Ukrainian psychiatrists learn from Australian refugee support

Four years into the full-scale war, Ukraine is grappling with a mental health crisis.

Research from the International Rescue Committee from April this year estimates 15 million people in Ukraine need psychological support.

At the coalface of the mass traumatisation is psychiatrist Antonina Pushko.

Dr Pushko, along with six other mental health specialists, made the long journey from Ivano-Frankivsk in regional Ukraine to Australia as part of a government-funded program in pursuit of new strategies to help the collective mental health of her nation.

"[The] number of the moral injuries among the civilians is very high because mostly everyone from the civilians has a family member who is serving in the army."

More than 15,000 kilometres away from Ukraine's front line, in Armidale in New South Wales's New England region, local clinicians are well-poised to assist their Ukrainian counterparts.

Armidale is one of Australia's 24 designated refugee settlement area.

Since 2018, hundreds of refugees from Iraq, Syria and the Democratic Republic of the Congo have made Armidale home.

Many have escaped harrowing war crimes and traumatic living conditions.

Armidale is home to almost 20 per cent of Australia's Ezidi community, also referred to as Yazidi.

Along with the refugee population, mental health specialists in the region are often tasked to treat patients for stresses they too are experiencing, such as drought, fires and floods.

No 'safe place'

In Ukraine, Dr Pushko said, clinicians in the war zone were struggling to provide treatment in such unsafe environments.

"Sometimes we have an air alarm at night, and for example a mental health specialist, psychiatrist, has not slept and he is coming to his room to consult a patient and the patient says, 'Oh I haven't slept' and a mental health specialist says, 'Me too,'"

"It is a pathological normalisation.

As the war rages on, mental health specialists are facing situations not seen before, including soldiers who have been held in captivity and have intergenerational trauma.

Dr Pushko said the approach to care she had seen in Armidale could be key to improving the service offerings back home, particularly developing trust between provider and client.

"Very often there is a stigma if the person talking with you has not witnessed these traumatic events, he could not understand you."

"Sometimes it is just a need to talk and to be heard by a specialist … this is the thing that we could learn from you."

The Armidale approach

Local rehabilitation coordinator and social worker Eaowyn Vaughn-Johnson works closely with refugees in Armidale who have experienced torture, conflict and displacement.

Ms Vaughn-Johnson said community building and coordination between different services were the most important strategies for rehabilitation.

"We provide acute mental health care, but the people that we work with have so many other needs that we just can't meet."

"Supporting people holistically and giving them the best care relies on collaboration, trust and strong relationships, whether it be with housing providers, domestic family violence, drug and alcohol services or refugee services."

Ms Vaughn-Johnson also believed the use of telehealth in the regions would be well-suited to Ukraine.

"I feel that if someone in Ukraine was bedbound in hospital, isolated in a different part of the country, [then] using telehealth they could still get the best care for their mental health," Ms Vaughn-Johnson said.

Lessons in reintegration

Olena-Kvitoslava Yatskiv is a social worker from Lviv, in western Ukraine.

Ms Yatskiv works at a war trauma centre as head of social reintegration.

Most of her patients have amputations or trauma.

She said there was high demand for her services but providing them was not simple.

"A lot of our patients still want to be useful for Ukraine."

"We don't integrate our patients to the peaceful life; it's a life a little bit far from front line, but the war is not over."

Ms Yatskiv said the holistic approach to reintegration in Armidale would help close gaps in care that existed in Ukraine.

"We have a huge gap between social services and medical treatment. We don't have the psychosocial support what you really have developed here in Australia."

"You have highly developed this community support here, everyone works like a multidisciplinary team."

"I think it's the best practice … how you provide this complex support for the clients."