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Mental Health in UN Peace Operations: Addressing Stress, Trauma, and PTSD Among Field Personnel

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Mental Health in UN Peace Operations: Addressing Stress, Trauma, and PTSD Among Field Personnel DECEMBER 2020 Mental Health in UN Peace Operations: Addressing Stress, Trauma, and PTSD among Field Personnel NAMIE DI RAZZA Cover Photo: UN peacekeeper guarding ABOUT THE AUTHOR the temporary operating base of the UN Organization Stabilization Mission in the NAMIE DI RAZZA is a Senior Fellow and the Head of Democratic Republic of the Congo Protection of Civilians at the International Peace Institute. (MONUSCO) in Mpati, North Kivu, 2012. Alexis Guidotti. Email: [email protected] Disclaimer: The views expressed in this paper represent those of the author ACKNOWLEDGEMENTS and not necessarily those of the International Peace Institute. IPI The author would like to thank all those who offered their welcomes consideration of a wide insights and perspectives during the interviews and consul- range of perspectives in the pursuit of tations conducted for this research project. She is particu- a well-informed debate on critical larly grateful to UN colleagues from the Secretariat who policies and issues in international supported the research and to current and former UN staff affairs. who shared their personal experiences and stories. She IPI Publications would also like to thank the military advisers, police Albert Trithart, Editor advisers, peacekeeping experts, and mental health experts Meredith Harris, Editorial Intern who informed the analysis and the permanent mission of Canada to the UN for facilitating a roundtable discussion with troop- and police-contributing countries in July 2020. Suggested Citation: Namie Di Razza, “Mental Health in UN The author is also thankful to those who provided Peace Operations: Addressing Stress, feedback on earlier drafts of the report. Special thanks to Trauma, and PTSD among Field Personnel,” International Peace Institute, Fabrizio Hochschild, Martin Girard, Jake Sherman, December 2020. Alexandra Novosseloff, Arthur Boutellis, and Alexis Guidotti for their valuable feedback and contributions. © by International Peace Institute, 2020 The author wants to express her infinite gratitude to Albert All Rights Reserved Trithart. This publication would not have been possible without his meticulous work and his patience, dedication, www.ipinst.org and support throughout the publication process. The author also thanks Meredith Harris for her help with the research methodology and proofreading, as well as Shilpa Venigandla and Alejandro Garcia for their background research. IPI owes a debt of gratitude to its many donors for their generous support. IPI is particularly grateful to the French Ministry of Armed Forces’ Directorate General for International Relations and Strategy (DGRIS) for making this publication possible. CONTENTS Abbreviations . iii Executive Summary . v Introduction. 1 Prevalence of Mental Health Issues . 2 Data on the Mental Health of UN Staff . 2 Data on the Mental Health of UN Peacekeepers. 4 The Impact of Mental Health Issues on the Effectiveness of Peace Operations . 6 Factors and Conditions Contributing to Mental Health Issues . 8 Hardship Environments . 8 The Nature of Peacekeeping Mandates, Approaches, and Responsibilities . 11 The UN Bureaucracy . 15 Institutional and Political Challenges to Addressing Mental Health . 18 A Sensitive Topic . 19 The Division of Responsibilities with Member States . 21 A Focus on Self-Care . 23 The UN Mental Health and Well-Being Strategy . 23 The Current Response . 25 Preparedness and Prevention . 25 Support Systems in the Field. 27 Post-deployment: Administrative and Legal Processes . 35 Conclusion: Upholding the UN’s Duty of Care to All Peacekeepers. 38 Raising the Profile of Mental Health in UN Peace Operations . 38 Pre-deployment Support . 40 Support During Deployment . 41 Post-deployment Support . 42 Annex 1. Approaches to Mental Health in Troop- and Police-Contributing Countries . 44 Annex 2. Approaches to Mental Health in Other UN and Non-UN Entities . 45 ABBREVIATIONS CAR Central African Republic CISMU Critical Incident Stress Management Unit DOS UN Department of Operational Support DRC Democratic Republic of the Congo ICRC International Committee of the Red Cross IFRC International Federation of Red Cross and Red Crescent Societies OCHA UN Office for the Coordination of Humanitarian Affairs OIOS UN Office of Internal Oversight Services PTSD Post-traumatic stress disorder R&R Rest and recuperation SSAFE Safe and Secure Approaches in Field Environments TCC Troop-contributing country UNAMI UN Assistance Mission in Iraq UNDP UN Development Programme UNDSS UN Department of Safety and Security UNHCR UN Refugee Agency UNSMS UN Security Management System WHO World Health Organization Executive Summary The