Mental Health Should Not Wait Until a Conflict’s End

In Ukraine, mental health needs are staggeringly high. The World Health Organization has estimated that 10 million people – roughly a quarter of Ukraine’s population – are at risk of developing a mental health disorder because of the conflict.

Historically, the dominant perspective for humanitarian efforts was to address mental health only after a crisis was stabilized.

“We weren’t starting to talk about mental health until many years into reconstruction,” Nguyen said. “And for many people, that’s too late.”

That thinking has changed. In a panel discussion hosted by the Center for Strategic and International Studies in May, Nguyen joined several experts who agreed that addressing mental health early is not only important, but integral to successful reconstruction.

One challenge in Ukraine is a high level of stigma surrounding mental health treatment, a lingering effect of the Soviet model with a centralized, hospital-based system that primarily addressed only severe mental disorders like psychosis and schizophrenia. Historical use of the mental health system to shut down political dissent sowed further fear and distrust.

That, too, is changing. Olena Zelenska, Ukraine’s first lady, has made mental health her central cause, leading media campaigns to encourage people to seek help and launching a national program focused on helping Ukrainians deal with stress and trauma.

Ukraine also boasts a robust educational infrastructure for mental health, with a large workforce of highly educated psychologists.

According to Nguyen, this creates a unique opportunity to address mental health needs in Ukraine now. More importantly, she says it’s the right thing to do.

“We know that unaddressed mental health issues impact your lifelong trajectory in a number of health domains, and we have a large body of research now showing that you can do a lot within an ongoing or developing crisis,” she said. “Providing those services, as much as we are able, is the ethical thing to do.”

Addressing community mental health requires a multi-tiered, pyramid-like approach, Nguyen said. At the top are the intensive treatments, like in-patient psychiatric management, that are highly structured, resource-intensive and focused on specific disorders. They impact a small percentage of the population and require highly trained providers.

Nguyen’s work focuses on the bottom tiers of the pyramid. Called psychosocial supports, they are geared more toward prevention: broad, low-touch programs that build coping skills and reduce stigma.

“It’s a public health approach that ideally minimizes the need for those higher levels of support, while also providing an entry point for those who do need those services,” Nguyen said.

Nguyen’s most recent publication – the study her team was completing during the 2022 Russian invasion – describes how they developed a prevention and referral program to help Ukrainian veterans and their families cope with stress and evaluate their own mental health needs. The team partnered with Ukranian veterans’ service organizations, training local providers who led workshops and gave valuable feedback to researchers every step of the way.

To reach as many people as possible, the workshops were advertised on Facebook and in community centers or veterans’ organizations. Registration was simple and workshops were delivered online. In each 90-minute workshop, five to 10 participants connected with others in their group, completed a self-assessment and received training in coping skills. Finally, they were given information on how to access referrals for more support.

These programs don’t replace treatment needs, but they are generally much easier to implement, help more people and require less training for providers, Nguyen said. Due to the variety of possible approaches to build and successfully integrate them into different service systems, they can be challenging to study. That means the evidence for what really works isn’t yet as strong.

What makes this research challenging, Nguyen said, is exactly what makes it so important. With more research on this type of program, more is learned about creating a full system of mental health care, from the bottom of the pyramid to the top.

Nguyen is adamant that when a humanitarian crisis emerges, it’s important to provide basic mental health supports and more intensive treatments. “We can do both,” she said.

Nguyen has a forthcoming paper reporting the outcomes of the workshops, which proved effective in improving wellbeing. She plans to continue scaling up supports to strengthen the full system of care in Ukraine.

She’s also working on getting a few initiatives off the ground focused on mental health and psychosocial supports for children and youth. “We tend to expect kids to just be resilient,” she said. “And that’s just not sufficient.”

In all her work with global mental health, Nguyen is passionate about the importance of giving voice and agency to the people in need of support, making them partners in the development process so that the programs are as relevant and valuable as possible.

She expressed a deep admiration for her team’s Ukrainian partners and their dedication and ingenuity as they continue to provide mental health services through extremely difficult circumstances. After the Russian invasion in 2022, many of them were displaced, but continued to provide services, even leading workshops from the hallway of a shelter in Poland.

“What we hope when we do this kind of research is to build up capacity that is sustainable going forward,” Nguyen said. “And I think in this case, it’s been really, really critical work.”