A public health approach to mental health during war is crucial as it addresses the widespread psychological impact across various societal groups, from victims of torture to veterans; and grieving families including children and widows.
By integrating mental health care into broader systems and emphasizing community-based support, this strategy ensures accessibility and destigmatizes seeking help. Policies developed under this framework can significantly aid immediate relief efforts and contribute to long-term recovery by fostering resilience, economic stability, and social cohesion.
Tailoring interventions to meet the diverse needs within a population, especially in a war-torn country, involves recognizing the unique contributions and challenges of groups like veterans, widows, priests, and teachers, facilitating a more inclusive and effective mental health environment.
Engaging these groups not only leverages their community influence but also addresses their specific mental health needs, strengthening the overall societal fabric against the backdrop of conflict and its aftermath. This article explores these challenges in more detail.
In a country at war
In a country at war, the pervasive impact on mental health across all societal groups—disabled veterans, families of soldiers, widows, those grieving, and children—necessitates a comprehensive public health approach to mental health care.
However international guidelines do not address the constraints of providing such services at a time of war, where constraints on resources are even greater, people are displaced, and communities often dispersed. On top of that,data may be closed or simply misleading because of the inability to accurately record cases and be transparent about needs.
Such an approach ensures that interventions are not only widespread but also tailored to meet the diverse needs of these affected groups. It recognizes that the trauma and stress experienced are not isolated to the battlefield but permeate families and communities, requiring solutions that address both individual and collective healing.
A public health approach to mental health is also important when mental health services are so stretched and there simply are not enough trained counsellors and psychiatrists to meet the needs. The holistic nature of public health strategies allows for the integration of mental health care into existing systems, making it more accessible to those in need. For example, by training teachers, clergy, and community leaders in basic mental health support, societies can create a network of first responders who can offer immediate support and direct individuals to professional care. Groups such as teachers are in a strong position to reach another vulnerable group – children. This strategy also plays a crucial role in destigmatizing mental health issues thus encouraging more people to seek help. Moreover, a public health approach facilitates the implementation of policies that protect and promote mental well-being, even in the midst of conflict. The stress of war trauma can be a trigger for chronic diseases including dementia and cardiovascular diseases, and so the impact of early intervention / mental health support can be a highly cost-efficient use of resources. Prioritizing mental health not only aids in the immediate crisis but also lays the groundwork for long-term recovery and stability, ensuring that the scars of war do not permanently hinder the societal and individual potential for growth and peace.
What are the characteristics of a public health-based approach to mental health? Traditionally a public health-based approach to mental health encompasses:
Prevention Strategies: Implementing programs to prevent the onset of mental health issues, such as community education, promoting resilience, and early intervention tactics. A specific priority at the moment is suicide prevention and the bereavement it causes.
Population-Wide Policies: Developing policies and regulations that create a supportive environment for mental health, like reducing stigma and ensuring access to mental health resources for all segments of the population.
Community Engagement: Engaging community resources, including schools, workplaces, and religious organizations, to create a supportive network for mental well-being.
Integrated Healthcare: Incorporating mental health services into the broader healthcare system to ensure holistic care, including physical and mental health.
Data and Research: Utilizing data to understand the extent of mental health issues, identify at-risk populations, and measure the effectiveness of interventions.
The challenge of data and evaluation
However in the case of a country at war, there is very little data because of the need for secrecy and security, and the situation can change very quickly, hence the need for critical review and understanding of the context in which the data was collected. A further complication is the very different needs of groups within the population and the ways they can be reached. Examples of different groups include veterans, widows, priests, and teachers. Case studies can be used for qualitative research and can be used as blueprints for sharing with other organisations and in different regions of the country.
The Churches – their unique role and burden
As community leaders, priests can be key in reducing stigma around mental health. Training programs can equip them with the skills to offer basic psychological support and guide individuals to professional help.
Providing Emotional and Spiritual Support: They can offer counselling and spiritual guidance to individuals struggling with the emotional aftermath of conflict. This support can be crucial for healing and coping with grief, loss, and trauma.
