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Mental Health Clinicians of Ukraine: Heroes Of Invisible Front

by Robbie Schneider

As the first anniversary of the Russian invasion of Ukraine approaches, Ukrainian mental health professionals are working to stem a growing mental health crisis while avoiding burnout themselves.

Psychologists, psychotherapists, and other mental health professionals work long hours in shelters and refugee centers, conducting individual therapy to support and restore mental health for a steady flow of people traumatized by being a victim or witnessing violence brought on by a yearlong war. Mental health clinicians also support other healthcare professionals and their colleagues who deal with their own traumatic experiences and events.

“Of course, there is the immediate goal of defending the country when we are talking about the war in Ukraine," said Eva Skinner-Regel, LICSW, M.Sc, M. Bioethics, Program Clinical Director with Health Tech Without Borders. "But behind that visible frontline, there is another front line, where the battle with the tremendous trauma takes place. The war challenges people's perception of self, space, and time. People's self-identity undergoes changes, which happens on top of the psychological and frequently physical trauma.”

According to the Ukrainian Ministry of Health, about 15 million Ukrainians need or will require psychological support. However, to be able to counsel individuals and provide psychological support effectively, mental health clinicians need to look after their mental health to prevent burnout and increase their own sustainability and internal resources.

“At the beginning of the war, in its first months, I was working non-stop: children, adults, art group therapy, clients who are refugees," said Ukrainian psychotherapist Irina D-ko. “I was working to the point of absolute exhaustion and through the exhaustion. I realized that I did not have any internal resources left, and I was unable to replenish them in my usual way through my personal art therapy and relaxation. All of what worked before stopped working, and that is when fortune sent me your program.”

Psychotherapist, Irina D-ko during the art therapy session.

Helping Healers Heal

Recognizing this gap in professional support, Health Tech Without Borders launched the “Helping Healers Heal” or 3H program, a peer-to-peer support and essential coaching program. The Helping Healers Heal program provides a safe, supportive virtual setting to mitigate symptoms of burnout and strengthen resilience and professional sustainability. Program participants meet online weekly with a mental health volunteer. During the meeting, Ukrainian mental health clinicians can process their thoughts and personal experiences of living and working in these difficult times for their country. The program's primary goal is to create an environment that is helpful for Ukrainian mental health clinicians in managing their distress and helping build their resilience and sustainability as they continue to support and treat the Ukrainian population suffering from the stress and trauma of war.

Psychotherapist, Irina D-ko (3 H participant)

“This is exactly what I think I give to my clients; I am with them, and I give them resources to deal with the trauma they experience. I share with my clients myself and my energy, my belief in light and life no matter what,” D-ko said. “My clients respond and lean on me, and for me to be able to continue to do it, I lean on you, on our meetings, on our conversations, on your support. So, I do not feel alone, I do not feel forgotten, and this is very important.”

As the experience of war in 2014 showed, many providers who worked during and after the first Russian invasion experienced burnout, anxiety, and increased prevalence of physical illness. The research literature on disaster medicine also reflects similar concerns about frontline workers who served in disaster and war zones.

Psychotherapist Natalya Z-la (3H participant)

“Especially now when death is so near, and people meet death every day,” Ukrainian psychotherapist Natalia Z-la said. “It is hard to continue to be effective as a therapist day in and day out in these conditions. There is a lot of death, and it is really hard to live through it without losing therapeutic sensitivity. I realized that I am going through a crucial period in my life when I am building a new me who will be able to continue to help others.”

The 3H program attempts to minimize and, maybe, reverse this trend by proactively providing Ukrainian mental health clinicians with peer-to-peer support.

“The 3H program allows the space and time to process emotions of their own trauma and space to talk about their own lives, problems, and themselves,” Skinner-Regel said. “They (Ukrainian therapists) spent all their time listening and supporting others, their clients, their families, their colleagues. 3H provides them with the opportunity to talk, process, and replenish, all of which is vital for therapists in their work.”

Psychotherapist Anna T-ko (3H participant)

Though receiving peer-to-peer support, mental health clinicians are able to successfully apply “the use of self” for their clinical analysis of their clients' perception of problems and responses to the impact of trauma-related experiences like the loss of a loved one, sexual violence, witnessing death and destruction, or experiencing displacement. 3H helps mental health providers restore and replenish the internal resources needed to build their clients' resilience and restore hope in the setting of unimaginable human tragedy and loss.

“If we talk about the future of any country experiencing any disaster or war, it's important to understand that mental health professionals hold people's pain and trauma and also need someone to hold theirs,” Skinner-Regel said. “We need to replenish that resource. We are helping the Ukrainian therapists to continue to work in the future so that they can help to rebuild Ukraine and the mental health of its people.”

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