Responding to PTSD: Learning from Locally Driven Approaches

The newly published NATO volume, Digital Innovations for the Prevention and Treatment of PTSD in Military Contexts, shares the value of community-led approaches to trauma support in conflict zones that are culturally rooted, digitally enabled, and operationally agile.

The book documents NATO's military mental health human centric approach and includes a discussion of why the integration of community-based approaches into military mental health strategy matters for anyone working in conflict-affected regions.

The Strategic Context

Ukraine's mental health crisis has exposed the limitations of traditional approaches. With over 6 million displaced children, hundreds of thousands of wounded veterans, and whole communities traumatised by bombardment, conventional specialist-led, clinic-based mental health care cannot scale to meet demand.

The NATO book, edited by Eric Vermetten, Iryna Frankova, Shorena Lortkipanidze, and Joseph Zohar, represents the most comprehensive attempt yet to survey of digital innovation and options for improving effective mental health support when traditional pathways are unavailable or insufficient.

NATO's Evolution and the Brain as Combat Space

Gerald Rots, NATO's former Strategic Medical Advisor, describes "Human-Centric Framework" which explicitly positions "the human being" as "the true centre of gravity in war"—recognising that despite military technology advances, human resilience and emotional strength ultimately determine conflict outcomes.

Robert Ursano's opening chapter reframes modern warfare: the brain as a combat space. Psychological operations, misinformation campaigns, and cognitive warfare deliberately target mental health as a strategic objective. If mental health is being actively weaponised, then psychological support becomes not just humanitarian work but strategic military capability—explaining why NATO now invests heavily in mental health infrastructure.

Where Locally Driven Meets Global Strategy

Our chapter appears in Section 6, "Cultural Adaptation and Long-Term Strategies for Change," after extensive discussion of AI-powered diagnostics, neurotechnology, and institutional frameworks. We introduce four hallmarks that define successful mental health interventions in conflict zones:

•       Agility: Rapid deployment and adaptation, including quick training and flexible models leveraging digital platforms.

•       Adaptability: Continuous feedback loops, cultural adaptation of evidence-based practices, and flexibility incorporating local healing practices.

•       Cultural Authenticity: Deep integration with local practices, beliefs, and social structures, including appropriate language, cultural norms, religious elements, and addressing stigma.

•       Scalability: Expanding impact whilst maintaining quality through digital platforms and sustainable implementation.

These hallmarks emerged from our Ukraine field observations and connect directly to themes in previous LSN briefings—from peer support groups and drama therapy, to veterans as catalysts for change, to holistic rehabilitation starting "at time zero."

The Power of Positive Deviants

One concept from our chapter that resonates throughout the book is "positive deviants"—individuals and organisations making disproportionate impact despite resource constraints often emerging from an innovative ideas or a new response to a previously overlooked need. The book documents five initiatives:

Moe Kolo served 2,621 people through digital CBT/ACT therapy, adapting format based on participant needs whilst grouping interventions around common symptoms rather than vulnerability labels to address stigma.

Supporting Wounded Veterans transformed traditional veteran support through digital innovation, combining Sports Rehabilitation pathways with remote EFT training for managing PTSD without requiring detailed trauma recollection.

Faith Leaders Support Network integrates spiritual and psychological support through online groups, mobile apps, and WhatsApp—enabling chaplains in active conflict zones to maintain continuous relationships with soldiers whilst managing their own referred trauma.

Lagerta, founded by a widow working with psychotherapists, offers three-stage digital support for military widows plus a free online platform training other psychologists about loss and grief—amplifying impact beyond direct service delivery.

Radooga serves 1,317 war-affected children across 10 cities, integrating robotics lessons with therapy to build technical skills whilst creating non-threatening environments for processing trauma.

Digital Technology as Enabler, Not Replacement

A crucial insight running through the book is technology's role as an enabler of human connection rather than a replacement for it. This connects to our August 2024 briefing on AI and Real World Evidence, where we explored how AI supports—not supplants—human judgement in trauma care.

Each Ukrainian initiative demonstrates this: Moe Kolo uses digital platforms for reach whilst maintaining patient-centric care; Supporting Wounded Veterans employs telehealth to extend personal connection; Faith Leaders maintain spiritual relationships through video conferencing; Lagerta leverages digital tools for community building amongst those with shared experience; Radooga integrates technology into therapy in age-appropriate ways.

In each case, technology enables what we discussed with Professor Walter Busuttil in our November 2024 briefing: the ability to "step away from tried and trusted approaches" when conventional pathways serve only a few, whilst maintaining the human elements essential to healing.