Promoting Reconciliation and Forgiveness: Religious leaders often advocate for forgiveness and reconciliation, which ultimately are essential for healing divisions within communities. They can facilitate dialogues and peace-building activities, helping individuals and groups to understand and empathize with each other's experiences and perspectives.
Offering Practical Assistance: In many cases, churches or religious organizations provide essential services such as food, shelter, and medical aid to those affected by conflict. Priests and pastors can mobilize resources and coordinate efforts to meet these physical needs.
Advocating for Justice and Peace: They can play a role in advocating for justice and human rights, ensuring that the root causes of the conflict are addressed, as well as the importance of the documentation of war crimes
Creating Safe Spaces for Healing: Churches and religious gatherings can serve as safe spaces where individuals can share their experiences, express their emotions, and find community support. These spaces can be vital for the psychological healing process. We have explored this in blog: https://www.lsngroup.org/post/healing-together-the-impact-of-peer-support-groups-in-war-torn-ukraine
Educational Roles: They can educate their congregations about the importance of the nature of trauma and the changes it can induce. This is something we have explored in an earlier webinar https://www.lsngroup.org/post/nurturing-recovery-purpose-and-growth-amidst-trauma-and-adversity
Building Community Resilience: By fostering a sense of community and belonging, religious leaders can help build resilience against future conflicts. This involves nurturing strong, supportive networks within the community.
Spiritual Leadership and Hope: Finally, as spiritual leaders, priests and pastors provide hope and a sense of purpose, which can be particularly important in times of despair and uncertainty following conflict.
Priests and pastors have traditionally played an important role in supporting communities affected by the trauma of conflict recognising that they tend to be embedded throughout local communities be they urban or rural, understand the local context and have a trusted role.
However sometimes the expectations placed on them can be huge and beyond anything their experience or training has prepared them for. This is illustrated by Pastor Sasha’s story.
'I am a pastor based in Kyiv and I experienced the full horror of the Russian attack on the city. In particular, I was heavily involved in providing assistance to the people living in Irpin and Bucha, towns that were the centre of sustained fighting and Russian occupation. Both towns have become notorious for the torture and brutality shown by the Russians.
As a pastor I experienced the full impact of the distress caused by the Russian attack and occupation. For weeks I was attending to men, women and children who had been brutalised by the Russians in horrific ways. Many people were completely trumatised. As a pastor I had never experienced anything like this and it was hard to know what to do. The sheer scale of the violence and harm done to people - old and young, men, women and children - was something utterly unimaginable. Even now, two years later, I am personally traumatised by the suffering that I saw.
What also upset me greatly was my inability to do more to help the people suffering. Nothing had prepared me for this horrendous experience and I felt powerless to help. This was a terrible thing to experience. As a pastor, people turn to me for comfort, counselling and advice but in the aftermath of Irpin and Bucha I felt under-prepared and unable to provide the help so badly required.
I would love to have specific training to help people traumatised by war and therefore be able to provide help to recover from the mental trauma caused. However, I am sure that some specific training is necessary together with access to professional psychologists to advise and help in extreme cases. Also, I am more than aware of the mental toll that helping people traumatised causes. So, it would also be important for pastors, like me, to have access to psychologists to help with our own mental wellbeing.'
Pastor Sasha'experience raises a number of questions:
How then priests and pastors be better supported?
How can priests and pastors be trained to recognize and treat PTSD?
What training materials such as videos, and support services such as access to immediate assistance from qualified psychologists can be made available?
And what can be learnt from existing initiatives?
These are all questions that the forum have begun to explore.
What might a support service for the churches look like?
Peer-based groups have a natural understanding of the dynamics and culture of each group. By addressing the specific needs of these groups and fostering inter-group support, a more inclusive and effective mental health environment can be created. This is illustrated in the challenges the churches face in supporting their priests and pastors, as well as their communities - be they in Ukraine, those who have been displaced from their communities or those who have left the country and are now part of the wider diaspora.
Tapping into insights from veterans' organisations around the world
One group which has been the focus of mental health support are veterans. Veterans organisations in the US and UK have been at the forefront of setting up community-based mental health programs addressing trauma, reintegration, and community support. These programs often emphasize peer support, leveraging shared experiences to foster understanding and healing. Training for resilience and coping strategies, as well as advocacy for policy changes to improve access to mental health services, are also key components.
