Caring for Those Who Care for Others: Mental Health in the Nonprofit Workplace and the Paradox of Pressure
While experiencing similar workplace trends and having to respond to societal stressors, nonprofit organizations and mission-driven for-profit companies pursue their work with fewer resources in the best of times.
Today, the need for the work nonprofits do is exploding, particularly with social crises, climate catastrophes, and reductions in government and private funding for social services.
While cultural and societal norms shape the pressures on nonprofit leaders worldwide, common challenges include donor expectations, resource constraints, and the emotional (and sometimes physical) toll of mission-driven work. These forces impose mental costs on deeply devoted leaders and workers, which can the nonprofit’s impact.
This means that those who care for others by working for and with nonprofits will be exposed to even more unhealthy stress as they work to fill the gap, putting their mental health at risk. The least prepared and most poorly supported nonprofit sector workers shoulder the greatest challenges. We do not incentivize nor make it possible for our best and brightest to work on our most important problems.
According to the Center for Effective Philanthropy, burnout remains a top concern for 95% of nonprofit leaders. As with any system comprised of small numbers of people, there are more single points of failure, many additional areas of risk, and significantly more sources of existential threats.
Problematic manager and employee behaviors are often minimized or ignored due to a lack of competency and resources to handle such issues. In turn, problematic behavior is sometimes hidden from donors for fear of losing funding. Suboptimal processes can waste resources, reduce productivity, and stunt organizational growth.
It is understandable. Managers and founders often operate with less formal training in or access to training on leadership or management, nor ongoing mentorship or coaching support. Like entrepreneurs and small and medium enterprise leaders, nonprofit leaders face multiple financial and human resources challenges. They are constantly doing more with less.
These would be easier to manage if they had access to comprehensive, integrated training programs or resources to enhance their ability to tackle the challenges of driving sustainable performance in mission-driven environments. This means devoting attention and resources to ensuring the reasonable and supportive mental health of nonprofit workers.
The situation is dire but provides an opportunity for change. Employees working for nonprofit organizations are more likely to report a toxic workplace than private industry employees (25% and 26% vs. 17%). Poisonous workplaces are associated with diminished psychological well-being, with 58% reporting fair or poor mental health. Employees in nonprofit organizations are less likely (65%) to report work satisfaction than in for-profit settings (76%).
In the first of a series of posts on stress and performance in the nonprofit workplace, we provide data and insights on the mental health of nonprofit employees and suggest how we — as donors, board members, leaders, and community members — can better care for the nonprofit workers, key shock absorbers of society.
A note from the authors David Ehrenhal, Bahia El Oddi, Carin-Isabel Knoop, Sylvie Maury, Daven Morisson, M.D., Arturo Natella, Antonio Sadaric, and Susanna Sjoberg: our multidisciplinary, multicultural, and international team seek to support nonprofit leaders for exponential impact — both within their organizations as well as on the billions of people they serve. Our backgrounds in psychology, economics, psychiatry, compliance, political science, and business converge around human sustainability at work.
The Exponential Impact of Nonprofits
Nonprofits employ over 245 million people globally.
A survey by Johns Hopkins University estimated that 7.4% of the global workforce (or 3.3 billion people) was employed by the nonprofit sector, making it one of the largest employers of any industry in these countries.
There are over 10 million nonprofits worldwide. In countries like India, where over 3 million NGOs operate, nonprofits address critical healthcare, education, and environmental protection gaps, making them vital to national health. European nonprofits employ nearly 12 million people.
Nonprofit organizations play a particularly vital role in the U.S. economy. As of 2023, there are approximately 1.97 million registered nonprofit organizations in the U.S. This total includes around 1.48 million 501(c)(3) tax-exempt organizations (including charitable, educational, and religious entities). Their number has steadily increased over the years, and nonprofits account for about 10% of all private-sector employment, or nearly 13 million jobs — nearly as many jobs as manufacturing.
Moreover, nonprofit employment is concentrated in a few key sectors in the U.S. — healthcare and social assistance account for 66.3% of nonprofit jobs, educational services (16.4%), and arts, entertainment, and recreation (2.6%). All have been affected by turnover and burnout both during and since the pandemic (see a post on burnout in the medical professions).
