Mental health crisis awaits war-torn Ukrainians


Oleg Chaban, a Ukrainian psychiatrist, witnessed firsthand the emotional devastation caused by Russia’s war on his country.

The head of psychology and psychotherapy services at Bogomolets National Medical University in Kyiv recalled a recent patient who two days earlier had seen her only child, a little girl, die when the bus in which they were trying to escape from the suburb of Irpin was bombed. .

“I was trying to help her find another reason to live because of course she lost the meaning of life with her daughter,” he said.

For the millions still in Ukraine whose lives have been turned upside down since the Russian invasion on February 24, the immediate struggle for survival centers on the most basic needs of food, shelter and medical aid. But the history of mass trauma suggests that the need for psychiatric support will inexorably increase after the acute phase of the emergency is over.

“In disasters of all kinds. . . psychological needs and psychological impact almost always greatly exceed medical needs,” said Joshua Morganstein, chair of the American Psychiatric Association’s Committee on Psychiatric Dimensions of Disasters.

“We often find that there is a long tail of mental health needs that extend well beyond the time injuries are treated and scars healed,” he added.

For some, the need for help is immediate. Chaban said he and his colleagues had noted an increase in stress-related conditions such as anxiety and sleep disturbances, as well as a range of symptoms affecting children such as incontinence.

The news that emerged in recent days of the massacre of civilians in the town of Bucha, near kyiv, had caused “a new powerful trauma to the entire population”, he added, speaking through a interpreter. The number of requests for help from victims of violence, some of whom were raped by soldiers, has “sharply increased”, he said.

Pre-existing mental health issues have also been exacerbated since the start of the war. “I prescribe antidepressants two or even three times more often than before, because of anxiety, insomnia and fear,” he said.

Ukrainians were facing the convergence of multiple disasters, according to Morganstein, who noted that the fighting “was taking place under the shadow of nuclear, chemical and biological threats in a country that has yet to recover from the Covid pandemic. -19 which lasted two years. .” This has made the response more complex “and will impact the ability of communities to recover”, he said.

A woman talks to a psychologist in Zaporizhzhia, southeastern Ukraine. Mental health professionals are also stressed, with many having to take shelter in basements © Dmytro Smolyenko/ Ukrinform/Future Publishing/Getty

Valeriia Palii, president of the National Psychological Association of Ukraine, said she and her colleagues have treated people struggling with “acute stress and trauma reactions” to loss in all its forms.

This situation had worsened as the war progressed, as people witnessed atrocities and suffered anguish over the unknown fate of friends and relatives. “A lot of people are in shock, a lot of people are desperate and hopeless,” she said.

Women and girls who have been sexually abused by Russian soldiers are now receiving psychiatric help at the hospital. “The girls are very emotionally traumatized, many of them have trouble communicating,” she said.

Neil Greenberg, professor of defense mental health at King’s College London who specializes in post-traumatic stress disorder, said some of the immediate impact on mental health could be mitigated by a sense of togetherness national as people united behind the fight against a clear enemy. .

But the challenge will be finding the personnel and facilities to help the nation recover from its war experience once a sense of esprit de corps faded. Palii said: “The problem is that our psychologists are also. . . under constraint. Some are under occupation or hiding in basements. His association had created a website to raise funds for a hotline run by professionals.

In the longer term, Ukraine should look to its European neighbors for help. Chaban said Ukrainian mental health experts are looking to Sweden, which has experience treating young refugees from Syria and Afghanistan, as they seek to deepen their understanding of prevention and treatment. childhood trauma, especially for orphans.

A broad approach will be needed to treat residents of an entire war-ravaged country, according to Greenberg. “If you have 2 million people who have been traumatized, you can’t, and you shouldn’t, give 2 million people 12 sessions of talk therapy,” he said.

Other techniques, such as neighborhood focus groups, would be needed to help build “community resilience”, he said. They could be facilitated by a volunteer who, with the right training, could be “better than a mental health professional.” They understand the local context better,” he added.

Palii doubted that Ukraine’s resources were sufficient to treat the emotionally scarred residents. The country’s mental health workers would need “strong support from colleagues in other countries” for the treatment and rehabilitation of war victims.

“When the war is over and we come out of our hiding places, we will see all this horror and realize the losses,” she added.

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