challenging environments where many psychosocial support in the field is inconsistent and contemporary UN peace operations are deployed fragmented, with three Secretariat departments all can take a toll on the mental health of both working on mental health and two separate uniformed and civilian personnel. There is counselling services. Post-deployment, when many increasing evidence that rates of post-traumatic long-term mental health issues manifest stress disorder (PTSD) and other mental health themselves, the UN provides few mental health issues are higher among people who have deployed resources to personnel. to UN peace operations than in the general popula- tion. This has serious consequences both for the To address these gaps, the UN system and UN performance, reputation, and finances of the UN member states urgently need to prioritize their and, more importantly, for the health and well- duty of care to the troops, police officers, and being of UN field personnel. civilians ready to live in dangerous, isolated duty stations with limited resources. To do so, they Three main stressors contribute to the high rates of should consider taking the following steps: mental health issues among UN field personnel. First, the environment where peacekeepers operate • Raising the profile of mental health in UN can be a source of stress, both in terms of the peace operations: The Secretariat and member security risks they face and in terms of their living states should shed light on the difficult conditions. A second source of stress is the nature conditions facing peacekeeping personnel and of peacekeepers’ work, including their difficult better assess the prevalence of mental health mandates, restrictions on what they can do, and issues among staff; strive to reduce the stigma their multidimensional working arrangements. associated with mental health; and come to a Finally, the UN’s bureaucracy, including its rules clear understanding of their roles and respon- and regulations, managerial culture, and human sibilities in supporting mental health needs. resources system, is one of the most acute stress • Providing more pre-deployment support: factors. There is a need to train and sensitize personnel on how to recognize mental health issues, Despite the prevalence of mental health issues, symptoms, and coping mechanisms. most UN staff have not received mental health Preparedness and pre-deployment training on support. There are several reasons for this. Mental PTSD, trauma, and mental health should be health remains a sensitive topic, with persistent based on minimum standards so that all stigmas, cultural approaches that vary from contingents are equally prepared and country to country, and an institutional culture equipped. that has made “fitness for hardship” a core require- • Strengthening support during deployment: ment for the job. The division of responsibilities for Both the Secretariat and member states should mental health support between the UN Secretariat, uphold their duty of care for personnel in troop- and police-contributing countries, and missions, including by fostering a culture of individual staff members also remains subject to care, offering adequate psychosocial support, debate. Moreover, while the UN put in place a and improving human resources arrange- Mental Health and Well-Being Strategy in 2018, ments. this strategy has been challenging to implement. • Continuing to provide support post-deploy- ment: The UN and member states should While the UN has established processes and recognize that their duty of care does not end structures to address mental health before, during, after field personnel return from deployment. and after deployment, major gaps remain. Pre- They should continue following up with deployment selection and training processes former personnel to ensure they are receiving include only cursory elements to prevent and raise the psychosocial support they need through awareness of mental health issues and to help dedicated structures and resources. personnel manage stress. The architecture for Mental Health in UN Peace Operations: Addressing Stress, Trauma, and PTSD among Field Personnel 1 Introduction witnessing the effects of war and atrocities can impact the mental health of any individual. Many contemporary UN peace operations are Nonetheless, the UN can work to improve the deployed in extremely challenging and non- mental health of its personnel and has taken permissive environments. Going far beyond important steps in this direction. The secretary- traditional peacekeeping, where UN military general has been vocal in promoting mental health, observers were monitoring cease-fires and peace and the UN Mental Health and Well-Being agreements in relatively peaceful conditions, the Strategy, launched in October 2018, has elevated Security Council has pushed UN missions to new the issue to a strategic
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