These are likely surprising metrics for nearly all readers — and drive home the point that a large section of the global workforce is dedicated not to making money or driving profits — but trying to help others across a wide range of modalities and social problems.
Nonprofit work impacts billions of people.
While exact figures on the total number of people served annually by all non-profits in the U.S. and globally are difficult to quantify, the sector’s importance is undeniable. These organizations provide services to a significant portion of the global population.
For instance, the U.S. Department of Housing and Urban Development reported that over 771,000 individuals experienced homelessness in 2024v b v, an 18% increase from 2023. Nearly two-thirds of them suffer from mental health issues. Nonprofits are often at the forefront of addressing such social challenges, offering shelter, food, healthcare, and other essential services to people in need, sometimes as a proxy for direct government intervention.
Nonprofits are often also on the front line of climate disasters and response across wide regions (as happens with hurricanes, earthquakes, fires, and other natural disasters). Their staff can experience significant distress as they help others deal with the immediate trauma of loss and displacement and subsequent eco-anxiety.
The impact ranges widely. Major global nonprofits like the Red Cross, which reached over 200 million people through disaster relief and humanitarian aid in 2023, and UNICEF, which reached over 28 million kids in 2022 with educational programs, work alongside millions of smaller nonprofits that might serve more specific populations and specific needs.
In addition, nonprofits’ impact is magnified by their advocacy work and contributions to local, state, regional, and global policy changes.
Finally, there’s a third major ecosystem to which they bring their multiplier effect. Nonprofits are often the executing arm of corporate, government, and public-private partnership initiatives that would otherwise be impossible to execute.
Their work is getting even harder.
Overall, the nonprofit mission impact is often held in check both by economic forces and workplace trends
On the financial side, adjusted for inflation, donor funding remains below its peak in 2021, and funders are changing their grantmaking practices, increasing restrictions, or focusing their resources. In tight times and high demand, funders often prioritize program delivery over operational support, leaving nonprofits under-resourced to support their workforce.
Also, the ten largest foundations and nonprofit organizations wield a great deal of economic power. Smaller nonprofits can be at their whim or need to rely on the goodwill of many, many smaller donors.
At the government level, the incoming U.S. administration promises to reduce social services funding in programs like SNAP and Medicaid, programs that support hundreds of millions of Americans. Anticipated budgetary constraints will also cut public health initiatives and social welfare programs. Other governmental transitions in Europe, Canada, and India don’t augur well for those in need.
On the human resources side, employee turnover is much higher than in the private sector, and nonprofits have difficulty attracting quality recruits. Many nonprofits cannot provide remote work or on-site daycare and perks that other employers can provide to recruit.
A nonprofit worker’s life resembles the American arcade game of “whack-a-mole” — as soon as you feel that you have a handle on one situation, another five pop up. And that happens to nonprofit leaders and workers all day, every day.
Delivering front-line service can mean long hours and complex and unpredictable schedules, and younger generations, more conscious of working toward work-life balance than their elders, may be less willing to make these tradeoffs.
Finally, nonprofits often lack clear incentive mechanisms to reward excellent performance or punish poor results.
Recruiting and retaining talent can be very challenging. Perpetual staffing shortages, in turn, cause delays for the nonprofit in providing services or long waiting lines for people needing help.
The added stress of underdeveloped leadership and poor processes that prevent nonprofit workers from doing their work in a safe and supportive environment fuels even more turnover. In the ensuing “continual training” spiral, nonprofits do more staff training than mission-driven work.
In organizations crucial for maintaining societal equilibrium, the downstream impact of such pressures doesn’t stop at the office door — it’s felt all the way downstream where the nonprofit and the community connect — and in each human connection to the nonprofit itself.
So nonprofit workers not only have challenging working conditions, but they must face external conditions that often bring them either to the breaking point or result in a kind of numbness where they are “going through the motions” — disconnected from the mission, the organization, and self. The lights are on, but nobody’s home, in other words — when the internal “light” of the nonprofit worker is the very thing that has the greatest impact on the end-user of a nonprofit’s services.
