The BEARR Trust Annual Conference 2023 – report by BEARR Trustee Sam Thorne

November 30, 2023

Ukraine: community support for mental health, resilience and recovery

The 2023 BEARR Trust Annual Conference, on 17 November 2023, focused for a second year on civil society responses to the war in Ukraine. Discussions showcased the inspiring work being done by small, local organisations to address the huge challenges of providing health and social support for millions of people who have been internally displaced and otherwise damaged by the war. 

Panellists from Ukraine discussed a variety of innovative, community-based projects, many enabled by funding from The BEARR Trust’s Emergency Appeal for Ukraine and Moldova. Projects included:

• Use of ‘seed boxes’ to help internally displaced people (IDPs) adapt to rural life in Western Ukraine
• Art therapy workshops for children of families who have been displaced
• Provision of long-term accommodation and support services for IDPs in Dnipro
• Mental health and other support services for various vulnerable groups in Odesa
• A helpline dedicated to averting suicides among veterans and the wider community.

Panellists described how their thinking was evolving, from the day-to-day survival mode of 2022 to more strategic planning for the next year and beyond. There was a general recognition among them that even if the war stopped tomorrow, the recovery – and the need for their services – would take many years: a generation or more. Some historical perspective on this was provided by looking at the example of Bosnia and Herzegovina and lessons that could be learned from that country’s reconstruction and development after war in the 1990s.

Given the intensity of work needed, over an indeterminate period of time, it has become increasingly clear how important it is to protect the mental health and morale of staff and volunteers who run these vital services. The conference therefore also touched on a new programme launched by BEARR in July, ‘From Group Therapy to Community Cohesion’, which is funded by the British Government through the British Embassy in Kyiv. An early programme initiative was a ‘volunteer revival camp’, in which some of the panellists participated. This was held in the Carpathian Mountains in September. You can find out more about the new programme and the camp on the BEARR website here.

The conference was a hybrid event, with about 70 participants joining online, from Ukraine and other countries, and 40 people attending in person at Voluntary Action Islington in London. There were two panel sessions and a plenary discussion, moderated by BEARR Trustees. 

Nicola Ramsden, Chair of The BEARR Trust, introduced and closed the conference. Nicola highlighted the impact of BEARR’s Emergency Appeal for Ukraine and Moldova, with over £520,000 raised from individual donors and charitable foundations, as of November 2023. The appeal remains open, and donations can be made online via this link, with 100% of proceeds going to partner organisations in Ukraine.

Panel 1 discussion

The first panel discussion was moderated by Megan Bick, with three panellists:

• Natalia Shmurikova, Center for Strategic Initiatives, Khmelnytskyi, Ukraine
• Liudmyla Byts, Friendly Space, Dubno, Ukraine
• Max Maslennikov, Charity Fund “Reconstruction of Ukraine”, Dnipro, Ukraine

Natalia, speaking online from Western Ukraine, described how the Center for Strategic Initiatives started work in February 2022, after the full-scale invasion, as thousands of refugees flooded into the Khmelnytskyi area from the east of the country. A major challenge was to help the new arrivals to integrate and in many cases adapt to rural life when they were used to living in cities or towns.

The ‘seed box’ project involved distributing boxes of sunflower, pumpkin and vegetable seeds to displaced families living in villages and remote areas. It was intended as a way of helping people learn to live off the land but also had unexpected therapeutic effects. These began to show through in May 2022, when the Kyiv, Sumy and Chernihiv regions of Ukraine were liberated and families started to think about going back. Volunteers tried to discourage them, as the regions were still unsafe to live in. The seeds helped to sway the argument. They were planted, in Natalya’s words, ‘with love and care’, so the families were invested in watching them grow and, as the summer went on, they wanted to stay around so that they could harvest the crops in the autumn. The project findings can therefore be summarised as: ‘Planting seeds can save lives’.

