Impacts of war highlighted by Ukrainian psychiatrist 

Ukraine had been transitioning towards more community-based mental healthcare before the war, heard the College of Psychiatrists of Ireland Winter Conference in November.

Speaking to delegates via video-link, Dr Dennis Ougrin, Consultant Child and Adolescent Psychiatrist, Enhanced Treatment Service, South London, and Maudsley, NHS Foundation Trust, said that a lot of the mental health budget in Ukraine has concentrated on inpatient care. 

“Health services were really significantly underfunded and as the story typically is, mental health was significantly underfunded within this underfunded health service,” he added.

Dr Ougrin graduated from medical school in his native Ukraine before moving to the UK for postgraduate training. He provided an overview of mental healthcare in Ukraine, attitudes to mental health, and the impact of war. 

Mental health-related sigma was a “significant issue” in Ukraine, he said. “It is reducing, I have to say, and a lot of my friends who are fighting on the frontline are really very open with their difficulty…. Nevertheless, mental health-related stigma is significantly higher in Ukraine than it is in the West.”

Prevalence of mental health conditions was “somewhat similar” to the rest of Europe, although there was a high rate of alcohol-related disorders in males. Dr Ougrin also noted that prevalence of suicide tended to be significantly higher in Eastern Europe compared to many other parts of the world. During wars and conflict, suicides often reduced significantly, but increased again post-conflict, he stated.  

Dr Ougrin also spoke about the ongoing existence in Ukraine of “internats”, which are “terrible, terrible places” that congregate large numbers of children and adults with disabilities in inhumane conditions. “If there is one thing we will need to address after the war it’s these terrible, terrible places,” he said. 

During the war there has been a substantial reduction in available healthcare facilities, with six psychiatric hospitals “totally wiped out” by attacks from Russia. 

A minimum of 100 healthcare workers had been reported killed. However, Dr Ougrin said this figure was “undoubtedly a significant under-estimate” and was increasing daily. 

In regard to Ukrainian children arriving to the UK, Dr Ougrin said most did not require specialist mental health services. “There will be some who need services, especially children of two types – one is children who have experienced brutal, almost unimaginable trauma… when they arrive in the UK they are basically mute, they don’t speak. It is a small group, but important. The other group are children with pre-existing anxiety disorders, ASD [autism spectrum disorder], ADHD [attention deficit hyperactivity disorder]… they need help.”

However, the waiting times to access mental health services in the UK were shocking to many Ukrainians, he said. 

“What we see in the UK is a huge waiting list and times for services and that is something families from Ukraine do not understand. So there must be some sort of expectation management there.”

In concluding his presentation, Dr Ougrin said that “one of the key things for our children is to be connected and not isolated…. I know people in Ireland have been amazing, offering help, and connecting our kids to each other.” 

The conference also heard the perspective of a HSE psychologist working with Ukrainian refugees and international protection applicants.

Clinical Psychologist Dr Hestor O’Connor, Psycho-social Lead post-Covid in Dublin South, Kildare, West Wicklow (DSKWW), spoke about the “loss of sense of personal agency” and institutionalisation experienced by applicants for international protection in Ireland. There were separate entitlements and processes in place for Ukrainian refugees and international protection applicants, with the latter only eligible to apply for a work permit after six months. International protection applicants entered a lengthy and “quite complex” process, which was marked by uncertainty, she noted. 

Nationally, there about 16,000 people seeking international protection in Ireland compared to about 4,000 last year (these figures are separate to Ukrainian refugees). Dr O’Connor also noted there were about 10,000 Ukrainian nationals in her area of DSKWW, although there were no accurate figures. 

Dr O’Connor referred to accommodation of protection applicants in congregated settings, which were overcrowded and made it difficult to deliver appropriate psychological care. 

There were already long waiting lists for psychology before the war in Ukraine and a lack of additional resources to meet the needs of those fleeing the war and international protection applicants.

Six free psychological sessions were available free of charge to Ukrainian nationals in their language through the MyMind service, but there had been difficulty encouraging take-up, according
to Dr O’Connor. 

“We are now doing a lot of work to try and increase that [take-up]. The asylum seekers cannot access this at the moment because there are no Arabic, Farsi, Dari or Somali speaking therapists… hopefully we might make inroads to address it.”

Dr O’Connor said there were “huge power imbalances” in the work with asylum seekers and refugees who were “so grateful” for any help provided. “You have to really watch the power imbalance, but also it gives you opportunities to look at your bias and prejudice…. For me, compassion has to be the base of everything we do.”