provide understanding and attunement is therapeutic and hopefully contributes to the wellbeing of persons who might desperately be seeking the support of the other.
2. Psychosocial Support for Health Practitioners.
Psychologists are in a good position support volunteer staff including doctors, nurses, and allied healthcare professionals who may be dealing with demands which cannot always be met and the frustrations which may well result from contexts.
Psychologists can support medical and allied health volunteers undertaking voluntary work in contexts which may be demanding on the resources of fellow volunteers and fellow workers.
In my role as a volunteer through Tshemba, I found myself moving increasingly into a role of supporting staff including doctors undertaking compulsory community service. Our meetings focussed upon the participants experience of working in a resource poor context where health demands would outstrip the capacity meet demands. My role has included basic counselling, debriefing, and more general mental health support to staff.
Engaging in reflective practice counters processes such as “burnout” and “compassion fatigue” by allowing doctors to reflect on their experiences, discuss challenges they may be facing, and find emotional support within their peer group.
3. Training and Capacity Building. Psychologists are in the unique position to provide professional development in a range of areas relating to mental health. Psychologists often have expertise in both pedagogy and discipline-related knowledge fundamental to promoting mental health, often through capacity building. Areas may include the assessment of presenting issues, principles of therapeutic approaches taking into account local understandings and values, teaching psychological first aid and the provision of more general professional development for health workers.
My colleague, Professor Ashraf Kagee, working with the Gaza Community Mental Health Programme (https://www.gcmhp.org)/, draws upon psychology to better understand the synergy between a public health and human-rights informed perspective to address the needs of communities living under siege and military activity. One such program involves training mental health workers to engage in effective psychology interventions.
Prof Kagee has commented that:
Many people in Gaza experience trauma, grief and bereavement as a consequence of the siege and regular military attacks. A political solution does not seem possible at this stage and thus people must cope with and manage their distress. Mental health professionals therefore play an important role by helping to ameliorate distress and using evidence-based approaches to treating people for conditions such as depression, anxiety and posttraumatic stress.
4. Supporting Aid Workers.
For many years, the Mandala Foundation, based in Melbourne, Australia, developed a suite of programs to support aid workers internationally. Programs included: pre-deployment training, psychological assessments, and offering emotional support through counselling and facilitating debriefing sessions, all aimed at facilitating the capacity of volunteers. Psychologists have provided training on trauma-informed care, established peer support programs, and offered ongoing support after volunteers return home. These efforts were designed to enhance the mental well-being of volunteers and ensure their effectiveness in providing care to those in need. Collaboration with psychologists has contributed to enhancing volunteers' overall well-being and strengthening the aid agency's ability to provide effective humanitarian assistance.
Some years ago, I travelled to Myanmar with the brief to provide support to psychosocial workers who were supporting the local population during the anniversary of Cyclone Nargis, which was responsible for causing catastrophic destruction and over 138,000 fatalities. Australia was a major source of aid to Myanmar. Several aid agencies were supported in the aftermath of addressing almost indescribably destruction. With the effects of climate change, it is likely that countries will see increasing demands upon aid workers and the demands placed upon personnel.
5. Organisational Development. Psychologists can assist organisations to be more effective in achieving their goals. The medical volunteer context can be complex and underpinned by differences in values, customs and expectations. Differences may occur between volunteers from different parts to the world, between volunteers and local populations and their respective values, with many volunteers coming from resource-rich communities or working within management structures which differ from the expectations of the volunteer. It is easy to get into an “us and them” mindset or feel stressed and rely on psychological defences such as splitting, giving rise to simplistic thinking and fostering a “blaming” culture. Psychologists are able to work with groups to recognise ways in which they may be able to assist organisation to optimise their effectiveness.
In my current context, I worked with a small group of staff who wished to gain a better sense of “working together”. It became clear that various members of the team had different ideas around authority and autonomy. At the same time, some members of the team felt less valued by more senior staff. These discussions led to more meaningful communication, and while it is unlikely that all difficulties have been resolved, participants have a better appreciation of the issues influencing the group.
Psychologists can add value to the mental health of patients, health practitioners, and organizations in challenging medical volunteering environments. I have focused on just 5 areas in which psychologists may contribute to medical volunteering. There are additional areas including: crises intervention, developing programs to address stigmatisation, advocacy and research, the assessment of mental health needs, and designing and implementing community-based mental health programs. Commitment to any one or more of these objectives is dependent on many factors including the time allocated to volunteering and the expectations and preparation which may be involved prior to implementing the potential programs as described.
I have outlined some areas in which psychologists may well be able to add value to the wellbeing of patients, health practitioners and organisations working in challenging and sometimes critical environments. Such involvements are of course, beneficial to communities and richly rewarding for the practitioner.
Psychologists have capacity to contribute to volunteering through:
Playing a crucial role in providing psychosocial support to patients facing mental health issues in medical volunteering contexts, despite language and cultural challenges.
Offering emotional support and counselling to healthcare professionals and volunteers dealing with stress and demands in post-conflict or under-resourced settings.
Providing training and capacity building in mental health-related areas, enhancing the skills and knowledge of other volunteers.
Supporting fellow volunteers through pre-deployment training, psychological assessments, emotional assistance, and debriefing sessions, ensuring their well-being and effectiveness in providing care.
Facilitating debriefing and reflective practices, helping volunteers process their experiences, discuss challenges, and find emotional support, thus countering burnout and compassion fatigue.
By Robert Schweitzer
Professor of Psychology, Australia
Related blog post originally appeared in Psychology Today.