Addressing the mental health crisis for Ukrainians in war and peace

Ongoing military operations by Russia not only pose a threat to the physical health of Ukrainian civilians but also grave danger to their psychological wellbeing. Mental health consequences of trauma are often overlooked and may be mostly invisible. As such, resources for mental healthcare are generally not prioritized. This neglect is a mistake. Humanitarian responses, including support from host countries, funders, and intergovernmental organizations must address both immediate and long-term mental health needs of Ukrainians.

Prior to war, mental health conditions, such as depressive disorders and post-traumatic stress disorder (PTSD), were Ukraine’s second leading cause of disability and affected roughly 30 percent of the population. The country was already burdened by one of the world’s highest suicide rates. Access to evidence-based mental healthcare, lack of trust in the mental healthcare system, and mental health-related stigma were serious barriers even before the war.

Since the Feb. 24, families have been torn apart, and over 5 million children have been forced to leave their homes, according to UNICEF; put differently, that is two out of every three Ukrainian children displaced. Bombing raids, the loss of — or separation from — loved ones, and escaping shelling and shootings are merely some of the atrocities that now characterize Ukrainians’ daily lives, including the timing of said bombings, which often occur at night, contributing to sleep deprivation and ongoing anxiety.

Recent studies have shown that in conflict-affected areas, one person in five is estimated to develop 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 to possibly develop 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 among individuals exposed to conflict can manifest as anxiety, fear of isolation, tearfulness, insomnia, nightmares, and more. Furthermore, adults and children with pre-existing mental healthcare needs or neurodevelopmental conditions, like autism, have unfortunately not been made a priority in Ukraine. Therefore, lack of access to care from properly trained professionals is exponentially compounded by the war.

The establishment of short- and long-term mental healthcare solutions across Ukraine and in host countries is essential.

In addition to treating mental health distress, initiatives should also focus on strengthening mental well-being, which involves developing resilience and coping strategies. For example, Dr. Sergiy Bogdanov, an associate professor at the National University of Kyiv-Mohyla Academy and a 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 that they have tested in collaboration with Johns Hopkins University, Dr. Bogdanov’s group treats symptoms of depression, anxiety, and traumatic stress. Though already delivering psychological care at several centers across Ukraine, they recently opened a new treatment center in Bucha, the site of significant violence and killing located close to Kyiv, to address the pressing mental health needs of individuals in that 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 Ukraine’s mental healthcare crisis, improving the identification of mental health needs, as well as preventing the development of psychiatric illnesses, should be heavily prioritized.

In Ukraine, long-term financing for mental health response and coordination between national and international partners will be important to ensure that psychosocial support offered to impacted Ukrainians is sustainable. Training health professionals in evidence-based mental health approaches that target trauma, such as prolonged exposure or cognitive processing therapy, are also needed. Other efforts could include providing trainings for teachers and pediatricians that improve their ability to screen for and recognize mental health distress among children.

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

Developing a coordinated response to Ukraine’s pre-war mental healthcare crisis, severely exacerbated by the current tragedy, is critical. Strong efforts to address mental health needs are gaining momentum; notably the First Lady of Ukraine Olena Zelenska is spearheading and advocating to strengthen Ukraine’s mental health and psychosocial systems and programs. In essence, championing mental health and recovery for Ukrainians requires recognition and intervention both while the war rages and after it ends.

Allies can help by maintaining both the current acute perspective and a long-range view; that will involve supporting particular care now and remaining engaged to aid Ukrainians in restoring, rebuilding, and expanding mental healthcare services beyond the time of war.

Kimberly M. Hook, PhD, MA, is a licensed psychologist who — since 2018 — has collaborated with academic and NGO partners in Ukraine on mental healthcare delivery and research. She also is a research fellow at Harvard T.H. Chan School of Public Health.

Jacqueline A. Hart, M.D., is director of the Bassuk Center on Homeless and Vulnerable Children, Families and Youth in Needham, Mass., which works with communities and organizations nationally to promote housing, health and other opportunities for individuals and families. She has more than 20 years’ experience working in lifestyle, behavioral and integrative medicine, applying those principles to vulnerable populations and marginalized communities.

This op-ed also benefitted from contributions from: Mark C. Poznansky, M.D., PhD., FIDSA, director of the Vaccine and Immunotherapy Center, Infectious Diseases Division, of Massachusetts General Hospital, professor of medicine at Harvard Medical School and co-founder of Heal Ukraine Group; Alice Barocco, a medical biosciences student at Imperial College, London; Dmitriiy Dribinskiy, founder and director of Autism Unity; Yulika Forman, PhD, LHMC, a special education consultant and advocate.