From Lived Experience to Leadership

One of the book's most powerful themes is the authority that comes from lived experience. Individuals who've experienced trauma and achieved post-traumatic growth possess unique authenticity—making them effective leaders in peer-to-peer encounters.

This isn't just about peer support groups (explored in our January 2024 briefing). It's about fundamentally reimagining who leads trauma response. Lagerta, founded by a widow, may offer more authentic support than even well-meaning professionals without that shared experience. Faith leaders who've witnessed combat bring different understanding to soldiers' spiritual crises than chaplains who've only studied theology.

This aligns with our June 2023 briefing on veterans becoming "catalysts for a more inclusive society." The NATO book provides institutional validation for what we've observed: lived experience isn't just valuable—it's often essential.

Mental Health as Part of Holistic Rehabilitation

The NATO framework recognises what LSN's rehabilitation work has long demonstrated: mental health support cannot be separated from physical rehabilitation. As our "Rehabilitation Starts at Time Zero" briefing argues, comprehensive care must begin immediately and address both psychological and physical trauma together.

NATO's Operation Renovator—establishing five military medical rehabilitation centres across Ukraine—explicitly integrates mental health support into physical rehabilitation pathways. This reflects the approach documented in our rehabilitation briefings: wounded veterans, amputees, and those with chronic pain require coordinated support addressing both body and mind.

The Supporting Wounded Veterans case study in the NATO book exemplifies this integration, combining Sports Rehabilitation with Emotional Freedom Technique for PTSD. Similarly, Radooga's work with war-affected children integrates robotics skill-building with trauma processing—addressing both developmental needs and psychological healing.

This holistic view strengthens the case for locally driven approaches. Just as early intervention in prosthetic care delivers better outcomes at lower cost, early integrated mental health support prevents psychological trauma from compounding physical disability. The mobile clinic model we've documented in Step In's work from Iraq to Ukraine demonstrates this same principle: taking integrated services to people rather than expecting traumatised populations to navigate fragmented systems.

Four Critical Implications for Policy and Practice

Drawing from both our chapter and the broader NATO framework, four critical implications emerge:

1. Early Intervention Requires Flexible Funding: The book emphasises that early psychological intervention is crucial and cost-effective, yet securing mental health funding when people are dying from physical wounds is nearly impossible through traditional budgets. The locally driven initiatives succeeded partly by operating outside traditional funding structures, using digital platforms to minimise costs and peer support to reduce dependency on scarce professionals. NATO's framework now validates these approaches—potentially opening pathways for more flexible funding.

2. Cultural Authenticity Cannot Be Retrofitted: Multiple chapters emphasise that interventions must be culturally grounded from inception, not adapted as afterthoughts. Digital platforms can support cultural customisation, but only if designed with that intention. A platform built for Western populations and then "translated" will never achieve the cultural authenticity of one co-designed with local communities from the start.

3. Scalability Requires Infrastructure, Not Just Technology: Whilst digital tools enable scaling, sustainable scaling requires training systems, data collection frameworks, quality assurance, referral pathways, and integration with existing health systems. This suggests a role for international support: help successful local initiatives build scaling infrastructure whilst maintaining the cultural authenticity and agility that made them effective.

4. Data Collection Is Political: Who collects data, what gets collected, and how it's interpreted shape resource allocation and policy priorities. When locally driven initiatives rigorously document their effectiveness, they create political leverage. Digital platforms can democratise data collection—but only if designed to be accessible to community organisations, not just institutional researchers.

Conclusion: A Fundamental Change in Approach

The NATO volume documents a fundamental change in how international institutions approach mental health in conflict zones—from expert-led service delivery to supporting community capability, from standardised protocols to culturally-grounded adaptation, from technology-as-solution to technology-as-enabler.

Having these arguments embedded in NATO strategy, documented in an official publication, and backed by leading researchers worldwide changes what's possible. Locally driven initiatives are no longer fringe experiments to be tolerated when institutional resources run out. They're recognised as essential components of effective trauma response—bringing agility, adaptability, cultural authenticity, and scalability that institutional programmes struggle to achieve.

The question now is whether international support systems can adapt accordingly. Can funders amplify what works locally rather than exporting what they know? Can institutions provide infrastructure without imposing structure? Can policy frameworks enable innovation rather than standardising it?

The NATO book creates pressure for these answers. For those working in the field, this creates both opportunity and responsibility—to demonstrate what's possible when locally driven wisdom meets strategic support, and to ensure that in scaling and institutionalising, we don't lose the very qualities that make community-led approaches effective.