International Community Must Prioritize Post-War Expansion of Ukraine’s Mental Health Care System

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COMMENTARY

As the international community increases the pace of planning post-war reconstruction in Ukraine, it is essential to expand the focus beyond infrastructure. Considerable resources must be devoted to healing the deep and painful—but frequently invisible—wounds that have scarred the minds of millions of Ukraine’s civilians and soldiers.

The mental health care needs in Ukraine are enormous. Russia’s invasion has inflicted unspeakable crimes against innocent civilians as well as brave soldiers defending their own towns and cities. A telephone crisis hotline established by the National Psychological Association (NPA) after the invasion provides free counseling to hundreds of Ukrainians every month seeking advice on how to cope with post-traumatic stress, depression, anxiety, phobias, inter-personal conflicts and divorce, as well as self-harm and suicide.¹

State psychiatric facilities as well as nonprofit mental health organizations are overwhelmed with patients seeking urgent care, while the most traumatized individuals are often unable to seek out assistance because their symptoms are so intense. International actors like the World Health Organization and International Medical Corps are already supporting Ukraine’s mental health care system.

These programs must be expanded to adequately support traumatized civilians, the postwar demobilization of war-afflicted soldiers, and the return of millions of refugees—all amidst likely postwar shortages in housing and jobs.

Ukrainians suffering from untreated or inadequately treated psychological distress are already taking a toll on Ukraine’s struggling economy, health care system and families. The overburdened mental health care system is leading to emotional burnout among some mental health care workers, with some contemplating leaving the profession and others remaining engaged but less productive.

Increased international funding for mental health care can help the state and the nonprofit system to support and complement each other, reaching as many suffering residents as possible throughout the large East European country.

Ukraine’s state psychiatric hospitals and clinics remain highly centralized, and medicalized institutions provide limited care through primary health care offices at the local community level, an assessment by the International Medical Corps concluded in March 2022.² In order to address these challenges, Olena Zelenska, Ukraine’s first lady, has launched an important new initiative to increase training and support for the state mental health care facilities and staff.³

The nonprofit mental health care system in Ukraine takes a significant burden off of the overwhelmed state system. Every child, parent, soldier, and senior citizen who gets care in a community nonprofit or small private practice is 1 less individual in line at a state clinic, and sometimes even 1 less inpatient hospitalization at a state psychiatric hospital. Nonprofit mental health care organizations are flexible and adaptive in addressing particular niche needs within various communities.

The nonprofit Psychologists in War, for example, sent teams of psychologists and psychotherapists into the small towns north of Kyiv after the Ukrainian army had pushed out Russian forces, so their staff could provide information and emotional support to isolated and traumatized local residents as quickly as possible.

Thanks to modern technology and international support, nonprofit associations like the NPA have been providing online training courses and seminars over Zoom and Viber so that Ukrainian patients around the country can receive the most effective forms of psychotherapy.

For example, Sarah Hedlund, PhD, a psychologist with the Washington School of Psychiatry in Washington, DC, initiated an online group in December to support and train psychologist supervisors, as Ukraine desperately needs a larger pool of supervisors to help early-career psychologists effectively treat their larger caseloads of patients during the war. These and other kinds of nonprofit initiatives are helping Ukraine build the foundations of a modern, flexible, and effective mental health care workforce during the war, and will only broaden and expand after the war is over.

It will also be essential to expand mental health care training to allied professions—teachers, nurses, family doctors, physical therapists, art therapists, and others—to reach as many Ukrainians in need of care as possible. These professionals can help to educate individuals and their families about the meaning of psychological symptoms and how to improve self-care, make referrals for appropriate treatment, and sometimes engage in certain kinds of supportive therapeutic care within their own organizations, further reducing the stresses on the mental health care systems.

Let us do everything we can to help President Zelensky and the Ukrainian army win this war, so that psychologists, psychiatrists, social workers, and other allied professionals can continue to expand their heroic work healing the psychic wounds from this criminal invasion, which will in turn reduce transmission of psychological traumas to the next generation of Ukrainian children.

Support NPA: Please support NPA’s wartime online training programs for psychologists in Ukraine by making a donation here.

Dr Palii speaking at European Congress of Psychology in Ljubljana, July 2022.

Dr Palii is a psychologist with a private practice in Kyiv and the president of the National Psychological Association (NPA) of Ukraine. In July 2022, she was awarded a Presidential Citation by the American Psychological Association (APA) for her leadership of NPA during the Russian invasion of Ukraine. Dr Lupis is a psychologist with a private practice in Washington, DC, the coordinator of NPA’s International Division, and a member of the International Relations Committee of APA Division 39 – Psychoanalysis & Psychoanalytic Psychotherapy.

The authors report that they have no financial disclosures to make.

References

1. Psychological help line of the National Psychological Association of Ukraine: summary report on quantitative indicators for the period June 6, 2022—January 9, 2023. National Psychological Association of Ukraine. Accessed March 8, 2023.

2. Mental health & psychosocial support rapid situational analysis: Ukraine—Kyiv, Odessa & Lviv. International Medical Corps. April 2022. Accessed March 8, 2023. https://cdn1.internationalmedicalcorps.org/wp-content/uploads/2022/05/IMC-2022-Ukraine-MHPSS-Rapid-Situational-Analysis.pdf

3. Olena Zelenska told how the initiative to create the National Program of Mental Health and Psychosocial Support is being implemented. The Presidential Office of Ukraine. December 28, 2022. Accessed March 8, 2023. https://www.president.gov.ua/en/news/olena-zelenska-rozpovila-yak-vtilyuyetsya-iniciativa-zi-stvo-80109