In the field on mental health and psychosocial rehabilitation in the areas of Ukraine affected by military actions (2015 – 2019)
Today we have a tragic situation in Ukraine. And we will have to deal with it for many years, decades of years. But many things started long time ago, and Lithuanian mental health care specialists already have collaboration with Ukrainian colleagues in the field of implementing and organizing psychosocial help for those who suffered from military actions in eastern part of Ukraine. This is a short story about it.
Laurynas Bukelskis, Vilnius Mental Health Centre, Lithuania
Ramunė Mazaliauskienė, Lithuanian Health Sciences University Kaunas Hospital, Lithuania
A very unexpected and cruel was in eastern Ukraine with numerous painful effects made us think how Lithuania could aid in dealing with conflict consequences. Group of mental health and health management specialists came to the idea that situation of Lithuania is convenient to offer help in establishing psychosocial rehabilitation, as we share common history with Ukraine and we have 30 years history of constant modernization of mental health system. Moreover, most of specialists, at least experienced ones, still speak Russian here in Lithuania, and at that time it was acceptable to communicate in that language, especially in eastern Ukraine. Having been trained by psychosocial rehabilitation specialists from western Europe, first of all – Netherlands, and being pioneers of this field in Lithuania, specialists from Vilnius Municipal Mental Health center along with leading colleagues from other organizations implemented several consecutives projects aimed to establish psychosocial rehabilitation service for soldiers, relatives of conflict victims and displaced persons.
Despite the fact that legally there were 4 separate projects, all of them had very similar pattern and all of them were focused on the same topic, both in mental health facilities and in Veterans hospital (which is still an unusual separation in health system for non-post USSR era citizens); differed only the districts where they were implemented.
The beginning of the activity was in 2015 in Poltava district, then Dniproptrovsk district in 2017 and unoccupied territories of Donetsk and Luhansk districts in 2017-2018 followed, and the last project was implemented in Kherson district in 2018-2019.
All projects had a common pattern:
primary visits of Lithuanian experts - the situation of mental health facilities was evaluated, and tailored theoretical training programs for separate regions in Ukraine were developed.
5 days of continuous training in each region (main topics - crisis intervention; PTSD, psychosocial rehabilitation, substance-related and addictive disorders, team work)
5 days of practical courses for Ukrainian health care specialists in Lithuania. Plans for separate institutions were also created during the training
Follow-up – visit of Lithuanian specialists back to Ukraine.
During the second phase of the project specialists who actually wanted to start working in the field of psychosocial rehabilitation were offered an opportunity of “workplace-based” practical training in similar units of mental health institutions of Lithuania. Specialists of all the team were invited – doctors, nurses, ergotherapists and so on. Probably that wouldn’t be important to stress in other circumstances, but strict hierarchy in Ukraine’s mental health care teams stroked us at that time, and we noticed that working in such way was a bit out of comfort zone, at least for some of Ukraine colleagues.
Needless to say, living in constant war since 2014 Ukrainians were both very motivated and already skillful enough (having plenty of patients due to war), so they needed only a helping hand and quickly arranged their profile to most convenient, according to their resources, mentality and so on. This is why participants from Zaporizhia and Kherson districts were trained by their colleagues from Poltava district (who underwent training in 2015 themselves) already in 2018.
The results of this activity were presented in WPA Regional Congress in Kiev in 2021. While preparing the presentation, we contacted several participants and asked about their experience in psychosocial rehabilitation.
Here are a few of them:
"Despite the difficulties, work on psychosocial rehabilitation continues…For each patient, a rehabilitation plan is developed after assessing his needs; we involve the patient's relatives and his close circle in the implementation. Work has been established with social services, where on a quarterly basis (…) socially unprotected patients who have no family ties are identified, a questionnaire is drawn up reflecting all social problems and submitted to the social services at the place of their registration. After that, joint work is carried out to solve all the identified problems. To date, work on 47 patients is being carried out in the Donetsk region. I hope our work will continue despite all the circumstances." Jurij Smal, Head of the Sloviansk hospital, Ukraine (2021)
"Based on the material obtained during the training, a program of psychosocial rehabilitation of patients of the day hospital KNP “Psychiatric hospital in Mariupol” was developed, tested, adapted and approved before quarantine. During the quarantine period, the day hospital was closed, but instead of it, mobile palliative and psychiatric support teams were formed in the hospital, which made it possible to provide psychosocial assistance during the quarantine period." Igor Kalugin, Head of the hospital, Mariupol, Ukraine (2021)
"(...)Along with complex treatment, including drug and occupational therapy, physiotherapy, cultural, educational and leisure activities, the following types of psychosocial interventions have been developed: • educational programs for patients; • educational programs for relatives of patients; • trainings to develop skills of daily independent life - cooking, shopping, family budgeting, housekeeping, using transport etc.; • trainings on the development of social skills - socially acceptable and confident behavior, communication, solving everyday problems etc.; • trainings to develop mental health management skills; • groups of self and mutual help of patients and their relatives; • cognitive-behavioral therapy aimed at improving memory, attention, speech, behavior; • family therapy, other types of individual and group psychotherapy." Zaporizhzhia mental health hospital, Ukraine (2021)
To sum up, during these 4 projects in 2015-2019 following results were achieved:
More than 250 Ukrainian specialists were trained, and more than 80 of them (specialists and administrators) underwent practical training in Lithuania;
11 psychosocial rehabilitation services were established;
More than 10.000 patients have received service since the beginning of the campaign.
We thought that we have to help our Ukrainian colleagues to deal with difficulties that they experience due to military actions in the eastern part of the country. But we could never imagine what was in front of the country and the mental health workers.