As Ukraine war drags on, civilians’ mental health needs rise

Nastya huddled in the back of a café near the train station where a missile killed dozens a year ago, breathing slowly and deliberately to calm herself. Overnight, her neighborhood was bombed again, and she couldn’t take it anymore.

Following the advice of her parents, the 20-year-old woman went that morning to a nearby psychiatric hospital – which also bears the scars of war after being bombed repeatedly, including a missile that destroyed parts of the building last September . But workers swept up the shattered glass, shoveled away the debris and continued their work, determined to stay in Kramatorsk, in the Donbass region of eastern Ukraine, to help those in need.

For Nastya, it’s been a lifeline.

“After today’s shelling, I can no longer deal with the anxiety, the feeling of being in danger,” said the speech therapy student, who last month gave only her first name to talk about seeking mental health care difficult decision. The stigma of Soviet-era psychiatry remains, when dissidents were locked up in mental institutions as a form of punishment.

“I just realized my mental health is more important,” she said.

Experts say there are hundreds of thousands of people like Nastya in Ukraine, and the number in need of psychological help is only expected to increase as the war continues. In December, the World Health Organization said that one in five people in countries that have experienced conflict in the past decade will suffer from a mental illness, and estimated that some 9.6 million people in Ukraine could be affected.

Russian invasion In February 2022, millions of people were displaced, lost loved ones, and forced to spend months in basements due to the constant shelling or the harrowing journey through the Russian-occupied territories.

For Nastya and many others, the war changed everything overnight. There was a previous — simple and happy life, going for coffee and laughing with friends. and one after.

“You wake up feeling surrounded by fear, anxiety, constant air raid sirens, flying planes, helicopters,” she said. “You’re just in a closed circle where there’s no old happy times, but a lot of fear. Fear of the unknown, fear of dying here and now.”

Hundreds of kilometers (miles) to the west, Tatyana, 38, a worker at the Zaporozhye nuclear power plant, has lived in the Russian-occupied town of Ernekhodar for four months, She shuddered as she described seeing bombs explode near the plant, and how her family endured the 24-hour ordeal to escape to Ukrainian-controlled territory.

When she registered for assistance at a support center in Boyarka, south of Kiev, she wept a few months ago. The staff called in a psychiatrist.

Tatiana said the therapy helped, and she asked not to use her last name to speak publicly about seeking mental health care. After a group therapy session last week, she paused in her speech with blank eyes and difficulty concentrating. She’s struggling to cope with what it’s like to live in war.

“It’s the fear that comes with realizing that you could lose everything in an instant,” she said. Life “is like a light switch. It can be turned off and never turned on again.”

Demand for mental health treatment has soared across Ukraine, professionals say, even as they deal with the effects of the war in their own lives.

“The need is huge, and unfortunately it’s only going to grow,” said psychotherapist Pavlo Horbenko, who has been treating people affected by the war at a center in Kiev since 2014, when Russia annexed Crimea and spread the war in eastern Ukraine. Created two proxies to separate the countries.

He has noticed a marked increase in patients seeking treatment for sexual violence, bereavement and suicidal thoughts. “It used to be one or two requests a week, now we can have 10 a day.”

Hobenko said that in other conflict-stricken countries, the need for psychotherapy increased rapidly after the fighting ended.

Right now, people are focused on surviving. “But when the war is over, … then we can relax. And when we can relax, the symptoms that have been accumulating come back,” he said.

Like a soldier wounded in battle who doesn’t feel pain until he’s out of immediate danger, “that’s when the wound starts to hurt. That’s what psychological trauma is.”

The number of mental health specialists in Ukraine has increased since 2014, but more are needed, Horbenko said. “Demand still far exceeds capacity,” he said.

Authorities have been seeking to increase mental health services across Ukraine.

At the request of the Ukrainian Ministry of Health, Lebanese psychiatrist Dr. Maya Bizri recently visited Ukraine as part of a project run by medical aid organization MedGlobal to assess needs and train doctors and nurses to identify mental health issues among colleagues and patients.

“The ones who are really affected are … healthcare workers,” Beazley said. “There’s a lot of training on how to deal with trauma patients or physical injuries, but nobody’s covering healthcare professionals’ healthcare.”

Under the MedGlobal program, doctors and nurses are trained to help themselves and their colleagues cope with stress, so they can in turn train others.

“There’s serious distress and serious unmet needs that aren’t being addressed, and if you want a resilient health care system, you’ve got to take care of your own people,” Beazley said. “And I think the Department of Health is very clear This, because they are very actively involved in it.”

Dr. Ludmyla Sevastianova, director of the Kramatorsk Psychiatric Hospital, said that is exactly what mental health professionals are needed to help them cope.

War “affects us as much as it affects patients,” she said. “We are also worried about our family, relatives and friends. But we are doing our medical duty and we are helping.”

Psychiatrist Sevastianova has made it her mission to “save hospitals so people can keep working, save hospitals so they can care for patients. That’s the goal, and it helps.”

But she is under no illusions about the possibility of long-term consequences.

“Things don’t go by without a trace. I cut my hand and I have scars. The same goes for our psychology,” Sevastianova said.

“Now we need to adapt, we need to survive, we need to provide assistance, we need to work. … What impact this will have, we will know later.


Elena Beccatoros, Associated Press

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