11th October 2021- After seven years of conflict, mental health needs among people in towns and villages near the contact line in eastern Ukraine remain high. Many have lived with the constant risk of violence since 2014. The COVID-19 pandemic has resulted in additional strain. The impact on their mental health has been severe. But seeking care can be difficult. Mental healthcare services remain centralised and concentrated in urban areas, making them difficult to access.
Empowered to provide mental healthcare services
Now, Médecins Sans Frontières (MSF) and other organisations are empowering family doctors and community nurses to provide the basic mental healthcare that patients so desperately need.
It’s easy to forget the psychological impact of conflict that has been going on for a long time.
For people still living through it, the trauma – both of the initial fighting and of the ongoing threat of explosions, shooting, bombing and landmines – is part of daily life.
“My daughter was just in front of me, ten meters away. I was at the doorstep."
"Suddenly, the shooting started. I just remember being hit on the head."
"Smoke was everywhere, windows smashed. I woke up [with] my grandson hugging me: ‘Granny, we are alive, we are okay’. "
"That was it – the last straw. I am a strong woman but at that moment I broke."
"There are no words to explain it, that feeling of fear. Safety didn’t exist at all,” remembers Tetiana Karadzheli, a resident of Kamianka village, Donetsk region.
MSF psychologists and the doctors and nurses we work with in eastern Ukraine see many patients struggling with depression, anxiety and other common disorders.
“Most frequently it’s acute stress and grief for the loss of their loved ones and homes. In addition, anxiety-related conditions are widespread."
"For example, insomnia. We are aware of multiple cases when grandparents witnessed their grandchildren die or where people have lost almost all family members,” said MSF Psychiatrist, Tetiana Azarova.
Training to address mental health needs
People living in small towns and villages often can’t afford to travel to cities or pay private mental health providers, even if they can overcome the stigma associated with mental illness and seek treatment.
“In villages no one usually pays attention to [mental health]. They think that nothing will help them and they just need to live through it and endure it,” said MSF Health Educator, Natalia Khatsko.
MSF’s project in Donetsk Region, in collaboration with the Ministry of Health and other partners, provides training and supervision to family doctors and nurses using the World Health Organisation’s mhGAP – an approach designed to enable non-specialist doctors and other healthcare workers to address some mental health needs.
“We are the first ones on everyone’s way – COVID-19 patients, patients with mental disorders. They always meet us first,” said Halyna Mohylevska, a family doctor from Chermalyk village, Donetsk Region.
“That’s when we decide on whether we can handle it ourselves or refer [the patient] to a psychiatrist or a psychologist, or we prescribe medicines.”
Oleksandr Vlasenko, Director General of Family Health Care Centre No. 1 in Kramatorsk City, Donetsk Region, explained, “There are two reasons why patients don’t want to see a doctor [about MH issues]: 1) because they do not understand that doctors can provide such assistance to them; or 2) because the doctor is not able to provide this assistance in a qualified manner.”
Family doctors and nurses have not previously been recognised as a part of the mental healthcare system, which has in the past prioritised centralised and psychiatric care, particularly in institutions.
Training and supporting family doctors and nurses is an example of the new approaches MSF and others are implementing to make mental healthcare services available for conflict-affected communities in eastern Ukraine.
More support and more programmes like this are needed to ensure that patients are no longer left to suffer in silence.
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