Finally, this strain is exacerbated by exposure to systemic issues contributing to compassion fatigue: “the onslaught of depressing news and commentary about political actions, wars, climate disasters and more [is constant]. The first few times you’re exposed to a perceived injustice, you feel fired up and ready to fight against it. But after repeatedly facing this moral assault, you start to feel fatigued, even withdrawn. Resistance feels futile.”
Understanding the Pressure Paradox: At the Intersection of Passion and Pathos
Some leaders turn impact reports into an exercise in hubris. They’re created so executives can satiate the needs of the board, and feel good about themselves, rather than to show impact. - Dan Lammot. CEO, Threshold
PRESSURE = IMPORTANCE × UNCERTAINTY × VOLUME
We believe that understanding the “Pressure Paradox” could help us support nonprofits: while the journey to great performance and creating a better future is advanced by drive and intrinsic motivation, too much of both, and improperly managed pressure can lead to downstream health impact on nonprofit employees.
Using an analogy from engineering to illustrate the impact of poorly managed stress at work, humans, like materials, have different properties, respond to strain differently, and can only be stressed up to a point — at the ultimate stress point, the damage done is irreparable. At that point and beyond, in a metal for example, there is no going back to the original properties of the material.
In some aspects of human health, for example our kidneys, there is little warning until complete failure. For our mental health, some of us recognize where we are on the stress curve and can step back or walk away — if our work and personal circumstances allow it. Most don’t recognize the problem or the “rupture” point until too late. We don’t feel these changes; they don’t hurt like a sunburn or a rash from poison oak. But they are nonetheless “silent killers.”
Many nonprofit leaders and employees are particularly at risk because some are drawn to their work as a way of addressing their often-unconscious psychological wounds. This interconnection of work and previous-life trauma can make make nonprofit workers more susceptible to trauma reactions, including the accumulation of small “t” trauma — everyday stressors and emotional strain that, over time, can manifest as anxiety, irritability, burnout, or difficulty setting boundaries.
Furthermore, secondary trauma (or vicarious trauma) is particularly significant due to the nature of the work, which often involves direct engagement with individuals and communities enduring severe distress, trauma, and hardship. Nonprofit work may include, for example, supporting abuse survivors, responding to disasters, assisting those in poverty, and helping those facing serious health challenges.
Many of us “on a mission” have succumbed to pressure and pushed ourselves and others too hard. Sacrificing “self” for the “other” (and employees for “others”) over very long periods.
It is not easy to reach prosocial goals, especially in the non-profit and compassion sector in which metrics are anything but monetary. In a normal business, targets are targets — and when you reach them, there is either a bonus or you can coast for a bit.
However, the opposite is true for nonprofits trying to serve stretch goals and extreme needs, where there is no “end” or “target” — there are always more people to serve and an effectively unending line of those in need.
Ignoring ourselves and those closest to us at work and in life creates problems like those described above — where the nonprofit care worker often ends up in worse shape than the people they care for.
For those serving the suffering, there is a type of contagion as well. Stressed people stress others. And when the natural and adaptive adrenalin and endorphin rush that comes with mission-driven work ends, it can be very painful.
So, in a world with a tearing social fabric, and given the external factors already described, leaders of nonprofits dealing with diminishing internal resources and nonprofit employees shouldering greater and greater burdens are at risk for themselves and the mission.
The key to effective leadership in these situations lies, in part, in becoming aware of our biological states and how we can learn to track them. If we can stay in the optimal performance zone where we can think clearly, make sound decisions, act decisively, and foster meaningful connections — everyone wins.
Our emotions and thoughts follow our physical states, not vice versa. “We are our emotions,” just like “we are our eyes” in a very real sense. Therefore, increased body awareness, knowledge of our triggers and what calms us, an understanding of unhelpful thinking styles, and good habits that regulate the nervous system are foundational in sustained performance and effective leadership. A dysregulated leader will create dysregulated teams and cannot connect well with others. As a result, mission effectiveness deteriorates rapidly.
Creating Escape Valves: What Can Boards, Donors, and Leaders Do to Relieve This Pressure and Better Manage These Risks?
