Mapping Mental Health Support For Resilient Activists

V September 30th, 2022
Findings from interviews with mental health practitioners in Malaysia,  Myanmar, the Philippines, Taiwan, and Thailand.

By Zulaikha Mohamad (Malaysia), Research Manager

Download a PDF version of this report here.

Theme 1: How Burnout, Traumas, and a Culture of Sacrifice Affect Activists’ Well-being 

Activists and human rights defenders come to mental health practitioners for a range of issues such as  depression, anxiety, anger, grief, and sleep difficulties. However, burnout was cited as the most  prominent mental health issue affecting HRDs, having been mentioned in more than half of the  conducted interviews. Practitioners recognized that the work of activists and HRDs can be both  emotionally and physically exhausting. A few reasons were given as to why this is the case. 

One of them is that human rights work can be deeply personal. More often than not, HRDs are involved  in causes that they have been or continue to be affected by. Psychological trauma is a recurring theme  within the interviews and is present in different forms. For instance, many HRDs come into this type of  work with past experiences of trauma related to their cause. A clinical psychologist in Malaysia pointed  out that some HRDs have not processed their traumas and they remain unresolved, which make them  more vulnerable to mental health issues. Dealing with an issue that is personal to activists can also lead  to re-traumatization. Additionally, many HRDs are at risk of experiencing secondary trauma due to  repeated exposure to people undergoing traumatic events. Safety and security are also major concerns  for activists as they tend to be subjected to harassment, hostility, and/or physical violence. As a result,  activists experience trauma and severe anxiety and stress. Practitioners also mentioned that activists  who manage to escape state violence often experience ‘survivor’s guilt’.

A watercolor wash that looks like a galaxy with text that reads, "Culture of Martrydom + Low Mental Health Priority = Burnout & Unsustainable Activism".

A culture of sacrifice and martyrdom was also cited as a prominent issue. HRDs often feel obligated to  sacrifice their time and well-being to serve a cause or the people around them. Taking a break is almost  unfathomable for some and can lead to feelings of guilt. Some practitioners pointed out that this  culture tends to be reinforced by leaders or colleagues within human rights groups and organizations. In  this case, practitioners are not able to offer much help in addressing the situation.

A watercolor wash that looks like a purplish–blue galaxy with 3 quotes from 3 mental health practitioners. The first quote by a mental health practitioner in the Philippines is "More and more human rights defenders were reported to experience high level stress, anxiety, and trauma from documenting cases of human rights violations. Day after day of documenting, hearing stories of abuses and killings have affected the well being of HRDs”. The second quote is by another practitioner in the Philippines that reads, “There is a culture of martyrdom where activists do not consider the need or cannot make time to prioritize their well-being given the overwhelming work or undervaluing of health literacy for activist mental health. Priority is always the community’s welfare over one’s own”. The last quote is from a practitioner in Taiwan that goes, “Some movements have conflicts internally or oppressions internally. So, when we can’t engage the problem internally, what we can do is sometimes more limited”. In the corner is a star map that connects the words “Trauma”, “Oppression”, “Guilt” and “Loss” to “Burnout”.

Theme 2: How a lack of time, urgency, and space prevents activists from accessing mental  health support 

Attitudes toward mental health were identified by practitioners as one of the barriers in providing  mental health support to HRDs. Mental health was often not prioritized or not deemed important  enough by both individuals and organizations. Seeking mental health support tends to be delayed and  only considered when HRDs are already going through a crisis. 

Due to the burden of human rights work and lack of importance on mental health, irregular or  inconsistent sessions also posed a challenge for some practitioners. Most practitioners interviewed  provide counseling or psychotherapy, which tend to require several sessions to be effective. They  reported that because work takes precedence before well-being, HRDs tend to reschedule or cancel  therapy sessions when urgent matters arise. 

In addition, financial costs and lack of resources are also the culprit behind inconsistent sessions. Low cost options to mental health services are limited and, due to their demand, waiting times can last  weeks or months. On top of this, interviewees identified that there is a lack of skilled practitioners who  can cater to activist clients. 

Some practitioners struggled with a lack of physical space to conduct sessions. In one case, the  practitioner was asked to conduct group therapy sessions by a human rights organization at their center.  Unfortunately, the center was not equipped with a space that was conducive for conducting private  sessions with no distractions.

