CINCINNATI, Ohio — Since February 2022, millions of Ukrainians have fled their home country, taking with them trauma and psychological distress — consequences of the war. While mental health services from host nations are helping, NGOs have stepped up to offer additional mental health support for Ukrainian refugees.
Ukrainian Refugees in Numbers
As of December 6, 2022, about 7.8 million Ukrainians (mostly women and children) are now scattered across Europe, with both Germany and Poland now hosting more than a million refugees each.
An investigation conducted by the Associated Press found that as of July 2022, about 2 million Ukrainians have been forcibly transferred to Russia and have endured human rights abuses along the way. Russia, as of December 6, has more than 2.8 million Ukrainian refugees within its borders.
War Refugees and Mental Health
Traumatic events induced by war, like violence, losing a loved one, rape, separation of families and a loss of belonging, increase the risk of mental conditions, such as depression, insomnia and post-traumatic stress disorder (PTSD).
According to the World Health Organization, even before the onset of the Russia-Ukraine war, 30% of Ukrainians suffered from mental health conditions. The impacts of war can exacerbate pre-existing mental health conditions. CARE International estimates that about 33% of Ukrainian refugees will develop anxiety, depression or PTSD as a consequence of the conflict.
Child Refugees and Mental Health
The trauma arising from war harshly impacts children. A review by Bronstein and Montgomery of 22 studies on the mental health of young refugees in high-income countries found that the prevalence of PTSD “ranged from 19–54%, with an average of 36% across samples.” And, in terms of depression, “the prevalence ranged from 3–30%, with an average of 18%.”
Children can also develop dissociative disorders like depersonalization, derealization and numbing as well as behavioral disorders like aggression and violent criminal behavior. Trauma from war can deprive children of the time necessary for cognitive-emotional processing and self-healing. Trauma can also cause children to regress in age-appropriate behaviors and face struggles performing normal daily tasks.
Mental Health and Poverty
Mental health and poverty have a close relationship. “Poverty is associated with volatile income and expenditures. The resulting worries and uncertainty can worsen mental health,” a study by Matthew Ridley and others explains. Poor mental health impacts one’s ability to make responsible financial decisions and increases the likelihood of contracting other chronic illnesses, which raises health expenditures.
In addition, accessing community services or support can be difficult for people with mental health issues, especially refugees in new environments, because of stigma or difficulties navigating the system.
According to a registry-based study conducted by Jonas Minet Kinge and others in Norway between 2008 to 2016, children born into poverty are several times more likely to have mental disorders than children born into wealth.
Children born into poverty are at greater risk of violence, exploitation and abuse, and are more likely to lack nutritious foods, quality daycare and health care. In addition, parental mental illness can negatively influence a child’s “cognitive development and educational attainment.”
PSAR Provides Mental Health Support For Ukrainian Refugees
Providing mental health support for Ukrainian refugees in Poland is Podkarpackie Stowarzyszenie dla Aktywnych Rodzin (PSAR) located in Rzeszów, Poland. PSAR was founded in 2015 with the goal of supporting children’s development. PSAR, with help from Project HOPE, set up the TUTU Psychophysical Development Center in May 2022 to help Ukrainian women and children process their trauma.
The Borgen Project spoke with the co-founder of PSAR, Jan Marković, to understand the mental state of the refugees and the TUTU Center’s work. According to Marković, Ukrainian refugees find it difficult to discuss their trauma due to the stigma in Ukraine regarding mental health. He says that some Ukrainian parents flat-out refused to allow their kids to receive mental health support at the TUTU Center. As such, staff members avoid mentioning mental health when refugees first come to PSAR. Instead, staff members may say something along the lines of, “this [activity will help]your children [feel]calmer,” to warm them up. The parents do become more trusting over time.
According to Marković, when children come to the TUTU Center, staff members take them to the “integration room” to play with other children. While there, two or more specialists observe the kids to identify signs of war trauma like aggression, withdrawal or an impulse to hide. Sometimes, the older children don’t show much emotion as their families expect them to take on the roles of adults and take care of their younger siblings. Specialists remind these children that they can step back into their childhoods while at the TUTU Center.
The TUTU Center Services
The TUTU Center’s child services benefit refugee families in a couple of ways. For one, the services allow mothers to have a couple of hours a day for themselves and allow them to look for a job or find a place to live. Activities like art sessions allow children to express their trauma in ways they struggle to describe through language alone. When children paint, therapists can engage with them using the painting as a point of discussion.
For adults, TUTU teaches relaxation techniques, social skills workshops and provides information on schools, medical centers and social services. As of late November 2022, the TUTU Center has helped around 4,500 Ukrainian refugees (primarily children) and provided 15,000 to 20,000 single participation sessions.
Dr. Nate Fuks
In Montreal, Canada, Dr. Nate Fuks, the director of The Virginia I. Douglas Centre for Clinical Psychology and Assistant Professor (Clinical) at the Department of Psychology at McGill University, set up an initiative to provide mental health support for Ukrainian refugees. He, along with 200 volunteers, including psychologists, social workers, counselors and interpreters, is currently helping around 90 Ukrainian refugees process their trauma at the Virginia I. Douglas Centre.
In an interview with The Borgen Project, Dr. Fuks, a native of the Ukrainian city of Kharkiv, said he learned in the first few days of the invasion that Russian forces destroyed the school and university he attended. He launched the mental health initiative, which operates under the umbrella of the McGill University Department of Psychology, to help Ukrainian refugees.
Dr. Fuks states that the initiative did not receive funding from the university — it was entirely crowdfunded by individual donations and donations from the Ukrainian National Foundation in Montreal. All the volunteers began working for free, though now, the center is trying to provide compensation for some.
Dr. Fuks talks about how trauma can impact a person’s ability to integrate into a country, their self-esteem and their ability to feel comfortable in their body. Dr. Fuks aimed to establish the initiative as soon as possible because the earlier the trauma intervention, the more effective the treatment is.
Volunteers learn about Ukrainian culture and the stigma of mental health treatment to establish rapport with refugees and help them warm up to therapy. The initiative offers individual and family therapy.
With the help of the Ukrainian National Foundation, the initiative set up supplementary activities like trauma-sensitive yoga, authentic dance movement classes and support groups. According to Dr. Fuks, these activities not only help Ukrainians process their trauma but also help them build friendships and social networks.
The benefits of the initiative can be summed up in the words of a particular refugee receiving the center’s services: “What you’re giving us is more useful and helps me more than bread and water.”
Though it is unclear when the war will cease or how many more Ukrainians will seek refuge abroad, what is clear is that the efforts of people like Jan Marković and Dr. Nate Fuks will lessen the toll of war by helping refugees to heal from trauma and rebuild their lives.
– James Harrington
Photo: Flickr