Going back to the three components of pressure, we consider here:
The crucial importance of the work and how this affects the stress level in organizations (and what it can realistically achieve) and what it means to lead them (and what can be done to support them);
x
The rising uncertainty of the work and the financial, social, and political environment (and how this can present as excessive commitment, an early stage of burnout) and the impact on employees (and how it can be reduced with a better understanding of drivers of engagement):
x
The increasing volume of work that nonprofits around the world need to shoulder.
Be more explicit and pragmatic about what an organization can achieve to avoid moral injury — to yourself and others.
The tension between an individual’s values and the realities of organizational or sector-wide constraints leads to emotional and ethical strain. The feeling of betrayal or people selling out when ideals are compromised can be very painful. Cognitive dissonance can occur when our ethics and morals hit systemic or monetary constraints.
In some instances, however, these conflicts reveal our inner conflicts between espoused theories and theories in use. The first is the beliefs and principles individuals claim to follow. These are the rationales people provide when explaining their actions to others. The second actually often govern our behavior, often operating unconsciously. For example, we might assert that we value open communication and collaboration — but make unilateral decisions without consulting our team or family.
Incoming nonprofit recruits who carry an idealized image of nonprofits can be surprised to discover discrepancies between what these organizations say and how they behave.
Chris Argyris and Donald A. Schön, the authors of this work, argued that such discrepancies hinder professional effectiveness and organizational learning. Below are a few questions to guide reflection.
Provide leaders with insight and support on their leadership style
The mental health and resilience of nonprofit leaders is particularly important because they have such an exponential impact — on their organizations and the billions of people they serve.
Focusing on “the cause” at the expense of well-being can create environments where leaders and teams are pushed too hard, creating an unsustainable tension, between passion and pathos and finding meaning at work.
Excessive demands are placed on leaders and teams and self-sacrifice and self-abnegation become normalized, overshadowing personal health, leading to burnout across an entire organization. In some instances, promotion of, and acquiescence to, excessive demands can be endogenous and perhaps a form of maladaptive narcissism, so-called communal narcissism-which is related to inflated perceptions of oneself within a bigger setting than just one’s immediate environment:
“This narcissism takes place in social, community situations that may be focused in the charitable or benevolent arenas or may just show up as people trying very hard to appear as good and caring friends or coworkers.”
This type of narcissism is positively related to more explicit self-views in communal domains (e.g., helpfulness), but not in agentic domains (e.g., assertiveness).
Nonprofits can also fall into collective narcissism, an exaggerated belief that one’s group is exceptionally important and deserves special recognition but is underestimated or misunderstood by others. Collective narcissism can be observed in almost all types of cooperative groups, even if all members of a narcissistic group do not exhibit individual narcissistic behaviors.
Under-resourced, “riding an endorphin high” on their effort, cheered on by those who are not as motivated and highly committed to the mission, leaders often overlook the need for more space for themselves and their teams to reflect, recharge, and recalibrate.
But even so, these are often blind spots that leaders either are unable to recognize or resist paying attention to and acting on. Coaching and active Board oversight can help protect non-profit employees from exposure to unhealthy workplace environments.
Understand the early stages of burnout as a warning signal.
Common interpersonal stressors, for example, exhaustion, cynicism, and the everyday inefficacy caused by human beings, do not fully capture the emotional impact of burnout in purpose-driven roles. There is far more personal identification with mission in these purpose-driven roles, which is a double-edged sword. Because one edge is the allure — the original attraction to the work itself. The other edge is what it will cost you to try to fix a problem that has no effective end. Failing here carries more weight because shame looms more heavily in the shadows. Envy and other interpersonal forces, including Schadenfreude, lurk.
Burnout often begins with a commitment to a cause or sense of being needed: “Without me, nothing gets done.” “My students / patients / constituents need me.” “Without me, more refugees might die.”
In the second stage of burnout, a set of micro-compromises often follows—these little ethical or emotional concessions that we make and those we see others make (or force others to make) in pursuit of mission.
Exhaustion comes shortly thereafter because decompression is always needed. The needle must come off the redline or the engine will melt. Even nuclear reactors require downtime and maintenance.
If we posit that emotional attachment to the work and passion for the mission are stronger in nonprofits, it becomes important to appreciate that negative emotions will be stronger as well as positive emotions. The “contagion of emotion creep” will be more powerful still in organizations focused on missions where life and death are constantly on the table.