Some practitioners need to conduct online sessions, in place of in-person sessions, due to the COVID-19  pandemic and existing security risks (such as monitoring of activists by the State). This was particularly  challenging for practitioners in Myanmar as their services tend to be disrupted by electricity cut-offs  and internet shutdowns. They also believed that sessions were more effective when done in-person.

A watercolor wash that looks like a greenish–blue galaxy with 2 quotes from 2 mental health practitioners. The first quote by a mental health practitioner in Malaysia is “So sometimes we had to have group therapy in the open space where there will be people walking in and out and it's not confidential, it's not safe and sometimes they'd be called to go to work midway through”. The last quote is from a practitioner in Myanmar that goes, “My personal belief is that services can be more effective when counselor-client interactions and engagement are in-person”.

Theme 3: How mental health practitioners need to be supported and equipped to support  activists better  

Practitioners were asked what they believed were the kinds of knowledge and skills needed to provide  mental health services to activists and HRDs. First and foremost, practitioners highlighted that mental  health service providers must be competent in the treatment or therapeutic modalities they use. A  solid foundational knowledge is a must.

Most practitioners emphasized the need to understand human rights work and what it entails. One  person mentioned that practitioners need to “understand the language of human rights defenders.” At  baseline, practitioners need to understand basic human rights principles and local laws. Several  practitioners suggested familiarizing oneself with human rights movements in their country and keeping  up to date with global issues. A few mentioned the importance of being competent in crisis  management and holistic security due to HRDs’ heightened safety risks.

Practitioners generally strayed from one-size-fits-all solutions and highlighted the importance of  considering context and nuance. For example, taking into account the impacts of being part of a  marginalized group (such as the LGBTQ community) on a client’s well-being and life experience. This  could aid in strengthening the therapeutic relationship and enable practitioners to provide appropriate  forms of support. Essentially, practitioners need to practice a reflexive approach.

A watercolor wash that looks like a purplish–blue galaxy with clouds of green. Written on top are 2 quotes from 2 mental health practitioners. The first quote by a mental health practitioner in Malaysia is “You need to know your therapeutic modality and apply it with confidence”. The last quote is from a practitioner in Taiwan that goes, “In addressing the issues that activists face, you need to have sufficient ability or experience to know what kind of issues activists would come under, or the pressures they face. You might need some basic knowledge of activism to understand their circumstances”.

Theme 4: How we need to come together to collectively build a culture of well-being for  activists 

A watercolor wash that looks like a purplish–blue galaxy with clouds of green, yellow and pink. Written on top is “We need to institutionalize mental health in human rights organizations if we want resilient activists and sustainable activism”. The words “Institutionalize”, “Resilient”, and “Sustainable” are highlighted with scribbles of lines and circles.

Practitioners were asked what can be improved about the resources available to provide mental health  support to HRDs. 

Several practitioners expressed the need to provide proactive and preventive solutions to mental  health support. This can take the form of training, workshops, and capacity building. Most practitioners  believed that a good understanding of mental health was needed for activist individuals and  organizations. They believe that activists need to be equipped with a basic understanding of human  psychology, emotional literacy, conflict resolution, and best practices for dealing with mental health  concerns both individually and as a collective.

Many practitioners expressed the need for institutionalizing mental health in human rights  organizations. A Thai practitioner noted that organizations need to create a strong work culture that  facilitates well-being. Several practitioners suggested conducting regular wellness sessions or retreats facilitated by mental health professionals and fully paid for by the organization. Some practitioners also  mentioned that organizations need to provide living wages because people working in the non-profit  sector tend to be paid low wages. A practitioner in Malaysia advocated for a system of accountability  that allows employees to question the organization (particularly higher-level employees) without facing  termination or any other punishment. 

There was also an emphasis on collaborative and community-based solutions to providing mental  health support to HRDs. Several practitioners called for the expansion of collaborative networks of care.  This is to reduce resource gaps and ensure more coordinated and effective efforts. Some practitioners  also mentioned that activists can come together to deal with their struggles as a collective.

