Working with Ukrainian refugees
BACP member blogs

Traumatic events are extraordinary not because they occur rarely, but rather because they overwhelm ordinary human adaptations to life. Aydin (2017) highlights that trauma is damage that disrupts our familiar ideas and expectations about the world – a violating damage to our way of life. This description aptly describes the experience of the Ukrainian refugee community.

Over five million Ukrainians fled the 2022 Russian invasion, carrying trauma and loss, exacerbated by the prospect of facing life in unfamiliar cultures, and the pain of family separation. In March the World Health Organisation (WHO) estimated that at least 500,000 refugees were suffering from mental health issues, overwhelming the already inadequate mental health infrastructure in eastern Europe. 

In the UK, a challenging entry process has visited frustration upon refugees and volunteers who’ve offered hospitality (Specia, 2022). Limited thought, it seems, has yet been given to the resourcing of mental health support for refugees and hosts as well as raising awareness of the importance of trauma informed support and cultural awareness for hosts.

The Refugee Council reports that over 60% of asylum seekers struggle with mental distress and a 2017 WHO study highlighted that Ukraine had the world’s highest prevalence of depression at 6.3% of the population. Although Ukrainian attitudes are shifting from a traditionally stoic outlook, suspicion of mental health services remains endemic; perhaps due to fear of incarceration linked to a Soviet practice of branding dissidents as mentally ill. Unsurprising then that psychological intervention is not an attractive option in Ukrainian society. In a Health Equity scoping review, the significance of working with humility, developing a knowledge of refugee culture, and integrating client language into services are emphasised. In my own experience, producing material in the Ukrainian language, has been an essential tool in reaching out, as has phrasing my literature in terms of offering listening support rather than emphasising the word counselling.

Whichever frame of therapeutic reference we may adopt, it’s imperative to recognise the neural repercussions of trauma; it’s disrupting, disabling, disorientating, devastating, disempowering, disconnecting, destroying, debilitating, and damaging (Herman, 2002; Tolstikova et al., 2005; Garcia & Rime, 2019; Buczynski,2020). I incorporate the principles described by McMahon (2014) in her work with supervision which places emphasis on offering emotional awareness, sensitivity, humility and the developing relationship as a basis for my work. Working in a way which honours these principles demands above all else, patience, respect, curiosity, humility, and the recognition that however fine-tuned we believe our levels of empathic understanding to be, it’s highly unlikely that we will come close enough to comprehend the depth of despair, anguish, and unresolved emotional distress present within our client.

Whilst reducing trauma and associated distress is key, equally significant in working with this community and their hosts is the adoption of a trauma informed approach. Adopting the principles outlined within the SAMHSA model (2014) and by Brennan et al. (2019), which overlay the need to develop with the client a sense of safety, trust, support, collaboration and empowerment alongside recognising the importance of cultural and historical contexts provide my starting points. For me, developing a sense of physical and psychological safety is the precursor to any talking support (Herman 2002). Taking time to establish trust and become known to the Ukrainian refugee community is essential. My focus has been upon collaboration, getting to know hosts and Ukrainian refugees, offering curiosity through rudimentary learning of the Ukrainian language, mistakes generating laughter, exploring Ukrainian history, and creating an atmosphere where refugee visitors regain a sense of respect, choice, and empowerment.

