How the Sane Ukraine Program—a Preventative Approach to Ongoing Stress and Trauma—Seeks to Support Psychological Wellbeing for Ukrainians amid Ongoing Conflict
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Traditionally, treatment for psychological trauma is initiated after the traumatic exposure has passed. A traumatic event occurs, or a traumatic stressor affects a person’s mood or performance, and mental health specialists may wait until the patient is safe to intervene and re-establish equilibrium. But what does a time-bound, discrete understanding of traumatic stressors mean for someone living in a war zone, where the potential for trauma, and the anxiety induced by that potential, are ever-present?
Sane Ukraine, a pilot program that seeks to address Ukrainians’ mental health concerns from a preventative rather than a curative frame, acknowledges that traditional understandings of when and how to deploy mental health interventions may not meet the needs of populations in wartime. And when trained and licensed mental health professionals train community members to provide psychosocial mental health education and support, mental health concerns can be more holistically addressed while increasing awareness of mental health issues and access to mental health interventions—although there is still a tremendous unmet need.
Why Mental Health Task Sharing in Ukraine
On February 24th, 2022, Russian forces invaded Ukraine, increasing many Ukrainians’ exposure to violence, displacement, family separation, damage to property, damage to infrastructure, and threats to wellbeing. The ongoing conflict with Russia has demonstrably negatively affected the mental and physical health of Ukrainian people, including those still living in their homes in Ukraine and those who fled the conflict to other regions within or outside of the country. The Office of the United Nations High Commissioner for Human Rights (OHCHR) verified 6,114 civilian deaths, 6,975,000 people internally displaced, and 7,600,000 refugees in October 2022. Prolonged violence, displacement, death of loved ones, traumatic experiences, loss of employment, lack of stability, and post-migration stress were shown to result in a deterioration of mental health, inducing depression, anxiety, and stress-related disorders.
Prior investigations of the impact of other conflicts, such as wars in Syria and the ongoing occupation of Palestine, have demonstrated that such environments are rife with both acute and chronic stressors. Acute stress reactions in the general population have started to be replaced with the signs and symptoms of chronic stress, with many Ukrainians exhibiting exhaustion and an increased onset of psychosomatic disorders, such as heart attacks—usually associated with senior populations—becoming more frequent in younger people. These impacts on physical health may seem less direct, but they are part of documented responses to overwhelming stressors. Additional stressful circumstances generated by the conflict, such as loss of electricity and heat during the winter, further increase precarity and anxiety—all while Ukrainians must attempt to function normally enough to work to support themselves and their communities.
Increased stress is evident as increases in demand for psychological support; such demand has overwhelmed the resources and capacity of professionals currently on the ground in Ukraine. Some interventions have been deployed to address this gap, including the WHO’s mental health task sharing approach, which trains community members to screen for, educate about, and provide stress management skills to those who are experiencing new onset of stress-related mental health concerns following traumatic stress exposures. These measures are a positive development, but they do not yet adequately meet the mental health needs of the general population. Among 1,165 refugees, internally displaced Ukrainians, and non-displaced Ukrainians, 81% exhibited symptoms of depression and 57% exhibited symptoms of acute traumatic stress; the majority of these study participants were actively working, studying, and volunteering. A majority reported that work, school, and volunteering activities also represented a welcome distraction and a sense of purpose which were beneficial to their mental health.
The Sane Ukraine Model
The ongoing war and following post-war conditions in Ukraine require systematic psychological interventions led by healthcare professionals, psychologists, and trained non-specialists embedded in Ukrainian communities. The focus should be shifted from only treating PTSD and trauma-related diagnoses after they arise, to understanding and proactively addressing those who are at risk due to ongoing trauma exposure and/or lack of protective factors. Disasters like war may produce multiple outcomes, including resilience, natural recovery, and post-traumatic growth. Acute stress reactions are part of normal recovery processes, but widespread, preventative interventions can provide the awareness and skills needed to promote resilience at individual and community levels, as a forthcoming study helmed by Kristina Bohdanova relates.
To respond to both acute and chronic mental health needs, a program called Sane Ukraine was created in March 2022 in Lviv by Mark Walsh and colleagues, which began providing mental health training to non-mental health professionals in Ukraine the following month. Initially, this training aimed to serve internally displaced Eastern and Southern Ukrainian people who had fled to Western Ukrainian cities like Lviv; the popularity of the project led to the development of a “Train the Trainers” program and an ongoing development with the Lviv City Council of Education, which has now trained all teachers in Lviv in psychoeducation and mental health skills. Currently, Sane Ukraine is focused on deploying the interventions to other regions, including offering this training to medical professionals and soldiers in frontline regions like Zaporizhzhia, Mykolayiv, Kharkiv, and Kryvyi Rih. Focus groups are used to ascertain community needs and training is offered according to community requests, in a responsive, community-based participatory model. The intention is to train over 2,500 more participants according to their needs, whether those include building an understanding of the consequences of traumatic stress, gaining preventative coping skills, or managing longer-term stress.
A Changing Approach to Modern Health Demands
The Sane Ukraine project is not only providing important care for Ukrainians but also showcasing a new model for preventative mental health care that deserves further research and attention. While specific traumas and stressors of people in war zones will vary, the precarity—and its mental health effects—that is associated with war is a global phenomenon. The results from our study of the Sane Ukraine project will have implications for mental health best practices for communities all over the world that have been affected by conflict, instability, and displacement.