How do you provide mental health support for people caught in a war zone? It may sound like an insurmountable challenge, but for Dmytro, this is his day job.
“There's a rule that emerged with the onset of the war: if you want to help yourself, help others.” he said.
Dmytro joined UK-Med’s Ukraine mission in October 2022, a few months after we launched our humanitarian response in the country. Initially working as a psychologist with the mobile clinic teams, he is now a Mental Health and Psychosocial Support (MHPSS) Supervisor.
Dmytro and his colleagues have provided nearly 10,000 mental health consultations since the programme began in April 2022, shortly after the full-scale invasion of Ukraine. The majority of these consultations were delivered in communities close to the front line in Kharkiv and Zaporizhzhia regions, where the psychological toll of war on civilians is most profound. In the same period, UK-Med staff in Ukraine have also delivered 48 MHPSS training sessions for hundreds of civilians and local health care staff, helping to strengthen existing capacity in the country.
But for Dmytro, his journey began before the conflict, when he chose to specialise in crisis psychology during his studies. On the outbreak of war, Dmytro realised that his professional skills were urgently needed and driven by a powerful desire to the people in his country, he decided to join UK-Med as a psychologist.
“The essence of crisis psychology work is to reduce the consequences of stress. Because if help is provided in time, then Post Traumatic Stress Disorder (PTSD) won’t develop.”
“In Ukraine, many people have experienced trauma and stress as a result of the war, especially those who have been displaced. Things like explosions or missile attacks cause anxiety, and persistent anxiety leads to depression. There’s also a lot of grief and loss, because losing loved ones on the front line is sadly not uncommon. Peoples’ wives and husbands die, and we also work with people to navigate this.”
Nearly half of all those who received mental health support from UK-Med since April 2022 have been displaced at one time or another. 75 per cent of them are also women. On the topic of loss – an experience that is far too common for many in Ukraine – Dmytro candidly recounted the story of one patient whose life was changed when his home came under attack.
“A bomb hit his home; he lost his mother, his house, and he was injured and lost his leg. When we first met, he was in such a depressive state. Small noises would make him jump, triggering flashbacks. PTSD was beginning to take hold.”
“The nature of our work in the field means that one consultation can be everything. For this consultation, I had to determine exactly what would help him, create a plan for his next steps, and maybe even teach him coping mechanisms.”
“For him, it turned out his coping strategy was repairing electronics. He said, ‘People bring me old phones, mobile ones, for me to tinker with.’ I suggested he give it a try. I said that he needed to occupy himself with something to engage the cognitive part of his brain, to cope with his emotions. After two months or so, it began to help; he became interested in life again, all through a simple solution which became a coping strategy.”
Breaking Barriers and Overcoming Stigma in Mental Health
In an active conflict zone like Ukraine, the work of Dmytro and his colleagues is invaluable. According to global estimates from the World Health Organization (WHO), one in five people living in an area affected by conflict is estimated to have a mental health condition, from anxiety and depression to PTSD. If the same estimates are applied to Ukraine, that means nearly 10 million people may be suffering from some form of mental health condition.
But despite the prevalence of these issues, there is a persistent degree of stigma associated with mental health conditions.
“There’s a certain stigma attached to psychological issues, as people often don’t distinguish between a psychiatrist, psychologist, and psychotherapist.” said Dmytro.
“But education and good practice go a long way in remedying this. There are certain rules that every crisis psychologist knows; how to counsel, and how to speak to patients. If we adhere to this, as psychologists, we can overcome the stigma and show people that [psychological support] is necessary. After all, the area of the brain responsible for physical pain and psychological pain have the same projection zone. Overcoming stigma helps a lot so people feel able to turn to psychologists when they need to.”
A Holistic Approach to Healthcare
To help breach the stigma associated with psychological issues, and to ensure UK-Med reaches as many people as possible with mental health support, psychologists are considered integral staff members of our mobile clinics.
“The work of mobile clinics involves a doctor, a nurse, a social worker, a psychologist, and of course, a driver who takes us to the location.” said Dmytro.
“We work closely with the social worker and the doctor, which is crucial to ensuring that we provide quality assistance to our patients. For the psychologist, this requires knowledge of clinical psychology because we need to communicate effectively with the doctors. Social workers also greatly assist us as they are the first responders, determining through psychological triage who needs psychological assistance first. We also receive referrals from doctors. That’s the essence of mobile clinic work.
“Sometimes I joke with my patients. I say, ‘Why do you think they take me along with the mobile clinic? To save on pills. Because the more you talk to me, the fewer pills you take!’ But it’s true that there is often a direct connection.
“Under constant stress, a person’s body works differently – elevated blood pressure, increased heart rate, blood clotting, and digestive problems – these are all consequences of stress. Because it all comes from the brain, mental trauma manifests through our physical state, and the body indicates that something is wrong.”
“Central to this is the idea that a person needs to be treated as a whole; you can’t separate the psychological from the physical. A person is holistic, and they need to be treated as such. Therefore, a psychologist is a necessary member of the mobile clinic. And frankly, I don’t know how it’s possible to deliver that kind of holistic service without a psychologist present.”
The Importance of Empathy
The relentless job of a crisis psychologist is never an easy one, even in the best of circumstances. Providing MHPSS support in a war zone, in your own country, requires an unparalleled degree of moral courage and emotional fortitude. But, remarkably, Dmytro treats it as part and parcel of his day-to-day work.
“What exhausts me more is the journey to the patients!” he said, “because often we spend two or three hours on the road in one direction only to reach the villages, and that’s exhausting.”
“On the other hand, there is a concept of ‘empathy’ in psychology, in everyday life, between people that is central to our work. It’s the ability to put oneself in another’s shoes, but consciously. I realise that it’s someone else’s life; it’s not mine. I won’t cry with them when they cry. Crying is normal, but we cannot leave someone crying. It’s important, as a professional, not to cry with the patient on the one hand, but not to become a cynical, burnt-out, indifferent person on the other.” said Dmytro.
“I sympathise with a person to the extent that I can help them. But after that, I try not to take it home. After all, I still have five more patients waiting for me, and I need to leave something for them.”
Dmytro is one of 55 Ukrainian staff working with UK-Med in Ukraine. To support them and their lifesaving work providing urgent medical and psychological care for people on the front line, we have relaunched our Ukraine Appeal. Please consider donating today.
