How to meet the needs of psychological support of the population in Ukraine;

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Mental disorders affect a person’s physical health, are often accompanied by various types of addictions (alcoholism, drug addiction), cause difficulties in social adaptation and integration, and affect a person’s ability to work. In Ukraine, this problem has been exacerbated by the full-scale war, writes Dyvys.info.

This creates serious challenges for both the state and society. Supporting human mental health has become one of the priorities of state policy. The combat capability of the Armed Forces and the resilience of the country as a whole in the face of enormous threats, including to its very existence, depend on its resolution.

Rector of the Ukrainian Catholic University Taras Dubko spoke about this at the Forum “Psychosocial Services: Current Challenges, Proposed Solutions, Coordination System, Accessibility for People” was spoken by Taras Dubko, Rector of the Ukrainian Catholic University.

photo: Psychosocial Services Forum in Lviv, February 9, 2024, Dyvys.info

Forecasts of growth in the need for psychological support

The Ministry of Health predicts that more than 15 million Ukrainians will need psychological support because of the war. At the same time, about 3-4 million people will need to be prescribed medication. After the war, at least one in five people will experience negative mental health consequences. According to the Ministry of Health, 20-30% of people who have experienced traumatic events may develop PTSD. In addition, in 5-7 years, the number of people with drug, alcohol, and other addictions is expected to increase. Due to the psycho-emotional stress caused by the war, Ukrainians will age by 10-15 years, meaning that diseases typical of mature and elderly people will occur 10-15 years earlier than they did before the war.

“If there is a forecast that 15.7 million people in Ukraine will need psychological help, then 3.5 million of them will have some kind of mental health disorder,” Taras reflects.

WHO predicts that by 2025, one in two Ukrainians may face mental health problems. According to some experts, it will take up to 20 years for Ukrainians to psychologically rehabilitate after the war.

The development of certain forms of mental disorders has a significant impact on people’s productivity and, consequently, on the country’s economy – losses from mental health problems can reach 4-5% of GDP.”

At the same time, the mental health curriculum in Ukraine covers less than 50% of the topics of similar programs in developed countries. Every second veteran and their family members will need psychological assistance. About 2 million people will potentially need the services.

Another problem is that, even if they recognize that they have mental problems, a significant number of citizens are not ready to seek help from specialists, believing that their difficulties are not serious enough, that they can cope with them themselves, and that there are people who need psychological help more.

“The problem of neglecting one’s health – both mental and physical – is, unfortunately, quite typical for Ukraine. Our fellow citizens often seek medical attention only when a disorder or disease has progressed to the point where it has become a serious threat, whereas diagnosing it at the initial stage would facilitate effective treatment and a quick return to normal life. Currently, less than 10% of the predicted prevalence of mental health disorders are diagnosed.”

Problems of supporting mental health of military personnel

Participation in a war or living in a war-torn area significantly increases the percentage of mental disorders among both military and civilians. PTSD, depression, and phobias are on the rise.

«While during the First World War and the beginning of the Second World War, scientists believed that only people with weak and unstable psyches suffered psychological trauma on the battlefield, and that mental trauma was synonymous with cowardice, the combat practice of the last years of the Second World War significantly adjusted these views. Thus, despite numerous measures to identify people with unstable psyche in the process of psychological selection for troops in foreign armies, psychological losses tended to increase.” – says Taras Dubko.

Many servicemen and women may experience symptoms of depression, anxiety, or an acute reaction to combat stress or combat trauma, depressive reactions, and generalized anxiety disorder after their first time in a combat zone. Many of them need the help of specialists, such as psychologists, psychiatrists, and psychotherapists, as they are at a higher risk of developing PTSD.

It has been established that 20% to 40% of military personnel need psychological assistance. Symptoms of acute trauma are detected in 60-80% of defenders who witnessed the deaths of their comrades or civilians or saw the bodies of the dead. The risk of mental health symptoms is higher for younger servicemen, aged 18-24, who have been diagnosed with symptoms of depression or have had problems with alcohol. Symptoms of PTSD develop in about 12-20% of soldiers who have suffered combat trauma but did not seek psychological help because they were afraid of being disrespected for showing weakness, cowardice, or threatening their military career.

“The state of mental health of military personnel is much worse than that of the rest of the population – anxiety and major depressive disorders are twice as common among the military as among civilians. The military are more likely to use substances that alter their mental state, with alcohol abuse occurring 2.3 times more often. At the same time, men in the army are more prone to such abuse than women. The latter are more likely to suffer from anxiety disorders, PTSD, and mood disorders. Soldiers who took part in active combat operations are almost 7 times more likely to have PTSD and abuse alcohol and other substances than other soldiers.”

