Responding to the mental health crisis of Ukrainians in times of war and peace

Responding to the mental health crisis of Ukrainians in times of war and peace

Russia’s ongoing military operations pose not only a threat to the physical health of Ukrainian civilians, but also a grave danger to their psychological well-being. The mental health consequences of trauma are often overlooked and can be mostly invisible. As such, resources for mental health care are generally not prioritized. This negligence is a mistake. Humanitarian responses, including support from host countries, donors and intergovernmental organizations, must meet the immediate and long-term mental health needs of Ukrainians.

Before the war, mental health problems, such as depressive disorders and post-traumatic stress disorder (PTSD), were the second leading cause of disability in Ukraine, affecting around 30% of the population. The country was already plagued by one of the highest suicide rates in the world. Access to evidence-based mental health care, lack of trust in the mental health system, and mental health stigma were serious barriers even before the war.

Since February 24, families have been torn apart and more than 5 million children have been forced from their homes, according to UNICEF; in other words, this represents two out of three displaced Ukrainian children. Shelling, loss or separation of loved ones, and flight from shelling and shootings are just some of the atrocities that now characterize daily life for Ukrainians, including when such shelling often occurs at night, contributing to sleep deprivation. and constant anxiety.

Recent studies have shown that in conflict-affected areas, an estimated one in five people develops a psychiatric illness such as bipolar disorder, schizophrenia and major depressive disorder. Given the far-reaching scope of this unsolicited war, millions of Ukrainians, young and old, are at risk of possibly developing mental illnesses in the future. At present, Ukrainians continue to experience traumatic events, such as sexual and physical assault or exposure to violent death and injury. Mental health distress in people exposed to conflict can manifest as anxiety, fear of isolation, tears, insomnia, nightmares, etc. Additionally, adults and children with pre-existing mental health care needs or neurodevelopmental disabilities, such as autism, have unfortunately not been considered a priority in Ukraine. Consequently, the lack of access to care from properly trained professionals is exponentially aggravated by war.

The establishment of short- and long-term mental health care solutions throughout Ukraine and in host countries is essential.

In addition to addressing mental health-related distress, initiatives should also focus on strengthening mental well-being, which involves developing resilience and coping strategies. For example, Dr. Sergiy Bogdanov, associate professor at the Kyiv-Mohyla University National Academy and clinical psychologist, offers an excellent model; he and his colleagues have been working on these parallel issues for years and have redoubled their efforts in response to the war. Applying tools and approaches they tested in collaboration with Johns Hopkins University, Dr. Bogdanov’s group treats symptoms of depression, anxiety and traumatic stress. Although they already provide psychological care in several centers across Ukraine, they recently opened a new treatment center in Bucha, the site of significant violence and killings near Kyiv, to meet pressing health needs. mentality of the people of this region. At the same time, Dr. Bogdanov is training teachers and school psychologists in Safe Space, an intervention promoting resilience and early intervention for children and adolescents, and is scaling up his efforts across Ukraine.

When considering long-term solutions to the mental health care crisis in Ukraine, improving the identification of mental health needs, as well as preventing the development of psychiatric illnesses, should be a top priority.

In Ukraine, long-term funding for the mental health response and coordination between national and international partners will be important to ensure the sustainability of psychosocial support for affected Ukrainians. Training of health professionals in evidence-based mental health approaches that target trauma, such as prolonged exposure or cognitive processing therapy, is also needed. Other efforts could include training for teachers and pediatricians that improves their ability to screen for and recognize mental distress in children.

For displaced Ukrainians, host countries should work to ensure access to affordable mental health care and minimize the social isolation of refugees. For example, social integration interventions that improve quality of life and adjustment could focus on language learning and building social support networks.

It is essential to develop a coordinated response to the pre-war mental health care crisis in Ukraine, severely exacerbated by the current tragedy. Sustained efforts to address mental health needs are gaining momentum; including the First Lady of Ukraine Olena Zelenska spearheads and advocates for the strengthening of Ukrainian mental health and psychosocial systems and programs. Essentially, defending the mental health and recovery of Ukrainians requires recognition and intervention both while the war is raging and after it is over.

Allies can help by maintaining both the current acute perspective and a long-term vision; this will mean supporting special care now and remaining committed to helping Ukrainians restore, rebuild and expand mental health services beyond wartime.

Kimberly M. Hook, PhD, MA, is a licensed psychologist who – ssince 2018 – collaborated with academic and NGO partners in Ukraine on mental health care delivery and research. She is also a researcher at Harvard TH Chan School of Public Health.

Jacqueline A. Hart, MD, is director of theBassuk Center on Homeless and Vulnerable Children, Families and Youthin Needham, Mass., which works with communities and organizations nationwide to promote housing, health and other opportunities for individuals and families. She has over 20 years of experience in the field of lifestyle, behavioral and integrative medicine, applying these principles to vulnerable populations and marginalized communities.

This editorial also benefited from contributions from: Mark C. Poznansky, MD, PhD., FIDSA, Director ofCenter for Vaccines and ImmunotherapyInfectious Diseases Division, Massachusetts General Hospital, professor of medicine at Harvard Medical School and co-founder of Cure the Ukrainian band; Alice Barocco, student in medical biosciences at Imperial College London; Dmitriy Dribinskiy, founder and director of Autism Unity; Yulika Forman, PhD, LHMC, Special Education Consultant and Advocate.

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