Clarify job expectations to promote engagement and safety.
According to Gallup, “Knowing what is expected of you at work” is one of the most foundational elements of engagement and Gallup’s Q12 employee engagement survey. Research suggests that a well-defined job provides certainty, security, and stability that can serve as the foundation of psychological safety (see video here).
In addition to safety, a well-defined job allows an organization to better shape company culture. That means an organization can properly filter people in and out of the various internal processes for better long-term performance and more appropriate employee culture fit.
Of course, such job fit and clarity of responsibility are challenging in smaller and more entrepreneurial ventures where everyone typically wears many hats. The same is often true of nonprofits.
Many nonprofits are grappling with internal equity issues, particularly around pay disparities and opportunities for advancement. Individuals might also be spending time on non-promotable activities when the path to and expectations for promotion are unclear. When that is the case, leaders generally also have unmet expectations around productivity and output.
It is also up to all of us to make working in non-for-profit organizations more sustainable — so that we collectively maximize their impact.
We all have a role in supporting nonprofit leaders and their organizations. Whether as board members, funders, neighbors, or collaborators, our collective efforts can create a more sustainable and compassionate ecosystem for those who care for others. Here are a few ideas.
As with any struggle, loneliness harms, and community heals. Reach out to nonprofit team members and leaders to ask how they are doing and how workplace trends might be affecting them. Chances are you have a lot more in common than you think.
Cash is king, but so is effort. In helping nonprofits, we can find ways to increase donations of financial and operational resources (money, supplies, or equipment) but also seek ways to donate time and energy (by volunteering directly, especially if we have business experience, offer mentorship or pro bono training to nonprofit leaders). Consider what your skills as a lawyer, accountant, friendly host, or IT guru could do for a nonprofit. Nonprofits shine when business leaders and nonprofit leaders act in concert to achieve sustainable, long-term goals.
Like in industry, referrals and exposure are golden. We can acknowledge and validate the work of non-profits we know by publicly recognizing their efforts or sharing their stories, inviting non-profit leaders and workers to speak at functions, or giving them exposure to other organizations we frequent, such as schools or spiritual communities.
Showing up on stage matters, but playing the assigned part matters even more. Volunteers who do what they want versus what an organization needs can have more of a drag-on impact than no volunteers at all. Consider also that if your nonprofit board seat was given for financial reasons, but you hold on to it for recognition value and not contribution value — it might be time to give up that seat in favor of someone who can have a genuine impact.
Empathy and humility go a long way in supporting nonprofits. If you are a donor or volunteer, be mindful of the pressure and challenges nonprofits face to avoid adding unnecessary stressors and being a know-it-all. Consider whether the input you provide is going to be useful. Many problems nonprofits choose to tackle are complex, intractable, and fraught with tradeoffs. Nonprofit workers are in the trenches with those problems — day in and day out. Your bird’s eye view is probably where those nonprofit workers started — so they probably know what you might have to offer already. Seek to learn from them, not direct their activities based on your imperfect knowledge.
It is also important to respect the challenge the nonprofit is addressing. Some people are broken early in the life they were born into (nature or nurture) to the point they simply can’t “bootstrap.” In other words, “how does the man pull himself up by his bootstraps, if he hasn’t any boots?” Despite what we think you may know, be open to different viewpoints, modalities, and the dynamic real-time adaptation most social services require.
Volunteering benefits both employees and nonprofits. Giving employees or reports more time off to volunteer can benefit nonprofits, your team, and your business. George Vaillant, a psychiatrist, described altruism as a mature defense mechanism that involves helping others without expecting anything in return. But we get a lot of satisfaction in return.
Turning Pressure into Purpose
The nonprofit sector lives at the intersection of passion and pressure, where the risks of burnout ripple far beyond individuals to impact entire communities. Understanding the paradox of pressure can allow boards and leaders to create an escape valve for their organizations—releasing unsustainable pressure before it builds to a breaking point. Even the most passionate leaders and teams have limits. Boards must align their expectations with realistic capacity. Donors must prioritize funding resilience alongside results.
And we must all recognize when pressure becomes counterproductive — it is not a weakness but an important signal.