A watercolor wash that looks like a purplish–blue galaxy with clouds of green, yellow and pink. Written on top are 2 quotes from 2 mental health practitioners. The first quote by a mental health practitioner in the Philippines is “Most activists already know that things should be borne as a collective but being able to practice it constantly is still a struggle. They’d like to do it alone, if possible, because they don’t want to be a burden to others. A huge part of counseling is undoing these tendencies and have them really commit to collective load bearing”. The last quote is from a practitioner in Taiwan that goes, “After 324, activists would form groups themselves and discuss their trauma themselves. This was a good way of dealing with it. They could find an organization they trusted in and have more discussion among themselves about these circumstances. I think that was a very positive development”. In the corner is a star map that connects the words “Safety”, “Community”, and “Resources” to “Self care”.

Reflections by Country Data Collectors

Graphics by Azzad Mahdzir (@azzadism)

The graphics are a quote from the project report, illustrated and spread over a series of four images. The background is dark blue paper. On it is text that reads, “Activists operate in a culture of martyrdom”. The word “Activists” and “Martyrdom” are enlarged and in yellow.    The background is dark blue paper. There is a collage of a pale blue hand holding a human heart as blood spills from it.

The background is dark blue paper. On it is text that reads, “Given the overwhelming work and the undervaluing of mental health literacy, activists do not prioritize their own needs and well-being”. The phrases “overwhelming work”, “undervaluing of mental health literacy”, and “activists” are enlarged. The last half of the sentence, “activists do not prioritize their own needs and well-being” is in yellow.    This is the last in a series of four images, where the quote ends. The background is dark blue paper. On it is text that reads, “There’s a tendency to prioritize community’s welfare over one’s own.” The phrase “over one’s own” is enlarged and in yellow. Below it in green is whom the quote attributed to, a mental health practitioner from the Philippines. Underneath the attribution is a green ribbon that represents mental health awareness. Next to the ribbon is the Innovation For Change East Asia logo.

A Culture of Martyrdom

Activists/human rights defenders have unquestionable love for their society so much so that the government wants to silence them. On 7 March 2021, nine activists and human rights defenders based in Region 4 of the Philippines were killed by state forces after allegedly harboring weapons and grenades and resisting arrest. The United Nations was appalled with these killings that mirror the human rights abuses that activists experience in the Philippines. This unfortunate event is just one of many instances where the government exceedingly applies authoritarian rule against activists/human rights defenders by means of harassment, censorship, violence, intimidation, and “red-tagging” or publicly accusing individuals critical of the government as communists and/or terrorists. 

With all these challenges in the pursuit of social justice and equality, activists/human rights defenders must make it a commitment to give equal priority to their well-being. They are at the forefront of any and all struggle to achieve their advocacy, but they are at the far end of looking after their own welfare. This begs the question: are they to be blamed for this, or are resources for mental health support inadequate to address their issues? If mental health support is available and everyone is aware of its importance, there is no reason for people — activists included — to not prioritize this. The government, in all the extent of its power, must utilize its resources to spearhead mental health programs for its citizens, instead of devoting them to silence activists/human rights defenders.

— Davidson Oliveros, MMH Philippines Data Collector

   

   

Acknowledge Small Wins

An activist’s work often has deep personal significance to them, and drawing on emotional reserves, it can be a source of fuel as they challenge dominant power structures and fight for improvements. However, when work is so intrinsically motivated, it can have strong emotional consequences as well. Just as activists strive for ambitious outcomes based on principles and ideals, they also tend to hold themselves to similarly hard expectations which, when not achieved, may result in harsh negative self-talk and eventually in burnout. In reality, change usually happens gradually, and ‘failures’ are rarely total losses. Activists who can acknowledge small wins and appreciate gradations of improvement may find themselves more resilient in the long run.

— Khoo Ghee Ken, MMH Malaysia Data Collector

   

   

Survivor’s Guilt

Mental health in Myanmar has long been a taboo topic for the conservative and patriarchal society. Depression and anxiety are believed to be signs of weakness that should be handled privately. Apart from this existing stigma, activists and human rights defenders also do not prioritize their mental or psychological health as an issue that needs addressing. 

On top of this, civic space has significantly shrunk due to intensified military crackdowns against the protesters. Many activists and human rights defenders have been arrested and arbitrarily detained, some even tortured to death during detentions. Activists have lost many of their colleagues, family members, and loved ones to the coup. Some activists are on the run, and some have even become members of the People’s Defense Force (PDF) in the areas controlled by the ethnic armed organizations (EAOs) to fight the military regime. As such, they have been separated from their family members and their loved ones. The military often arrests the remaining family members, investigates and threatens them in retaliation against the pro-democracy activists. The military also commits arson, burning down the whole villages and townships that are known for active PDF resistance. 

