Psychiatrists Worry About Ukraine’s Long-Term Mental Health Challenges

Irina, her husband and 4-year-old son hid in the cellar of their house in Chernihiv, north of Kyiv, for three weeks as intense fighting, including a tank battle, raged around them.

“At first my son seemed to be coping okay,” she says. “But then with unrelenting stress, shelling and blasts, there was a deterioration — the boy started to become withdrawn. He became nervous. He started to stutter,” she says.

Their escape from Chernihiv wasn’t gentle either.

“We had to drive along a road, which we knew was mined. And we saw a lot of burned-out cars with people, families, scorched inside. We tried to ignore it all and just continue because we had our kid and just wanted to save him,” she says.

She doesn’t know what her son saw, what he took in from the carnage and how it is churning inside him. He was in his booster seat in the back of their car. She hopes he slept through a lot of the dangerous and terrifying journey from Chernihiv.

“I have not tried to raise anything with him about what he saw,” she added. She has heard that drawing is good therapy for traumatized children and has been encouraging him to do so.

So far, he has been drawing repeatedly the yellow and blue Ukrainian colors.

Many Ukrainian evacuees say they have noticed their children have changed and seemed to be displaying signs of trauma and stress, even those who did not witness at first hand horrifying scenes.  Some exhibit rage; others seem withdrawn. Some are bed-wetting.

“It won’t just be combatants, we will have to help after this war,” says the Reverend Mykola Kwich, a Greek-Catholic priest in western Ukraine. Kwich is a trained counselor and has helped rehabilitate soldiers suffering from post-traumatic stress disorder.

“Civilians who have gone through bombardments and shelling and have witnessed a lot will need help,” he said. “We are expecting to have to do a huge amount of psychological work. We will have to do this work because it will impact our society and lead to more problems.

“Wars are about destruction. In the same way towns and buildings get damaged during war, so with people inside. After war, you can’t be the same person. But there are methods and therapy we can use to help restore people’s mental health and assist them to pursue a normal life, if they are willing. Of course, you won’t return to being the person you were before,” he adds.

Refugee reception centers in central and Western Ukraine are trying to offer traumatized adults counseling and play therapy for kids. “We do have specialists and priests coming to visit the evacuees” says Valeriy Dyakiv, director of a reception facility sheltering about 300 evacuees in the central Ukrainian town of Vinnytsia.

“Prayers calm people a little bit,” he adds. “And for children there are different types of activities. We had a puppet show the other day, and for some kids it was a huge surprise because they were from small villages and they had never seen puppets before,” he says. The activities for the kids also involve drama and poetry readings.

 The center managed by Dyakiv has the benefit of having as an evacuee a well-known Ukrainian actress, Olena Prystup, who fled her hometown of Kharkiv, the beleaguered eastern Ukraine town. “My favorite role? Prystup ponders when asked. “Ophelia,” she then says.

That seems highly fitting what Prystup is trying to do now — to help traumatized children deal with their stress. William Shakespeare’s Ophelia, from the drama “Hamlet,” is a young Danish noblewoman and potential wife for Prince Hamlet, who, due to Hamlet’s actions, ends up falling into a state of madness that ultimately leads to her drowning herself.

“We have two groups of kids,” Prystup says. “The youngsters are learning some poems by heart and then reciting them at short performances. And the older ones, teenagers, are actually working on a play right now. I don’t know how it’s going to shape out. I hope it is going to be okay, and some of them are talented,” she adds.

Professional psychiatrists worry, though, that Ukraine doesn’t have the health care capacity to cope with what is likely to be needed when the war is over. Even before Russia’s invasion, Ukraine suffered a high prevalence of depression, alcoholism and suicide compared to some other European countries.

A report by the World Health Organization in 2020 noted that mental health disorders are the country’s second leading cause of disability and affect about 30 percent of the population. The WHO also noted that many Ukrainians distrust psychiatry because of the Soviet past when psychiatry was used as a tool of repression — dissidents were often accused of being “mentally ill” and incarcerated in hospitals during the Communist era.

It said in a report, “Challenges include a large institutionalized psychiatric system associated with human rights violations, alongside public stigma and low awareness of mental health. Social services for people with mental disorders are limited or absent in the community.”
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