Given such positive outcomes, the seed box project was repeated in 2023, this time with assistance from village heads and other partners. Related projects have included a ‘berry bush’ initiative and another to supply gardening tools. As in the seed box example, the emphasis of the Center’s work has shifted to partnering with voluntary groups that operate at an even more local level. For example, a competition was held in summer 2023, in which eight villages were awarded €300 each to implement their winning proposals for therapeutic activities, such as flower-planting, history tours, book readings and excursions. At a village level, Natalia said, €300 can make a big difference.

Liudmyla, also joining online from Western Ukraine, echoed some of these observations. In 2022, her organisation Friendly Space had focused on providing the bare necessities for IDPs (housing, food and clothing) but this year had been able to expand into providing art and play therapy for children. Workshops have been attended by around 375 internally displaced children from other parts of Ukraine, along with 280 children from the local region. In her view, ‘art therapy heals people’s souls’. As well as enjoying the painting and decorating activities, children socialise and connect, they learn resilience and how to overcome difficulties. 

Liudmyla talked of developing their services to also include family days, where parents can come along with their children. All their workshops are regularly evaluated, through participant surveys, to ensure they continue to prioritise services that are needed and effective. The greatest indicator of impact, she said, was in seeing at the workshops ‘the sparkle in children’s eyes’.

Max picked up on the theme of needing to plan and develop services sustainably for the long term, and the challenges of scale. Dnipro was hosting around 400,000 IDPs, compared to a pre-2022 population of 900,000. The city has become a hub of IDPs from the frontline battle zones and occupied territories. Although volunteers try to encourage people to keep moving west, many wait in the hope of going back home as soon as the fighting has stopped. The problem, he said, is that their homes are more likely than not to be completely destroyed and uninhabitable. Demining, for example, is likely to take 15 years or more.

In response, Max’s organisation has re-focused from arranging temporary housing to providing IDP accommodation for the longer term. They have just acquired an 800-square-metre shelter that can house 50 people for five years. Max felt it crucial to give people this stability so that they can plan their futures and integrate with local communities. Once housing is sorted out, the organisation can help in other ways, such as upskilling people, finding more bespoke solutions for people with disabilities and putting on activities for children, such as IT and sports. 

Max also talked about the experiences of volunteers and the importance of managing their mental health. He described a feeling that you are constantly facing a mountain of challenges, a sense that you’re never doing enough and the high risk of burnout that follows. He found there are two psychological approaches to dealing with this: talk through the problems or take the problems away. The ‘volunteer revival camp’ in the Carpathians was about the latter, giving people a break to recharge. The first camp was held in September, with volunteers staying at a hostel in the mountains, networking and doing team-building and therapeutic activities. The highlights? Mushrooming expeditions and a massage therapist with a portable massage table…

A Q&A session included questions about the potential longevity of the war, interactions with local authorities, support for people with disabilities and how The BEARR Trust can best help. 

Natalia gave an example of the long-term impacts on villages whose male populations have been decimated by the war. Losing twenty men can be catastrophic for a small village, in terms of its capabilities to carry out traditionally ‘male activities’ such as building and handiwork, managing livestock and gardening. Women need to be trained to do this work.

The panellists agreed on the ongoing importance of the services provided by Civil Society Organisations (CSOs), given that local authorities could not fulfil all needs and were of mixed effectiveness. Collaboration between CSOs and local authorities could also be patchy, with some positive and negative examples given.

Natalia suggested that the enabling of CSO networking and online communications was a valuable way in which The BEARR Trust could continue to support their work. 

Panel 2 discussion

The second discussion was moderated by Michael Rasell, with three panellists:

• Tamara Lomadze, Povernis, Odesa, Ukraine
• Dr Reima Maglajlic, Department of Social Work and Social Care, University of Sussex, UK
• Paul Niland, LifeLine Ukraine

Tamara joined online from Odesa to talk about the mental health and other social support that her organisation provides to several vulnerable groups:

• Internally displaced people, of which there are around 100,000 in Odesa, including around 40% still living as refugees
• Families of veterans, dealing with the fear for their loved ones on frontlines and/or families whose loved ones have returned disabled and/or with PTSD
• Veterans themselves, who may not yet have received demobilisation packages, who are finding it difficult to adjust back to civilian life and who may be struggling with alcohol, drugs, aggression and suicidal thoughts
• LGBT+ and HIV positive people, who may be dealing with the above issues as well as being stigmatised socially or by their families
• Single parents, who may have older dependents as well as children, and who may be living below the poverty line.