Many of these activists carry a ‘survivor’s guilt’ for all the losses incurred, and they suffer from anger, sadness, emotional unrest, and distress, which then lead to anxiety, depression, and PTSDs. There is a need to raise mental health awareness and awareness of activist-friendly mental health and psychosocial support (MHPSS) services among activists and HRD.

— Anonymous, MMH Myanmar Data Collector

The graphics are a quote from the project report, illustrated and spread over a series of four images. The background is emerald green paper. On it is text that reads, “Passion-driven fatigue and burnout are the most prevalent issues faced by activists in Myanmar now”. The words “Fatigue”, “Burnout” and “Activists” are enlarged and in yellow.     The background is emerald green paper. There is a collage of 3 hands, red, yellow and pale green, holding up the 3 finger salute. On the red hand, which is on the forefront, has a trail of stars mapped together.

The background is emerald green paper. On it is text that reads, “For them, the ‘rights defender’ title carries a great responsibility - to help people fight for justice”. The phrase “Rights defender” was enlarged and “carries a great responsibility” is in yellow.    This is the last in a series of four images, where the quote ends. The background is emerald green paper. On it is text that reads, “When they can’t, they feel demotivated about these things beyond their control”. The phrase, “They feel demotivated” is enlarged and in yellow. Below it in green is whom the quote attributed to, a mental health practitioner from the Myanmar. Underneath the attribution is a green ribbon that represents mental health awareness. Next to the ribbon is the Innovation For Change East Asia logo.

Fatigue & Burnout

Activists and HRDs feel that it is their ultimate responsibility to fight for equality and justice; and that the people rely on them. This mindset, both knowingly and unknowingly, imposes constant pressures on activists and HRDs. 

On the other hand, the military’s restrictions on access to electricity, mobile communications, and internet noticeably hamper and impede their pro-democracy and human rights work, affecting their communications and logistics arrangements. This has a huge negative impact for activists and HRDs operating in the most sensitive areas with active conflicts and ongoing clashes among EAOs, PDFs, democracy alliances, and the military brigades. 

Even existing NGOs located in the cities and urban areas with less active clashes face sustainability and credibility issues due to the military’s large-scale scrutiny on civil society organizations — which include not being able to openly receive and withdraw funds from the international aid and development partners and risks of social punishments for legitimizing the military regime by receiving funds and operating under INGOs that have signed MOUs with the relevant ministries in Myanmar controlled by the military’s SAC. 

These hardships, challenges, and distressing situations drive activists and HRDs into fatigue. They often feel hopeless, helpless, and voiceless for things beyond their control. There is an urgent need to facilitate dialogues among the host communities, CSOs, and the development partners to find the most feasible solutions that could affect lives.

— Anonymous, MMH Myanmar Data Collector

The graphics are a quote from the project report, illustrated and spread over a series of four images. The background is deep red paper. On it is text that reads, “Joining social movements means putting yourself on the line, committing to help others”. The phrase “Social movements” is enlarged and in light blue.    The background is deep red paper. There is a watercolor illustration of three people holding placards and a flag and celebrating.

The background is deep red paper. On it is text that reads, “and devoting yourself to something bigger, something more than just yourself”. The words “Bigger” and “Yourself” is enlarged and in light blue.    This is the last in a series of four images, where the quote ends. The background is deep red paper. On it is text that reads, “But if you can’t take care of yourself, you will not have enough strength for the movement”. The phrase “Take care of yourself” is in light blue. Both the phrase and the word “strength” are enlarged. Below it in green is whom the quote attributed to, a mental health practitioner from Taiwan. Underneath the attribution is a green ribbon that represents mental health awareness. Next to the ribbon is the Innovation For Change East Asia logo.

Take Care of Yourself

Many activists join social movements because they are hoping to be part of something larger than themselves. This can be powerfully meaningful. Yet, work as an activist can sometimes be isolating and, in recent years, there have been many stories about individuals that become alienated or expelled from their families because of their political activism.

