Vanya, a Ukrainian soldier, pulled up his T-shirt to reveal a nasty scar that he got while fighting in the war in Ukraine — he said that he was hit half a millimeter from his heart. 

Vanya is staying at Lisova Polyana, or Forest Glade, a veterans’ mental health and rehabilitation center in a quiet, wooded area just 30 minutes from downtown Kyiv, Ukraine’s capital. 

(None of the soldiers that The World spoke to for this story are identified by their full names because they are on active duty and in many cases, returning to the front lines.)

Vanya has been at Forest Glade for four days and said that he was hoping he would be better by now, though he didn’t share the details of his treatment or recovery.

He is among the 220 men and women being treated at the center, which is run by the Ministry of Health; it works on “invisible wounds,” including stress disorders, depression, anxiety, PTSD and traumatic brain injuries. They also treat people who were tortured or held in captivity.

After nearly 1,000 days, Russia’s war against Ukraine is causing mental health issues for soldiers and civilians alike. Ukraine’s Health Ministry estimates that 15 million people will need psychological support in the future — or 40% of the population. 

The Ukrainian government said it’s in the process of developing a comprehensive new veterans policy that includes psychological care and career support for people transitioning back to civilian life. In the meantime, mental health professionals are scrambling to modernize an outdated system to accommodate the vast needs.

Kseniia Voznitsyna, the chief doctor at Forest Glade, said that Ukraine has experienced psychologists, but even they may need additional skills training to deal with military trauma.

 “This is happening now with a lot of trainings in Ukraine — this process is happening widely,” she said.

At Forest Glade, she explained, they take an integrative approach: “It’s a bio-psycho-social approach. We have a big team. Psychologists, psychiatrists, neurologists, physical therapists, speech therapists.”

Clinical case managers work individually with the soldiers, ensuring that they show up for appointments, and they plan excursions for them, Voznitsyna said. Patients receive plenty of complementary methods of treatment, including everything from acupuncture to yoga to art rehabilitation classes.

Forest Glade has a long waitlist, and patients usually stay for several weeks before returning to military service. 

Soldier Volodymyr, speaking in front of a group of other men in line to get a haircut, referenced the physical therapy, but not the mental health treatment he was receiving at the center. 

“It’s great,” he said. “I was treated here, it’s a little easier on my foot, easier on my back.”

He could stay longer, he said, but as platoon leader, he was eager to get back to his men in eastern Ukraine.

War trauma ‘is not for one day’

For many Ukrainians, seeking out mental health care means overcoming long-held stigmas going back to the Soviet period when political opposition figures were often sent to psych wards. 

“Because Soviets used this as an instrument, this is a huge stigma towards psychiatry,” said Dr. Orest Suvalo, executive director of the Institute of Mental Health of the Ukrainian Catholic University. “We even still feel it now, after 30 years of Ukrainian independence.”

Meanwhile, demand is only growing. PTSD isn’t the only consequence of traumatic experiences. Ukrainians are also dealing with depression, substance abuse, loss and anxiety.

“It’s important to pay attention to the trauma-informed approach to train people and explain to people in many different specialties how to speak with people,” he said. “Because we are predicting that everyone could have some kind of traumatic experience.”

Dr.  Oleh Berezyuk at Unbroken, a national rehabilitation center in Lviv, said that the country’s mental health challenges are multilayered; there is the sheer number of people who need help, plus, the brutal nature of their trauma.

“We have to care for every soldier, for every civilian who suffered from the war trauma, which is very important because war trauma, it’s not for one day,” he said. “And you cannot treat it just by one simple intervention. You have to prepare people to live in a different reality.”

That’s why Unbroken is treating mental and physical trauma together in the general hospital, a successful model that they are recommending to other hospitals, Berezyuk said.

Others, like Victor Dosenko, a professor of pathophysiology at the Bogomolets Institute of Physiology in Kyiv, are working specifically on PTSD.

Dosenko is studying biomarkers and how to detect PTSD. 

“It’s a bad opportunity, but medicine, medical progress moves forward when there are challenges,” said Dosenko, who has also been advocating for a PTSD center in Ukraine.

The importance of preparing a family 

Veterans need to return to an understanding society where they can find work and medical help, said Tetiana Kril, head of the mental health program and psychological support centers Razom With You. 

When her husband returned home from fighting in 2017 after Russia’s earlier invasion of eastern Ukraine, “I realized how important it is to prepare a family,” she said. “Because every soldier returns to his family. And today, there are already 3.5 million veterans in Ukraine, and by the end of the war, we expect there will be 5 million.”

Yrii Liashuk, who works for Razom for Ukraine, said that when he was discharged from the military last year due to an injury, his family was supportive. His wife became his “personal psychologist,” he said.

He joined the military in 2012 and had thought it would be his lifelong career. 

He stays busy with a job as a security officer and running a company that makes drones. He believes veteran reintegration will be one of the biggest challenges ahead. 

“Society needs to be prepared for the fact that heroes with unique challenges will live with us,” Liashuk said. “We need to understand this.”

The post ‘We have to care for every soldier, for every civilian’: Ukraine faces major mental health challenges as a result of war trauma   appeared first on The World from PRX.