All these groups need housing and social support. Giving people practical help to deal with the stresses of bureaucratic paperwork is often as important as psychological support. Her organisation therefore takes a team-based approach for each person they support. Casework teams consist of a psychologist to address mental health issues, a legal advisor to deal with documentation such as pensions, and a case officer to help with bureaucracy and daily chores.

Paul also spoke online from Ukraine on the topic of mental health support for veterans and other people traumatised by the war, emphasising the huge scale of support required. Between October 2019, when the LifeLine Ukraine Foundation was started, and February 2022, the organisation provided about 1000 instances per month of support, to veterans of the earlier conflict in Donbas. This had risen to about 4000 instances per month by summer 2023, by which time the foundation had expanded its services to anyone affected by the war, as well as veterans. 

In total, LifeLine Ukraine had provided 76,000 instances of support by November 2023. Based on statistics suggesting that around 15% of those calls are potential suicide cases, this would amount to around 10,000 lives potentially saved, something that Paul said the organisation is very proud of. However, the need is ever growing. The foundation is having to recruit and scale up to cope with the demand. Paul estimated that there are around six million IDPs in Ukraine and another four million overseas who will require varying forms of support and PTSD treatment over the coming years.

Reima discussed lessons that might be applied to Ukraine from research into how Bosnia and Herzegovina reformed its mental health systems after war in the 1990s. This experience could be seen as a kind of ‘message from the future’, 20–30 years down the line, much of which was hopeful.

A key insight from Bosnia and Herzegovina is that war can trigger big changes in society. There was a transformation of services in Bosnia and Herzegovina after the war – from long-stay hospitals and ‘white coats’ to community-based health provision, with access to psychiatrists in more informal settings and peer-group support. 

Reima discussed a study that she had co-produced on survivor-run support initiatives in Sarajevo, based on interviews with 50 people from a cross-section of society, with a range of health needs. Findings about ‘what helps’ included:

• Provision of mental health services within a community setting, rather than more formal clinical environments such as hospitals
• Design and management of services by people who have been through the traumatic experiences themselves
• The importance of practical support to help with paperwork (Reima observed that Slavs seem to be born with a folder of paperwork that constantly accumulates through their lives)
• Avoid ‘coercive services’; people don’t want to be forced into things; they want to have agency, know their rights and how to fight for them
• Opportunities for employment and income, alongside the social support.

A Q&A session followed, and a Plenary discussion, chaired by Janet Gunn, in which there was further discussion of themes including the decentralisation of services and the resources needed to tackle mental health challenges of the immensity seen in Ukraine. Participants also discussed issues around a rise in domestic violence connected to the war, and the politics of language.

Reima expanded on lessons from Bosnia and Herzegovina. Long-term planning and holistic thinking are vital in developing services; you can’t just focus on one sector. Also, the importance of working with local organisations that understand local circumstances. Funders will always have their priorities, and organisations on the ground will have their local needs and priorities; there needs to be negotiation between the two. There are no quick fixes, and you need time and space to talk through the problems. Scholarship and knowledge-sharing can expedite these conversations. There was a note of optimism from the Bosnia and Herzegovina experience that ‘life continues and life will find a way’.

Tamara and Paul discussed the resource pressures on hospitals, local government and health professionals. Paul cited statistics suggesting that there were around six times fewer psychologists and psychiatrists per 100,000 people in Ukraine than in Germany and the United States. Tamara gave an example of how her organisation works with local hospitals to manage potential suicide cases.

Ideas for developing more capacity included training more people to run community support groups and providing more resources to support people already working in health and social care. A participant online gave an example of how a British mental health charity had supported health professionals in Dnipro by running regular, online ‘train-the-trainer’ sessions.

On a final positive note, panellists agreed that the surge in civil society to fill gaps in health and social care bodes well for the future of Ukraine, however daunting the challenges.