A term used in Taiwan to describe burnout is 運動傷害, which translates to “sports injury”. More literally, this would be rendered as “movement injury”. This is a pun, then, on “social movement,” in that participation in social movements can lead to injuries — whether physical or emotional. Sometimes movement injuries occur due to traumatic incidents, such as the fallout from the 324 incident during the 2014 Sunflower Movement. Other times, this is due to the mental stressors from activism.  

Sometimes, activists seem to be driven by a sense of guilt towards themselves and others. The failure of a movement to accomplish its goals or a personal sense of failure within a movement causes activists to blame themselves. To rid themselves of this sense of guilt, sometimes they throw themselves further into the movement. However, not taking care of themselves and placing the needs of the movement first may not allow for accomplishing one’s goals either, in that one needs to first take care of one’s self in order to carry out activist work.

— Brian Hioe, MMH Taiwan Data Collector

The graphics are a quote from the project report, illustrated and spread over a series of four images. The background is purple paper. On it is text that reads, “Activists have this feeling of guilt when it comes to self-care”. The word “guilt” is enlarged and in yellow.    

The quote ends on this image. The background is purple paper. On it is text that reads, “With everything that needs to be done, time for self-care, mental health, and well-being is the least prioritized”. The phrase “time for self-care, mental health, and well-being is the least prioritized” is in yellow. Below it in green is whom the quote attributed to, a mental health practitioner from Thailand. Underneath the attribution is a green ribbon that represents mental health awareness. Next to the ribbon is the Innovation For Change East Asia logo.   

Self-care is Not Selfish

Activists who work for social change need to see their  struggle through the lens of mental health. Well-being, psychological support, self-care, and self-loving are all necessary for social change. So, why do activists feel guilty when it comes to caring for themselves? Why do activists put the needs of others before their own to the point of wearing themselves out completely?

How can we resist oppression if we oppress ourselves too?

Self-care is not selfish. Self-care is a form of resistance. It is a responsibility.

— Akekawat Pimsawan, MMH Thailand Data Collector

The graphics are a quote from the project report, illustrated and spread over a series of four images. The background is maroon colored paper. On it is text that reads, “Often those in movements have conflict with each other”.    

   

A Toxic Internal Environment

Not all of those that participate in social movements agree with others. Certainly, for movements, it is necessary that there is healthy, productive disagreement and debate, so as to seek the best solutions for a movement going forward, or to make tactical adjustments as needed. 

However, what proves to be an issue for the mental health of activists and human rights defenders is that many of those disagreements are not expressed in a healthy manner. Oftentimes, because they are operating in high-stakes environments, and see themselves as shouldering the weight of society, they end up attacking each other. 

This has a detrimental effect on the mental health of activists when they are already facing external pressure in their efforts to change society. As such, in some ways, activists may be fighting a dual-front war, both externally directed at society, and internally within the movement. 

This was highlighted by all of my interviewees. In particular, some interviews pointed to left-wing labor organizing as a subset of activism in which there was much in-fighting, as well as a toxic internal environment. Some also referenced that left-wing labor activism had a culture of group self-criticism that could be damaging to an individual’s mental health or self-esteem.

— Brian Hioe, MMH Taiwan Data Collector

The graphics are a quote from the project report, illustrated and spread over a series of four images. The background is golden yellow paper. On it is text that reads, “The government’s mental health service system is not client-friendly and does not provide support based on needs”. The phrase “Is not client-friendly” is enlarged and in black.    The background is golden yellow paper. On it is text that reads, “Treatment is based on a ‘one size fits all’ program, mostly relying on medicine”. The phrase “One size fits all program” is enlarged and in black.

The quote ends on this image. The background is golden yellow paper. On it is text that reads, “This fails to consider clients’ personal realities, circumstances, and needs”. The phrase “personal realities, circumstances and needs” are enlarged and in black. Below it in green is whom the quote attributed to; a mental health practitioner from Thailand. Underneath the attribution is a green ribbon that represents mental health awareness. Next to the ribbon is the Innovation For Change East Asia logo.    The background is golden yellow paper. There is a watercolor illustration of a Venn diagram, made of purple, orange and pale green circles. Written in the purple circle is “circumstance”. Written in the orange circle is “realities”. Written in the pale green circle is “needs”. And the center where all the circles converge is an illustration of a blue head with rain clouds inside.

