Throughout the full-scale Russian invasion, Ukrainians have demonstrated their endurance and resilience. Yet, no matter how steadfastly faced, such events inevitably impact individuals' mental health, no matter how strong they believe themselves to be.

The depth of an individual's emotional response to an ongoing war isn't always directly correlated with the immediate challenges they've faced. Indeed, the trauma of witnessing the war from a distance can deeply affect one's mental state—even if they are not in immediate physical danger. Viktor Liashko, Minister of Health of Ukraine, estimates that 14 million Ukrainians are in need of psychological aid. This is an urgent priority as, to be effective, professional counselling must be administered as promptly as possible.

Even before the onset of the full-scale Russian invasion, many Ukrainians grappled with a myriad of mental health issues, such as post-war syndrome, loss, and trauma from abandonment. The number of people suffering from such conditions has increased manifolds since 24 February 2022. The United Nations Development Programme (UNDP) has extended its support by providing several grants in support to initiatives designed to provide psychological aid to Ukrainians during the war. This article delves into the most successful of these initiatives, engaging with their specialists to discern what makes their approaches particularly effective and impactful.

To find out more about why supporting mental health is so important right now and how this support has changed due to the ongoing war, we have asked the team of the ‘Comprehensive Programme for Providing Psychological Aid to Ukrainian Population (in and outside Ukraine)’ project of the National Psychological Association of Ukraine, led by its President and project manager Valeriia Palii. The project has been active since 2017 and currently includes over 1,700 professional psychologists and psychiatrists. They offer free psychological aid to Ukrainian citizens both in Ukraine and abroad. The organization is the only Ukrainian member of the European Federation of Psychologists’ Associations. 

The idea of creating a toll-free mental support line emerged during the COVID-19 pandemic, but the line became fully operational at the outset of the war in 2022. The project was made possible due to grant support from UNDP Ukraine and funding from international partners, such as the European Union, and the governments of Denmark and Canada. 

Project Administrator Olena Dorohavtseva said operating the support line during the incessant attacks was a challenge. “We work online, and it was hard when blackouts and power outages began,” she said. “We had a site operating in Germany, so we were able to transfer calls to each other when some areas had no power or internet connections, and thus ensured we always stayed online.”

Psychologist Oleksii Liashenko says 14 percent of calls are social enquiries, meaning people are asking for monetary assistance or some kind of support for repairing their damaged property rather than for psychological aid. In such cases, the administrators always ask if there is a need for psychological aid; many answer they don’t feel like they need it, but some do agree to a conversation. Another 86 percent of calls are related to mental health. Those are people aware of their needs who address the psychologists about specific issues. 

How psychological support is provided to internally displaced men and women

Nearly 8 million people have been forced to flee Ukraine since the Russian invasion began, according to data reported by the United Nations Refugee Agency (UNHCR). Another 6.5 million people have sought refuge in other parts of Ukraine, becoming internally displaced.

Kostiantyn Tatarkin is the project manager for the Urgent Actions for Crisis Psychosocial Adaptation, Resilience-shaping and Elimination (UA-CARE) project of the Development Foundation NGO, an initiative supported by UNDP and funded by the European Union. He said the most important aspects of their activities is the provision of effective psychological aid to internally displaced persons. “The project was designed to assist internally displaced persons in nine oblasts,” he said. “Our focus was on internally displaced persons, but in group sessions we provided assistance to everyone. When a person needs help, no one cares if that person is a veteran, an internally displaced person or someone else. The need is right here and now, so we have to help.” 

Mr Tatarkin talked to us about project activities that include primary psychological aid in the form of group sessions in each of the oblasts, and sometimes in communities as well. Professionals engaged in the project stayed in oblast centres as well as in host communities, accepting internally displaced persons and holding group sessions right there. Individual therapy is a face-to-face activity, but many sessions also had to be held online, especially during mass missile attacks when it was impossible to gather people in one place. 

Independent professionals offer mental support in various ways, such as chats, chatbots in Telegram, phone calls, individual counselling, and group therapy. Olena Romashka, another representative of the Development Foundation NGO, outlined several elements that helped them implement the project: “We had nine oblasts and there was a provider in each oblast,” she said. “Three providers happened to be from occupied territories. A female psychologist from Sviatohirsk worked in Lviv, and a mental health service provider from Enerhodar in Zaporizhzhia. She had a high degree of trust from the people in those areas. The provider in Kropyvnytskyi was a serviceman’s wife who had harsh experience of fleeing Mariupol.”

According to Iryna Vereshchuk, Vice Prime Minister for Reintegration of Temporarily Occupied Territories, about 1.2 million people still remain in these territories. Most of them require psychological support and counselling. 

Liliia Shapovalova, an expert in this project supported by UNDP and the EU, shared her experience and challenges she had faced when working in Zaporizhzhia Oblast. “About 70 percent of Zaporizhzhia Oblast is now controlled by Russians, while Zaporizhzhia city itself is under the control of the Government of Ukraine and is 30 km away from the frontline,” she said. “This means constant shelling takes place virtually every night. It’s like a ‘cradle’ for displaced people. Many of them pass through Zaporizhzhia city. Connections are really awful. We reported about it and people used to go out to the banks of the Kakhovka Reservoir to get in touch with their families or psychologists. Or they would climb to the upper floors of high-rise buildings after the beach near the reservoir was mined. It was really hard for both psychologists and their clients, because people would even call late at night.”