Meanwhile, it can be stated that the Armed Forces of Ukraine are insufficiently staffed with psychologists – 29% of the staff is understaffed. Only 62% of psychology officers have a degree in the specialty. According to a study of the staffing of the Armed Forces of Ukraine, there is one psychologist for 400-500 servicemen. Instead, for example, the Israeli army has a standard of military psychologists and social workers – 1 specialist for 70-90 people.

photo: Shpalta

State policy of psychosocial support

The Interagency Coordination Council on Mental Health and Psychological Assistance to Persons Affected by the Armed Aggression of the Russian Federation against Ukraine was established. A Project Office for the development of a national program of mental health and psychosocial support was established at the Ministry of Health. It is declared as “a platform for uniting all partners, which permeates all levels – professional and political circles, practitioners, international experts, and volunteers.”

The Project Office includes experts from the Ministry of Health, the Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring of the Ministry of Health of Ukraine, and the NGO Bezbariernist. Expertise and support in the project implementation is provided by WHO and the global Reference Group on Mental Health and Psychosocial Support of the Inter-Agency Standing Committee.

As part of the program’s development and implementation, it is envisaged that:

  • conducting an expert audit with the involvement of WHO experts, which will be used to create a model of the care system;
  • Developing a step-by-step plan for implementing the model after discussing it with a wide range of representatives of the professional community, experts, and public opinion leaders;
  • building a system of training, certification, and quality monitoring of psychologists, psychotherapists, and psychiatrists working in the system of most ministries;
  • training of family doctors, psychologists, social workers, and educators in rapid psychological support techniques;
  • creating a register of specialists and methods, systematizing data, developing a model for retraining and retraining personnel, and a system for attracting them.

An audit of the population’s needs for mental health services was conducted.

And at an expanded meeting of the Interagency Coordination Council on Mental Health and Psychological Assistance to Victims of Russian Aggression against Ukraine, the Operational Roadmap was presented“Priority multisectoral mental health and psychosocial support interventions in Ukraine during and after the war”. The document defines the priorities that should guide everyone working in the field of mental health in a humanitarian crisis.

“The Roadmap was created after a series of consultations with Ukrainian authorities and national and international agencies working in the field of mental health and psychosocial support and involved in emergency response in Ukraine. The consultation process was organized by the Ministry of Health with the support of WHO in Ukraine in cooperation with the Technical Working Group on Mental Health and Psychosocial Support and the Reference Group on Mental Health and Psychosocial Support in Emergencies of the Inter-Agency Standing Committee.”Taras explains.

The operational roadmap will allow us to respond quickly to challenges here and now. It identifies the priorities that should guide everyone working in the field of mental health in a humanitarian crisis. This will allow us to coordinate our actions in accordance with analytically determined priorities.

The National Program of Mental Health and Psychosocial Support has been developed:

  • a handbook “Basic Skills for Caring for Yourself and Others”;
  • a new section of the Barrier-Free Handbook – “Ethics of Interaction in Times of Stress.”
  • stress management in the BetterMe: “Mental Health;
  • “Tell me honestly, are you okay?” TV commercials, a self-help kit from Ukrainian stars and TV presenters;
  • a series of animated videos about the nature of stress and how to help yourself and your loved ones.

Public initiatives to provide psychological support

Specialized non-governmental organizations make a significant contribution to maintaining the mental health of citizens. In particular, the National Psychological Association (NPA) in early June 2022. launched a toll-free hotline in Ukraine that operates in the format of audio and video calls. The NPA has set up similar hotlines in twenty European countries with the help of foreign partners. The lines are staffed by professional psychologists with relevant experience and training in crisis intervention.

“This is important because not all countries provide Ukrainian refugees with not only financial and medical support, but also psychological support. In addition, thanks to such hotlines, Ukrainians abroad maintain a mental connection with their homeland.”

There are other platforms for free psychological assistance. These include, in particular, the round-the-clock psychological support “Zaporuka” and “Resilience Hub”; the psychological support group “Razom”; the psychological support center “ObyMy”; the psychological counseling center “Open Doors”; the online platform “Tell Me”; telegram channels “Psychological Support” and “Peremoha” (the latter is for people aged 8 to 22); the online program “Being a Parent of an Angel”; the National Professional Line for Suicide Prevention and Mental Health Support “Lifeline Ukraine”; the Rehabilitation Center for Free Psychological Assistance “Step Towards”, etc.

Psychological support for veterans

According to the register of providers of psychological rehabilitation services for veterans and their families, 48 healthcare facilities in different regions of the country provide psychological rehabilitation services.

“We can predict that their number will continue to grow. At the same time, we use modern methods of psychosocial support for veterans that do not require referral to specialists. They emphasize interaction and mutual assistance among people in need of such support.”

For example, as part of the Mental Health for Ukraine project, which is being implemented with the support of the Swiss Agency for Development and Cooperation and with the assistance of the Ministry of Health of Ukraine and the National Psychological Association of Ukraine, a manual on “Organizing Veterans’ Peer Self-Help Groups” was created to provide better psychosocial support to veterans. It contains recommendations for local governments at the level of territorial communities on how to establish these groups.

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