Ukraine faces a mental health crisis among soldiers and civilians alike

A mother and son embraced in the car park outside a imposing Soviet-style building, sprinkled with snow amid pine forests on the outskirts of Kyiv. The Veterans’ Mental Health and Rehabilitation Centre; housing 200 patients, offers much-needed expertise amid the ravages of the war.

Renat Pidluzny suffered a back injury and concussion two months ago near Bilohorivka in eastern Ukraine’s Luhansk region. “We put ourselves out in the open so the Russians would fire, meaning we’d be able to spot their positions,” the young soldier recounted. “But we came under shelling from Russian tanks. Sometimes I’ve got a headache all day. I have to take medication. I have memory problems. After fighting for a year, at times my hands were shaking; my whole body was shaking. A lot of my comrades suffer from the same thing,” he said.

Pidluzny is suffering from post-traumatic stress disorder (PTSD) and is staying in the centre so he can heal and return to the front lines after successful treatment. His mother, on a visit to see her son at the centre, said she, too, could do with some psychological support. The war greatly affected the family as they come from Kupiansk, a town in the northeastern Kharkiv region that was under Russian occupation from February 27 to September 10. “I lived through the occupation,” she said. “I know what it’s like to be bombed day and night. I don’t know how I survived. I’m anxious, a lot of things frighten me, and I don’t sleep well.”

Pidluzny and his mother hugged again. “The best medicine is to see my son alive and well,” she said, her voice full of emotion, as she got into the car at the end of her visit. The fatigue and suffering imposed by the war was palpable as they bid goodbye.

‘We’ll still be talking about it a century from now’

Pidluzny and his mother are just two among thousands of Ukrainians suffering from severe mental health disorders including anxiety, panic attacks, depression and insomnia.

The Mental Health and Psychological Support Centre in Kyiv treats all civilians who arrive free of charge. Since Russia occupied Crimea and parts of the Donbas in 2014, “we have received more than 6,000 patients”, said the centre’s director, Victoria Soloviova. Demand skyrocketed when Russia launched its full-blown invasion in February 2022.

“I was struck by the story of a woman who spent more than a month in a cellar in Mariupol last March, trapped there by the bombing and fighting,” Soloviova said. “There were about a hundred people down there in that shelter. There was no electricity; they had to use candles to see. Then when she came out, there were dead bodies on the street. She had to go through an FSB filtration camp – a screening and interrogation process by the Russian security services – before she could get to safety here. Several weeks later, she entered a café. They were lighting candles there. She had a flashback and a panic attack. The episode prompted her to seek psychological counselling.”

There are also several people at this mental health centre who did not endure such grave situations, but nevertheless find it impossible to cope with the stress and uncertainty of living in Ukraine as the war rages.

Eugene Bozhenko, a psychologist at the centre, was seeing a mother who lives in Kyiv. Her three children are being educated from home via the Internet, and she laments that she has “no space of her own”. At the same time, Bozhenko continued, “the constant air raid alerts put her under a lot of stress; she is always scared of another attack on Kyiv”.

The war is putting great strain on families even far away from the front lines in the east and south. “Men who are off fighting in the army invariably worry about their families,” Bozhenko said. “Sometimes women who have fled to another country meet another man there. I hear more and more stories of couples divorcing and families breaking up.” The overall mental health situation is so bad that Bozhenko would like the Ukrainian government to implement suicide prevention measures.

“The psychological consequences of this war will last 35 to 40 years at the least,” Soloviova added. “Everything that happened will be passed from generation to generation; we’ll still be talking about it in a century.”

Ukraine became a highly militarised society when Russia invaded a year ago. Men are strongly encouraged to join the armed forces and fight. If they do not, pressure from both society and the state compels them to show they are contributing to the national struggle in one way or another. Men between 18 and 60 years of age are not allowed to leave the country without special permission. All this pressure adds to the psychological strain.

Dealing with war-related trauma is a top priority for the Ukrainian military, which has wowed the world with its  courage and the strength of its resistance. At that Veterans’ Mental Health and Rehabilitation Centre, some of the soldiers have just returned from Russian captivity, including some who were tortured.

One Ukrainian soldier, Anatoly, expressed great relief that the clinic was able to help him. “I had a concussion last September. I’d been fighting in the Kherson region, and then in Bakhmut. Since February 2022, only four soldiers from my infantry platoon survived. All my friends are dead and I am traumatised. It took several weeks for the officers to let me leave the front line and get treated,” Anatoly calmly explained.

The psychiatrists treating Anatoly said he is still showing severe PTSD symptoms. Drawing on techniques honed by psychologists treating traumatised US and Israeli veterans, they use a mixture of acupuncture, yoga, magnetic therapy and physiotherapy to get his psychological state back to normal.

“Most of the soldiers we treat come back from the eastern front, notably the area around Bakhmut,” said Tatiana, head of the clinic’s team of 15 psychiatrists and psychologists. “Many soldiers are tired right now; they aren’t rotating them out of the front line enough. They have burnout and mental health issues. Many are unable to go back to fighting. They have to get treatment so they can either resume combat or go back to civilian life.”

These issues have amplified as the war has dragged on. The past year has been characterised by large-scale exchanges of artillery fire and increasingly sophisticated combat techniques. “We’re dealing with a lot of concussions and brain injuries from the explosions going off night and day over long time periods on the front lines; it’s a high-intensity conflict,” noted Ksenia Woznicya, the centre’s director.

‘Mass psychotherapy’

Elsewhere, psychologists have put Ukraine’s mental health crisis at the centre of public discourse, breaking taboos around the subject. “In Ukraine, people aren’t accustomed to going to a psychologist except in response to domestic violence,”  said Ana, a psychologist at a facility in Kyiv helping refugees from Mariupol, the port city that was under a brutal Russian siege from February 24 to May 20 last year. Originally from the Donetsk region, Ana has had to flee war twice – first from Donetsk to Mariupol in 2014, and then from Mariupol to Kyiv in 2022.

The clinic where Ana works offers social and medical assistance to the 19,000 displaced people from Mariupol. Ana’s schedule is always crammed. “I have eight or nine appointments a day. All my patients come from Mariupol. We’ve all had the same experiences. So it’s a bit more than the usual doctor-patient relationship, because we have so much in common.”

Patients often talk about the same things: fear of loud noises, including the sounds of airplanes or sirens, and several other forms anxiety stemming from the war.

These wartime experiences have helped coalesce Ukrainian unity and national identity – but it comes at a steep price.

“I could go and live in Australia, because that’s where my parents live,” Ana said. “But I decided to stay in Ukraine. I’m not a nationalist, but now I feel Ukrainian, I feel a connection with all Ukrainians. It’s like we’re engaged in a process of mass psychotherapy.”

Around 10 million Ukrainians, a quarter of the country’s population, have experienced some form of mental illness, according to the World Health Organisation (WHO).

The WHO is working to train all its medical staff in Ukraine in treating mental health issues and is trying to ensure that the prevalent mental health issues there are addressed immediately, instead of waiting for the war to end.

“We’re going through difficult times,” Bozhenko said. “PTSD affects five to six percent of the population in average, peaceful societies. In Ukraine, we expect this figure will reach 25 percent of the population within a few years. We’ve got to face this reality. The war is making us stronger every day, but it is constantly testing our mental resilience.”

This article was translated from the original in French.