References

American Psychiatric Association APA (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM) 5. Arlington: Washington, DC: American Psychiatric Association
Aydin, C. (2017) How to forget the Unforgettable? On Collective Trauma, Cultural Identity and Mnemotechnologes Identity an International Journal of Theory and Research, 17.3, pp 125-137 https://www.tandfonline.com/doi/full/10.1080/15283488.2017.1340160
Brennan, R., Bush, M., Trickey, D., Levin, Levene, C. and Watson, J. (2019) Adversity and Trauma Informed Practice A short guide for professionals working on the frontline: Young Minds https://youngminds.org.uk/media/3091/adversity-and-trauma-informed-practice-guide-for-professionals.pdf
Buczynski, R., Siegel, D., MD; van der Kolk, B., Ogden, P., Porges, S., & Lanius, R. (2020) The Neurobiology of Trauma – What’s Going On In the Brain When Someone Experiences Trauma? National Institute for the Clinical Application of Behavioral Medicine https://www.nicabm.com/confirm/treating-trauma-master-2/
Economist (2022) The wreckage within: Ukrainian refugees need mental health care that their hosts lack https://www.economist.com/europe/2022/04/30/ukrainian-refugees-need-mental-health-care-that-their-hosts-lack
Garcia, D. & Rime, B. (2019) Collective Emotions and Social Resilience in the Digital Traces After a Terrorist Attack Association for Psychological Science https://journals.sagepub.com/doi/pdf/10.1177/0956797619831964
Gentleman, A., and Halliday, J. (2022) The Guardian “It’s terrifying here”: families are sick and scared in Ukraine as they wait for UK visas https://www.theguardian.com/world/2022/mar/30/its-terrifying-here-families-are-sick-and-scared-in-ukraine-as-they-wait-for-uk-visas
Halliday, J. (2022) The Guardian Inhumane Homes for Ukraine scheme requests security scans for baby girl https://www.theguardian.com/world/2022/apr/24/inhumane-uk-homes-for-ukraine-scheme-security-scans-for-baby-girl?CMP=Share_iOSApp_Other
Herman, J. (2002) Recovery from psychological trauma. Psychiatry and Clinical Neurosciences https://onlinelibrary.wiley.com/doi/full/10.1046/j.1440-1819.1998.0520s5S145.x#:~:text=The%20recovery%20process%20may%20be,event%2C%20and%20reconnecting%20with%20others
Lau, L.S., and Rodgers, G. (2021) Heath Equity Cultural Competence in Refugee Service Settings: A Scoping Review, 5 (1), pp 124 – 134 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990563/pdf/heq.2020.0094.pdfMcMahon, A. (2014) Four guiding principles for the supervisory relationship. Reflective Practice: International and Multidisciplinary Perspectives https://www.researchgate.net/publication/262583853_Four_guiding_principles_for_the_supervisory_relationship
National Association for People Abused in Childhood NAPAC (2016) Working with Adult Survivors of Child Abuse in a Trauma-Informed Way https://napac.org.uk/courses/working-with-adult-survivors-of-child-abuse-in-a-trauma-informed-way/
Reid, A. (2015) Borderland: A Journey Through the History of Ukraine. London: Weidenfeld & Nicolson.
Substance Abuse and Mental Health Services Administration SAMHSA (2014) SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
Specia, M. (2022) As UK Offers Homes to Ukrainians, the Process Lags Behind the Good Will New York Times
The Guardian (2022) A humiliating process: Ukrainians caught in red tape trying to reach UK relatives https://www.theguardian.com/world/2022/mar/14/a-humiliating-process-ukrainians-caught-in-red-tape-trying-to-reach-uk-relatives?CMP=Share_iOSApp_Other
The Observer (2022) Hundreds of Ukrainian families halt bids to reach UK after visa delays https://www.theguardian.com/uk-news/2022/may/01/hundreds-of-ukrainian-families-halt-bids-to-reach-uk-after-visa-delays?CMP=Share_iOSApp_Other
Tolstikova, K., Fleming, S., & Chartier , B. (2005) Grief, Complicated Grief, and Trauma: The Role of the Search for Meaning, Impaired Self-Reference, and Death Anxiety https://journals.sagepub.com/doi/10.1177/105413730501300402
Refugee Council (2022) Mental Health support for refugees and asylum seekers https://www.refugeecouncil.org.uk/our-work/mental-health-support-for-refugees-and-asylum-seekers/?doing_wp_cron=1652124333.1350450515747070312500
World Health Organisation (2022) Refugee and migrant health https://www.who.int/health-topics/refugee-and-migrant-health#tab=tab_1