Mental health care for Ukrainian military personnel during the war

On February 24th lives of more than seven hundred thousand Ukrainians have changed, they joined the ranks of the Armed Forces of Ukraine to protect the Motherland. Managers, programmers, farmers became servicemembers (riflemen, mortarmen, unit commanders), and only a quarter had combat or service experience. The soldiers went through all the stages of psychological response to extreme stress: the rise of the first days, a decline on the 40-45th day, stabilization and then decline around the 4-5 month. Adjustment disorder following acute concussion due to mine-explosive injuries are quite common mental health issue among military in Ukraine.

The System of mental health care and rehabilitation in the Armed Forces of Ukraine is under construction and at the initial stage. However, we cannot just mimic a mental health support system of NATO countries. The number and funding for psychiatrists and psychologists in the Ukraine Armed Forces is insufficient. Uniqueness of current situation is that we are fighting on our territory, where military personnel also assisted by civilian doctors within the framework of a single medical space. Mental health support in Ukraine undergoes important reforms as well and it is being rebuilt according to the principles of the WHO Optimum Composition of Service with the focus on the provision of mental health service on the primary care level (Cabinet of Ministers of Ukraine, 2017).

According to the intervention pyramid (IASC, 2007), the provision of mental health support and additional training level by level should be:

• Psychoeducation, a digital self-help tools, chatbot for wide service population;

• mhGAP training for general practitioners at the primary care level (including modules on acute concussion management), and psychological recovery skills training at the level of medical centers of units;

• First Psychological Aid training, psychological self-help training with a focus on resilience at the level of the Moral and Psychological Support Service;

• Specialized mental health aid, training of psychological recovery skills for military hospital staff;

• Rehabilitation programs in rehabilitation center;

Reconstruction of the field of mental health in the army requires effort and financial support, but it creates additional opportunities.