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Mental Health Outreach in Ukraine

A novel approach breaks through Ukraine’s historical stigma about mental health.

Key points

  • The memory of Soviet abuses of the mental health system makes many Ukrainians reluctant to seek help.
  • An estimated 15 million Ukrainians need psychological support as a result of the Iivasion.
  • An innovative program sidesteps reluctance to seek care.

As with many others, life changed dramatically for Yuliia Karnas last year when Russia invaded her native Ukraine. At the time, she had a rewarding job in Berlin, working as a legal consultant in technology. Then she “abandoned everything I was doing so I could help my country.”

She immediately asked herself, “What can I do that will be most helpful?”

The answer: mental health. “When you look at the need, mental health is under-represented in the overall efforts to help Ukraine.” Having grown up in Ukraine, she knows why this is.

Reluctance to Accept Mental Health Assistance

During the more than 70 years of Soviet rule, many Ukrainians were aware that the Soviet government regularly used alleged mental health issues to control people who opposed the regime. If the government disapproved of an individual’s politics, that individual might receive a false diagnosis of a mental disorder. Schizophrenia, she reports, was a favorite.

The individual might be committed to a psychiatric hospital. While there, he or she could be subjected to forced medication, including drugs with debilitating side effects. The threat alone was a powerful incentive to keep people from opposing the regime.

Soviet abuse of the mental health system means that even today, decades after the abuse ended, many Ukrainians are reluctant to interact with the mental health system. The stigma lingers.

Mental Health Needs Are Severe

And yet, Karnas recognize that the need for mental health assistance in Ukraine is severe. As she points out, "The.Ministry of Health of Ukraine has estimated that 15 million people—that is, every third Ukrainian— require psychological support after the full-scale invasion.”

Looking over the landscape of need, Karnas realized that not only was there reluctance to accept mental health assistance, but also, in the areas where it was most needed—near the front lines—there were rules preventing many NGOs from operating. Between stigma and geography, Ukrainian needs for mental health assistance were underserved.

A New Mental Health Organization

Karnas and a colleague, Hanna Kolesnichenko, worked together to create a mental health project aimed at supporting Ukrainian women in ways that were sensitive to the stigma attached to mental health services. Operating near the front lines, the organization is TYSHA, Ukrainian for “silent.”

The project provides group therapy sessions that take place in cafes close to the front lines. “Having the sessions in a café or restaurant,” Karnas explains, “means participants will feel more comfortable than meeting in a professional’s office.”

Among the difficulties commonly dealt with:

  • A husband or child killed in the war
  • A home or livelihood destroyed
  • Becoming a refugee
  • Being raped or sex trafficked and confronting enormous social stigma

Holding therapy sessions in cafes near the front line has been a successful approach. “So far, with these support groups, we have directly touched the lives of 6,000 people. We are in the scaling-up phase, and our numbers are growing every month,” says Karnas.

How It Works

The efforts are facilitated by psychologists and groups meet for six weeks. The approach adopted by Karnas and Kolesnichenko was suggested during a workshop with Jack Saul, Ph.D., and Elissa Eppel, Ph.D, and the International Association of Group Therapy (IAGP).

Women attending the group therapy sessions are provided with knowledge and evidence-based exercises drawn from cognitive behavioral therapy. The exercises aim to impart skills for coping with stress and anxiety, falling asleep, feeling empathy, and supporting family members who are enduring stress.

According to Karnas, “Women have continually reported feeling the first positive changes in their mental well-being after only three sessions. In the case of every second women, this was the first time they had tried mental health services. This itself is a huge result in such a stigmatized society.”

Julia Karnas, Used with permission
Members of the Tysha Team
Source: Julia Karnas, Used with permission

Helping the Helpers

Karnas’ focus on unmet needs has her branching out to help the helpers. “The therapists and others who are helping others can become extremely burned out. They’re not only supporting others, often they need to cope with their own personal tragedies.”

As she adds, “People like me require support from the international community to keep doing all the good things we’re doing. We need access to knowledge, we need to network, and we need funding.” She relies heavily on the online effort Cosmopolis, connecting helpers and help seekers to support one another.


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