Between 23 March and 6 April 2023, a survey was conducted in collaboration with the KCSA’s Social Policy Department using the “Kyiv Digital” app.  The aim was to gauge stress levels among Kyiv's residents and understand their coping mechanisms. Of the 9,795 respondents, a mere 11 percent described their mental state as stable. A significant 38 percent experienced anxiety or fear about their future. Another 18 percent cited discontent arising from sleep disruptions or fatigue. Both constant irritability and a sense of apathy were felt by 12 percent of participants, while 9 percent reported feelings of loneliness.

Yuliia Paskhina, a psychologist and the project manager for the "Mental Support Hotline for the Families of Missing Persons, War Prisoners, Survivors of Torture or Sexual Violence," spearheads an initiative run by the NGO International Confederation against Corruption, Organized Crime, and Terrorism. This initiative is in partnership with the NGO Community Self-Help. The hotline, specifically designed to support families of missing persons, war prisoners, and survivors of torture or sexual violence, was brought to fruition with the grant support from UNDP and the EU.

On the challenges of establishing the hotline, Ms. Paskhina commented, “Our field of expertise is incredibly niche, yet its need surged with the onset of the war. Regrettably, there were no existing hotlines that specifically addressed these pressing issues at that time. Our primary objective was, and remains, to deliver psychological aid.”

Counselling over the hotline usually takes 40 to 50 minutes. About 15 minutes is needed for a person to talk about their problem; then the operator and the psychologist set out what needs to be done. As the hotline is highly specialized, there were also ‘non-core’ phone calls that needed referral, such as how to help restore windows or how to sell a flat. 

Some callers needed assistance reaching the Security Service of Ukraine, the police, or other relevant contacts to gather information about individuals who had been captured. As per data from the partner organization, 60 percent of the callers are from families of individuals who are missing or captured. Approximately 25 percent come from families of those who have endured torture or sexual violence. Operators note that callers often hesitate to admit they have personally experienced sexual violence. Instead, they may initially say they merely witnessed it. However, as conversations with psychologists progress, it often emerges that the trauma was experienced firsthand.

Remedial art therapy 

People experiencing various emotional conditions related to the war may change their usual behaviour or priorities. Self-blame intensifies, making it impossible to live a more-or-less ‘peaceful’ life. Primary psychological aid is exactly what Ukrainians need now.

Ulyana Shchurko, Head of the NGO Centre for Social Innovations, shared her experience of providing mental support through the project ‘Lviv Unites and Reinforces: Primary Mental Support to Internally Displaced Persons’ that has also been implemented with support from the UNDP and the EU. “We have already been working as a civil society organization for 10 years,” she said. “We had the temerity to be founded right before the Revolution of Dignity, so we had to respond to all the challenges that emerged afterwards. 

“Our goal was to discuss education, culture and social processes. What we got instead were children who witnessed the Revolution of Dignity, and children whose parents had died in the anti-terrorist operation. We realized we needed to work with them. We also had some experience of socialization of orphaned teenagers that had experienced trauma. Our intention was to bring them back to society. As we put the emphasis on culture, we tried to combine it all together. Our project focuses on creativity as an element of primary psychological aid.”

According to Olesia Datsko, project manager and Deputy Head of the NGO Centre for Social Innovations, the first internally displaced persons that arrived – alumni, former teachers, friends and acquaintances – all came to the Academy. “We had a huge influx of people, both famous and unknown,” she said. “Anyone who was willing could come and help making camouflage nets. We emphasized that net-making was primarily about social integration. “We realized that it wasn’t enough to provide mental support or simply be with a person. They need to feel needed. The environment is important as well. We come to the Academy because it has this informal atmosphere, a lot of students and so on. You can open up to people here. Everything around breathes art, so people find it psychologically comfortable here.” 

Therapeutic support in hard times 

UNDP, in partnership with the governments of the Republic of Korea and Germany, has been able to help Ukrainians overcome emotional stress caused by the ongoing war through a number of joint efforts with the SpivDiia Charity Foundation under the project “Supporting the rehabilitation of people with disabilities caused by the war.”

The mission of this partnership is to raise awareness of mental health, and of the availability of mental health support through group sessions and individual counselling, adapted to vulnerable population groups. These sessions are conducted by specialized social workers who are members of multidisciplinary rehabilitation teams operating in healthcare facilities today.

The project has implemented special training courses and webinars, such as ‘How to get ready for a serviceperson coming back home’ and ‘Facilitating veterans’ transition to civilian life.’ These tailored programmes are designed to address unique issues faced by those affected by the war, offering practical guidance and support.

One of the most notable achievements of the cooperation between UNDP and SpivDiia is the provision of psychological aid and counselling. Over 8,000 people from across Ukraine have accessed and received this vital support, through either personal interactions or through the call centres. These services have had a profound and positive effect on the lives of people who struggle with emotional stress caused by the war.

One of the call centre’s clients, a woman who prefers to remain unnamed, said working with a therapist has helped her understand the direction she should go from now.  “I realized that things are actually not as bad as they seemed,” she said. “I felt easier and calmer after every session, and more capable to address various issues. The overall impression left after these sessions is no doubt positive, and I firmly intend to continue with this therapeutic journey.”

No matter which specific path is chosen by psychologists or activists, any contribution to Ukrainians’ mental health is invaluable. Support being offered to vulnerable groups and people in need of special assistance will take Ukrainians one step forward towards the enhanced mental health and well-being required to survive in the context of war.