Ukraine’s Mental Health System Strives Under Strain of ‘Continuous Traumatic Stress Disorder’

Mental health in Ukraine is trending upwards one year after a ground-breaking summit led by First Lady Olena Zelenska, according to leading practitioners. But major challenges remain as the country copes with what one expert calls “Continuous Trauma Stress Disorder” and struggles to meet wartime demand for emotional and psychological support.

The improvement in Ukraine’s mental health system has three key aspects, the experts told Kyiv Post, for which they give full credit to the leadership and vision of the President’s wife.

“Olena Zelenska is the singular figure in Ukraine’s mental health,” Dr. Oksana Senyk, Associate Professor of Psychology and Psychological Therapy at the Ukrainian Catholic University (UCU) in Lviv, who is training the next generation of psychological professionals, said. “Her personal involvement has changed the paradigm and made reform and growth possible. There is a new way of thinking now.”

During the Soviet regime, mental health was not a topic for discussion around most Ukrainian kitchen tables.

The first of the major changes has been a rapid destigmatization of mental health issues. Historically, for both cultural reasons and because of the weaponization of psychological issues during the Soviet regime, mental health was not a topic for discussion around most Ukrainian kitchen tables. Now, even the advertisements of the bus shelters in Ukraine’s cities regularly feature mental health information and provide opportunities to seek and get help.

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Berezhinskaya, a theatre director, had railed against Russia’s actions in Ukraine, saying Moscow’s soldiers were killing civilians and destroying cities in a naked land grab.

Paul Niland agrees from the coalface of Ukrainians’ mental health challenges as the founder and Executive Director of Lifeline Ukraine, a crisis support hotline that is answering some 4,000 calls per month.

“The biggest positive change is that we are discussing this issue more. Ukraine has always been hampered in creating effective responses to mental health questions by simply wanting to sweep the issue under a rug,” Niland said. “Nowadays, however, there is more of a general realization that any one of us can be affected by a mental health crisis and we are all exposed to daily realities in life that can leave us struggling with emotional issues.”

Secondly, there has been a strong growth in what’s called “community-based mental health service provision.” This is a shift toward supporting people in the community, including to avert crisis, rather than mainly through government-run and formal medical institutions, which are often a physical and philosophical legacy of the Soviet era and designed for those who are acutely unwell.

Mental Help is an example of the trend. Supported with USAID funding, it provides online support and therapy to people in need, including more than 400 therapeutic clients since its founding in 2022. At no cost, clients can select from some 16 therapists who specialize in different forms of treatment and book time for sessions. Its practice is founded on the principles of ease, convenience and confidentiality.

Dr. Nataliya Grinko, an Associate Professor of Clinical Psychology at UCU and psychotherapist for Mental Health, said that the platform is well-suited to the wartime context.

“By using tele-health technology and being flexible, we give Ukrainian clients the support and respite from the conflict that has sadly become part of their daily lives,” she said. “It’s a way to debrief, process and heal from the unique range of issues people are confronting.”

In addition to providing direct support, non-government service providers like Mental Help contribute to greater psychological understanding and acceptance in the broader community, Dr Grinko added.

Niland agrees that the “proliferation of organizations” providing mental health services is a key trend. But he adds that “what is needed now is better coordination between these organizations.”

“In the field of mental health nobody is competing with another, and we should all look at the kind of services that we provide as complementary to one another,” he said.

The third key development in Ukraine’s mental health sphere is greater government recognition of and resources for mental health. This includes the formation of a Coordination Center for Mental Health in the Cabinet of Ministers which was formed after the First Lady’s Summit. It seeks to coordinate mental health efforts between ministries, NGOs and international partners under the banner of the How Are U? initiative. 

“We see greater prioritization and focus on mental health by key decision-makers, and that’s really important, for example, in setting standards of excellence for the overall system,” Dr. Senyk said. “It also sends an important signal from the top about it being okay to have the mental health conversation.”

Against those strides forward, and the emotional and mental resilience in society which they protect and promote, the full-scale war against Ukraine however continues to significantly impact on the broader community’s psychological well-being.

“Treating trauma assumes that there is a past traumatic event that can be identified, isolated and addressed. However, the situation in Ukraine is much more complex,” Dr. Senyk said. “There is a constant stream of contemporary traumas of different types and proportions – whether it’s the bombing of a city or news of relatives killed in military service – which represent a huge challenge to care and treatment. We can call it Continuous Trauma Stress Syndrome.”

In this respect, Niland said, “it’s a normal reaction to having been subjected to an abnormal way of life.”

Also, when it comes to supply and demand, the number of available psychological professionals is far below what’s required to meet the needs of Ukrainians. Waiting times of up to six months to see a private psychologist are widely reported.

Research that Niland was recently part of found that Ukraine has 0.7 qualified psychologists and psychotherapists per 100,000 of population whereas the figures in Germany and the United States, respectively are 7.3 and 7.9 licensed practitioners per 100,000 population, which is more than a ten-fold difference. 

Niland further notes that demand for Lifeline’s services is likely to be 2000 more calls per month that currently cannot be met due to funding constraints and that the number of callers with suicidal intent has risen during the war to 20 percent of total, which is in excess of international averages.

“While we have our challenges, we’re blessed with outstanding practitioners, even if there are not enough of them. We have to fill the gap between supply and demand for mental health services and support, and, as we do it, it is critical to also establish a real ecosystem of holistic and continuous care,” Dr. Grinko said.