Understand Social Inequality and Injustice

One of the problems in Thailand is that policymakers treat everybody’s trauma the same way — by prescribing medication. However, these medications do not fix the toxic and oppressive conditions that created the traumas. Activists then return to these environments feeling hopeless and worthless.

It is important for mental health service providers to recognize the impact of social inequality on people and understand that the state’s mental health services can also make vulnerable people feel even more vulnerable. Without realizing this, these service providers could end up being part of the system of oppression. Mental health service providers must, therefore, train themselves to understand social inequality and injustice, even in the mental health service setting.

— Akekawat Pimsawan, MMH Thailand Data Collector

   

   

Organizations Are Partly Responsible for Burnouts

A sad reality described by mental health practitioners is that too often, organizations are at least partially responsible for the burnout among activists. Despite improving mental health awareness, NGOs continue to under-resource and deprioritize staffs’ mental well-being, especially when ‘productive’ work is the opportunity cost. One psychologist who ran group therapy sessions for NGOs noted that it was common for activist clients to drop out halfway through sessions because they have been summoned by work. This cultural issue is not helped by the entrenched narrative of the ‘activist as martyr,’ which glorifies, or even insists, on personal sacrifice in the service of the cause. 

Senior activists and NGO leadership who care about the resilience of their movements need to start committing to institutional improvements for the sake of their people.

— Khoo Ghee Ken, MMH Malaysia Data Collector

The graphics are a quote from the project report, illustrated and spread over a series of four images. The background is gray paper. On it is text that reads, “It is important for mental health practitioners to understand how oppressive structures”. The phrase “Systems of power” is enlarged and in deep pink.    The background is gray paper. On it is text that reads, “how oppressive structures and systems of power, such as gender and sexuality, influence a person’s well-being”. The phrase “Impact on a person’s well-being” is enlarged and in deep pink.

    This is the last in a series of four images, where the quote ends. The background is gray paper. On it is text that reads, “A practitioner must, therefore, make a personal commitment to liberate society from these harms”. The phrases “A practitioner” and “Make a personal commitment” are enlarged and written in deep pink. Below it in green is whom the quote attributed to; a mental health practitioner from the Philippines Underneath the attribution is a green ribbon that represents mental health awareness. Next to the ribbon is the Innovation For Change East Asia logo.

Systems of Power

Social institutions affect people’s well-being. Schools in all levels of education, for example, have the responsibility of nurturing the minds of the youth while providing them safe spaces to reach their fullest potential. In the Philippines, however, lesbian, gay, bisexual, and transgender (LGBT) students are exposed to experiences that have adverse effects to their well-being such as gender discrimination, bullying, and assault. While the Philippine Congress passed the Anti-Bullying Law of 2013, which protects the citizenry from bullying and harassment based on sexual orientation and gender identity among other issues, LGBT students still suffer discrimination from other students, their teachers, and school policies that are discriminatory in nature. Such negative experiences in school cause harm to students such as them losing interest in learning leading to absenteeism and school transfer and physical and psychological injuries. 

People experience bullying, discrimination, violence, and harassment not only because of their sexual orientation and gender identity but also because of other factors such as financial capacity, political views, educational attainment, and religious belief to name a few. Even activists/human rights defenders experience untoward incidents at their own homes, communities, and workplaces because of these factors. The effects of oppressive structures and systems of power have a wide reach in society and cause psychological scars to its victims from an early age up to their maturity. To combat this, the intervention of mental health practitioners is important in providing psychological guidance and support to concerned individuals. Mental health practitioners must enrich themselves by studying and understanding how oppressive structures and systems of power govern their lives and, at times, cause harm to people. Being a mental health practitioner does not only involve addressing psychological concerns but being with activists/human rights defenders and the people, in general, in their fight for social justice and equality.

— Davidson Oliveros, MMH Philippines Data Collector

About the project

Mapping Mental Health Support for Activists is a research project that aims to map out supportive mental health service providers for activists and human rights defenders in the region. It will be a survey conducted in six countries to learn who among mental health service providers have experience working with activists, understand the struggles they go through, and recognize the value of mental wellbeing in defending civic space. The intention is for this initial step to contribute as a starting point of a regional referral system that could potentially support the resiliency of activists in East Asia in terms of managing mental health and promoting holistic security.

Download a PDF version of this report here.

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