The war in Ukraine has led to almost 6,000 civilian casualties, including 2,665 deaths, as recorded by the Office of the United Nations High Commissioner for Human Rights and 164 attacks on health care facilities reported by WHO as of 25 April. People with mental disorders, cognitive, intellectual and psychosocial disabilities remain a group of concern in these circumstances. They rely a lot on support of their families and communities, health and social care services which are stretched themselves.
In 2021, Ukraine launched a new mental health service model Community Mental Health Teams (CMHTs) with the support of WHO. As of February this year, 65 CMHTs were created and provided person-centered and recovery-oriented care to people with severe mental disorders throughout the country. Many psychiatric hospitals limited the scope of their services due to security risks. The CMHTs started to use remote consultations such as phone calls or video calls more often while continuing to care for their patients who stayed locally or in neighboring countries. The teams in Mariupol and Chernihiv continued to support their patients until the last day before their offices were damaged or destroyed by shelling. The majority of CMHTs report shortage of psychotropic medicines and some face limited food supply, clean water, heating, electricity, and sanitation due to recently damaged infrastructure and usual supply chains.
Psychologist Natalia, Lviv – “The division of responsibilities in the team has changed a bit – more and other responsibilities have been added – counseling refugees, interaction with volunteer organizations involved in the supply of medicines. Therefore, we consult clients more by phone. We go to them only when they insist on it.”
Psychologist Alina, Vinnytsia – “Part of the staff of the psychiatric hospital resigned and went abroad. Therefore, the number of responsibilities has increased. In addition to working in a team, I am involved in the work of the commission for the issuance of permits for weapons and work in inpatient departments. Therefore, work with clients on the phone has had to increase.”
Psychologist Irina, Kherson – “I work online from home. The city is occupied, so the team does not go home to clients, as movement around the city is unsafe; and clients are afraid that someone will come, because there are cases of robberies. I need knowledge on how to help people with acute stress and panic attacks. There are problems with medication, but most clients bought in stock because they were discharged for 3 months.”
Nurse Tatiana, Khmelnytsky – “There is a shortage of medicines and we started to collaborate more with district psychiatrists who help to obtain medicines in pharmacies close to patient`s home do decrees risks associated with movements across the city. We have less to go home for security and low fuel.”
Psychiatrist Mykhailo, Kramatorsk – “We work more by phone – fuel shortages and security issues. I am also involved in work in the hospital, where the number of cases of acute stress has increased. There are no benzodiazepines – we have a small supply of diazepam for cases of status epilepticus. Problems with sleep disorders are corrected by other drugs – amitriptyline, mianserin, etc.”
Despite many challenges, Ukrainian Community Mental Health Teams were able to adjust to new demands and working modalities and address the needs of people they support with incredible commitment and dedication. “We have been revising our previous support to the teams trying to familiarize them with humanitarian response principles and bring more practical help and basic supply” – said Alisa Ladyk-Bryzghalova, officer on mental health, WHO Country Office, Ukraine.