War also leads to massive mental health crisis in Ukraine | War in Ukraine

“I have a trauma myself. I show symptoms,” Anatoliy Kushnirchuk told NU.nl. “Insomnia, anxiety and I almost had a stroke.”

The 43-year-old resident of Boetsja is a Baptist minister and spiritual counselor (chaplain) with the reservists of the Territorial Defense. Together with about thirty others, he decided to defend his hometown when the Russians invaded on February 24, 2022. The army and police had already left.

The group’s light firearms and Molotov cocktails had little effect against the armored Russian superiority. The liberation of Butcha, just over a month later, came too late for thirteen of Kushnirchuk’s comrades. He and the other surviving residents then had to bury their loved ones and pick up the pieces, while the fighting continued elsewhere in the country.

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More than two years after the Russian occupation, the vast majority of material damage in Butcha has been repaired. Other forms of damage are permanent, Kushnirchuk says. As a church leader, he must guide his traumatized community while struggling with his own demons. “My family and two fellow pastors help me with that.”

Kushnirchuk most often sees people suffering from survivor’s guilt and continuing to torment themselves with questions about their own decisions and those of others. “‘Why did we stay, why didn’t we run? Where were the forces?’ Some are desperate for someone to talk to about it. Others are still completely devastated and unable to do so.”

The war also leaves deep spiritual scars in Ukraine. The World Health Organization estimated in mid-March that 9.4 million Ukrainians have or are at risk of a mental illness. The Ukrainian government believes that 30 percent of the population, more than 12 million people, need some form of psychosocial help.

“It is impossible to prepare for something of this scale,” said Anna Didenko, mental health director at the Ukrainian Red Cross. “We have provided psychosocial care to more than half a million people in the past two years and that is a drop in the ocean. The situation is not stable, it is still an emergency.”

Didenko: “The list of challenges is enormous and varies from region to region, from group to group. Take for example the approximately four million displaced Ukrainians, who have to adapt to their new lives. Or the veterans returning from the front. We see many different symptoms, such as stress, anxiety, depression and sleep problems.”

Before the outbreak of war in 2014, Ukrainian mental health care was not in good shape. The system still has many features from the Soviet era, with a great emphasis on medication and admission to psychiatric hospitals. Other treatment methods, such as talk therapy, are hardly offered.

The war has exacerbated existing problems within the system. The Ukrainian government was forced to make even more cuts in mental health care. Staff shortages in the sector continued to grow. Hundreds of medical facilities, including many mental health institutions, were also damaged or destroyed by war, especially in the east of the country.

There are also still major stigmas surrounding mental health in Ukraine. In the Soviet Union, psychiatric hospitals were often used to hide dissidents and other enemies of the state. A 2021 survey found that 75 percent of Ukrainian respondents viewed psychiatric institutions as prisons rather than places of treatment. Mental problems are often still seen as something to get through.

Didenko of the Red Cross sees that attitude slowly changing. “More people understand that you have to take care of yourself, also mentally. Younger people in particular talk openly about this, it no longer scares them. They think about it very rationally: ‘If you have hardly slept for three weeks, then there’s clearly something wrong!'”

According to Didenko, it is now important to carefully identify what mental health care is needed and how it can be organized. “The Ukrainian government understands that the need is great. There are now working groups with more than three hundred different organizations throughout the country.”

The Red Cross estimates that basic psychosocial care can be sufficient for 80 percent of those in need of care. The remaining 20 percent require specialist mental care.

Didenko currently mainly sees concrete opportunities to help the first group. “We need to train GPs to tackle the most common mental health problems,” she says. “At the same time, much more needs to be organized at population level, for example training for veterans. What is stress? What are the signs that you are really not doing well? These are basic things that can really make a difference.”

As for the group needing specialist care, Ukraine will have to rely heavily on international aid. The outdated Ukrainian mental health system must be dragged into the 21st century – under the greatest possible pressure. Didenko: “Demand continues to grow and will continue to do so for the next ten to fifteen years, if not longer. We need long-term support and a structured approach. We cannot build a sustainable system if we do not know where we will be next year to be ready.”

Chaplain Kushnirchuk from Butcha has a simple message for Ukraine’s allies. “We need professional therapists for children, for widows, for veterans. We need people who have experience with this kind of trauma. Come here and train our people. Only then can we as a community come back to life.”

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