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Article Excerpt
Abstract
Psychosocial assistance in emergencies plays an important role in alleviating suffering and promoting well-being, but it is often a source of unintended harm. A prerequisite for ethically appropriate support is awareness of how psychosocial programs may cause harm. This paper underscores the importance of attending to issues of coordination, dependency, politicization of aid, assessment, short-term assistance, imposition of outsider approaches, protection, and impact evaluation. With regard to each of these issues, it suggests practical steps that may be taken to reduce harm and maximize the humanitarian value of psychosocial assistance.
Resume
L'assistance psychosociale dans des situations d'urgences joue un role important dans le soulagement de la souffrance et la promotion du bien-etre ; mais, souvent, elle est la source de prejudices non intentionnels. Une connaissance de la facon dont les programmes psychosociaux peuvent causer des prejudices est un prealable pour un support ethiquement convenable. Cet article souligne l'importance de la prise en consideration des problemes lies a la coordination, la dependance, la politisation de l'aide, l'evaluation, l'assistance a court terme, l'imposition des approches par des personnes exterieures, la protection, et l'evaluation de l'impact. Il suggere des mesures pratiques qui peuvent etre prises par rapport a chacun de ces problemes pour reduire les prejudices et optimiser la valeur humanitaire de l'assistance psychosociale.L'assistance psychosociale dans des situations d'urgences joue un role important dans le soulagement de la souffrance et la promotion du bien-etre ; mais, souvent, elle est la source de prejudices non intentionnels. Une connaissance de la facon dont les programmes psychosociaux peuvent causer des prejudices est un prealable pour un support ethiquement convenable. Cet article souligne l'importance de la prise en consideration des problemes lies a la coordination, la dependance, la politisation de l'aide, l'evaluation, l'assistance a court terme, l'imposition des approches par des personnes exterieures, la protection, et l'evaluation de l'impact. Il suggere des mesures pratiques qui peuvent etre prises par rapport a chacun de ces problemes pour reduire les prejudices et optimiser la valeur humanitaire de l'assistance psychosociale.
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For many years, psychosocial support to refugees and internally displaced people was viewed through the lens of Maslowian psychology (1) as a second-tier operation, something to be done after one had met people's basic survival needs in an emergency. More than any other single event, the December 2004 tsunami showed that the psychosocial effects of catastrophic events are not secondary but primary dimensions of the lived experience of emergencies. For a child who had hoped for a good life but who in a matter of minutes lost her home, family, village, belongings, and many friends, the psychosocial shocks were not secondary to her material losses or things to be dealt with later. This brief but catastrophic moment convinced the world that psychosocial support ought to occur at the same time one applies the most immediate life-saving measures in areas such as health, water and sanitation, shelter, and food aid.
This increased priority of psychosocial interventions is owed in part to the professionalization of the field of psychosocial assistance to displaced people. This trend is evident in three respects. First, there is a rapidly growing literature on the psychosocial impact of forced migration that spans multiple continents, age groups, and kinds of vulnerability and that increasingly takes into account issues of gender, class, and culture. (2) Second is an expanding array of promising practices in supporting displaced people (3) and increased attention to the importance of documenting the impact of psychosocial programs. (4) Third is the development of global, inter-agency guidance regarding psychosocial support. Following a mandate from the Inter-Agency Standing Committee (IASC), twenty-seven UN agencies and consortia of non-governmental agencies (NGOs) have recently constructed the first global guidance on the minimum response to mental health and psychosocial support needs in emergency settings. (5) This guidance simultaneously points practitioners in the directions that have proven most effective and cautions against harmful practices.
Despite the increased professionalization and legitimacy of the field of psychosocial assistance to displaced people, there are significant, ongoing concerns about respect for the humanitarian imperative "Do No Harm." In nearly every emergency, unnecessary harm is caused by the very humanitarian operations that are intended to support affected people. (6) One of the main factors that enables harm is the paucity of systemic evidence regarding which psychosocial interventions work or are most effective per dollar of investment. Although the field of psychosocial assistance shows increasing professionalization, it does not have the impressive array of proven interventions visible in humanitarian sectors such as health. In the absence of hard evidence, psychosocial interventions are often guided by preconceptions, personal preferences, and ideologies rather than by applied science that takes into account the unique historical, political, cultural, and social realities of the affected people and their situation. Too often, emergencies serve as a testing ground in which well-intentioned psychologists, including those who have little or no field experience, ply their latest tools, most of which have not been validated in the local context.
The likelihood of causing harm owes much to myriad factors such as the competitive structure of the humanitarian enterprise, uncertainties about its fundamental goals and orientation, (7) the power differential between outside agencies and local people, (8) the complexities of local culture and politics (9) not to mention the complexities of humanitarian politics, (10) and the lack of appropriate training for international psychosocial workers. Also, most professional codes of ethics and institutional review boards, neither of which were designed with large-scale emergencies and diverse cultures and situations in mind, offer scant guidance or oversight. For most humanitarian workers, the author included, the pressures of an emergency overwhelm the propensity for self-reflection. The sad irony is that without critical self-reflection, one is unlikely either to see the inadvertent harm one causes or to take the steps needed to correct and prevent harm.
This paper aims to identify some of the main ways in which psychosocial interventions cause harm and to offer concrete suggestions regarding how to prevent harm. It seeks to avoid denigrating the field of psychosocial support or paralyzing workers by suggesting that psychosocial programs inevitably do more harm than good. Rather, its goal is to offer constructive criticism that strengthens psychosocial work by helping to prevent unnecessary harm. My core assumption, derived largely from field experience, is that much harm can be prevented through a mixture of critical self-awareness and action. With this in mind, I will examine seven key issues, which are not exhaustive but which arise repeatedly and warrant...
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