For example, Supporting Wounded Veterans (SWV) in the UK offers a comprehensive approach to assist veterans with physical or mental injuries through various programs designed to enhance their recovery and reintegration into society.
The SWV mental health resilience programme shows the diverse needs of veterans requiring mental health support, providing options beyond a "one size fits all" model. It encourages veterans to engage in Sports Habilitation or Pain Management Pathways as a first step, leading to further support tailored to their specific needs. After completing the initial programs, veterans are invited to participate in these pathways, offering guidance and support for finding fulfilling careers and reintegrating into society. Emotional Freedom Technique (EFT) is provided to their veterans with PTSD, pain, and other mental health difficulties who have participated in a SWV program. These EFT sessions are non-invasive and do not require detailed revisiting of trauma and aim to help veterans cope with anxiety, depression, PTSD, and chronic pain.
A common challenge with support for veterans is ensuring early intervention. Mental health needs are often overlooked in acute phase of trauma as the focus tends to be on life support. The evidence demonstrates how cost-effective early interventions can be, potentially transforming long-term outcomes as explored in this blog 'Rehabilitation starts at time zero' https://www.lsngroup.org/post/rehabilitation-starts-at-time-zero. However, it is often challenging to influence policy and practice early in the care pathway when resources are often under the greatest time pressure.
Moe Kolo – a case study in peer-to-peer support
Another initiative which we have documented is Moe Kolo, a project based in Lviv that provides support groups for Ukrainians coping with the psychological impact of war.
Led by a team of mental health experts, Moe Kolo blends the expertise of professionals with the power of shared experience. In a support group, the isolation and loneliness that often accompany trauma can be replaced by a sense of belonging and shared humanity. The team of psychologists incorporate evidence-based practices, teaching participants practical tools and techniques for managing stress, anxiety, and other symptoms of trauma.
Moe Kolo's approach relies on a peer support model, with moderated group sessions focusing on specific issues. They initially targeted families of fallen soldiers, people with life-changing injuries, and refugees, but expanded to address anxiety, depression, and suicide among the general population. A recent workshop on PTSD attracted a very large number of registrations, indicating a significant demand for education about mental health issues. The three key issues they addressed include the scale of the problem, cultural resistance to online therapy, and geographical inaccessibility.
Peer-to-peer support groups like Moe Kolo are more than just a source of comfort and connection; they are a lifeline for individuals and communities grappling with the trauma of war. By providing a safe space for sharing, learning, and healing, these groups play a critical role in rebuilding lives and communities shattered by conflict. For a profile of Moe Kolo see https://www.lsngroup.org/post/healing-together-the-impact-of-peer-support-groups-in-war-torn-ukraine
Widows, Lagarta and the authenticity of the lived experience
Widows often face unique psychological and social challenges. Lagarta was set up by a widow and psychotherapist to provide support for other widows – with services rooted in her own experience. Lagarta’s focus is on providing widows with grief counselling, financial support, and community integration programs.
Conclusion
Addressing mental health in post-conflict societies is crucial for ensuring long-term stability and recovery, as it aids in healing trauma, prevents violence escalation, supports reintegration, boosts economic recovery, fosters social cohesion, lightens healthcare systems' load, and strengthens societal institutions. By tackling these challenges, mental health initiatives contribute significantly to rebuilding the social fabric and promoting a sustainable, peaceful future for communities affected by conflict.
In conclusion, a public health approach to mental health in war-torn environments is imperative for addressing the multifaceted psychological impacts on diverse societal groups. By integrating care into broader systems and fostering community-based support, such strategies enhance accessibility, reduce stigma, and promote resilience. This approach, focusing on prevention, widespread policies, and community engagement, lays the foundation for both immediate relief and sustainable recovery. It underscores the importance of adapting interventions to meet varied needs, ultimately contributing to a society's long-term stability and growth post-conflict. This holistic and inclusive method not only addresses immediate mental health needs but also rebuilds the social fabric, ensuring a future where communities can thrive despite the scars of war.