Recently, Ukraine’s Parliamentary Committee for Healthcare held a session where the MPs considered psychological rehabilitation of Donbas conflict veterans and measures necessary to cut the number of suicides among the veterans. According to Oleg Druz’, the Head of Psychiatrics Department of the Chief Military Clinical Hospital, '93 percent of Donbas conflict veterans are potentially dangerous to society and need treatment'.
Bloggers, volunteers, veterans and the active servicemen responded in no time: ‘What, the Colonel from the defence ministry calls 93 percent of war veterans ‘a menace to society’? Numerous memes and flash mobs – even hashtag #1of93 – flooded the Internet, mocking the statement. Given the public outcry, defence minister Stepan Poltorak suspended Druz’ from his office and appointed an internal investigation in this case. After that, the doctor’s associates came up with an explanation, saying he just misspoke, while depicting the situation worldwide, but not in Ukraine.
Psychologist and trauma therapist Kateryna Pronoza commented on the statement as follows: ‘U.S. Department Veterans Affairs published results of their own researches over the last years. Having interviewed over 100,000 veterans, the researchers found out that, given the proper psychological support, no more than 17 percent of veterans in the U.S. are diagnosed with PTSD syndrome. In other countries like the U.S. and Canada, the number does not exceed 15 percent. The overall percentage makes maximum 50 percent, based on the foreign surveys, like the one made by the National Center for PTSD. Thus, I found it difficult to say what that doctor meant when mentioning the 93 percent figure. However, I can tell this case led to a powerful public reaction and the reason for discussion, as well as to a nice sense of unity – “I am not alone, even if I’ve got issues’. It means we’re invincible!’
In late 2015, President Poroshenko issued two important documents, which actually gave an impetus in the rehabilitation of war veterans in Ukraine. Civilian and military psychologists join efforts and go to the frontline in order to assist those in the need. Non-profit organizations are being created, foreign specialists are being invited; but there’s still a big lack of psychologists working in this specific area in Ukraine.
Frank Pucelik, well-known psychologist and the consultant for the Peace Corps, survived the Vietnam War. In an interview he gave in 2015, Pucelik said Ukraine urgently needs to invite specialists from the countries involved in wars. ‘There are five specialists in this area, I worked with every one of them; together, we worked on a technology leading a person out of the PTSD syndrome. Ukraine soudl also have such program. So, these people can train 500-800 best psychologists in Ukraine. Then, these experts go to every region and every hospital in the country, training more specialists. In six months, you will get 10,000 well-trained people ready to prevent catastrophe. Russia imagines a weak, demoralized Ukraine, you know. The politicians in Kyiv tell me not to worry about it, and they say they’ve got in under control. Well, it’s a war going on in Ukraine, and here I am, training people. In several weeks, 150 of my students will have graduated. But we need 10,000!,’ he said.
In December 2016, combat veteran Vadym Svyrydenko became the Presidential Envoy for Rehabilitation of Donbas conflict veterans who suffered combat traumas.
Every battalion in the army should have its own certified psychologist; but in fact, there are places where there aren’t any. Add the fact that some of these ‘psychologists’ are morale officers, which is quite different job.
The actual psychological support in the Ukrainian army consists of three major directions: a) psychological diagnostics, b) psychological training, and c) psychological follow-up. In Ukraine, there are huge problems in all three areas.
Military psychologist Serhiy Hrylyuk explained that groups of experts come to every army brigade, in order to provide servicemen with the first psychological aid and sort out those in critical condition; then, such people get more qualified assistance. According to him, currently, the staffing level among psychologists in the military is about 50 percent. ‘Young specialists are reluctant to serve with the military, because they can get much higher salaries in the civilian sector,’ he said.
Many servicemen are reluctant to see a psychologist; they have another option, which is to talk to a chaplain. The military chaplaincy is now being actively restored in Ukraine; currently, 60 churchmen serve with the army, and some more work with the National Guard now. According to the army’s Major General Oleg Hruntkovsky, by the end of the year, all military units will have their own trained chaplains, regardless of their religious denomination.
Since early 2017, over 2,000 Ukrainian servicemen were rehabilitated at medical facilities in Ukraine; 75 of them, together with their families, undertook rehabilitation procedures abroad – specifically, in Macedonia and Georgia.
Why servicemen hesitate to turn for psychological assistance?
I interviewed some of the veterans I happen to know, asking them to name three reasons why they avoid seeing a shrink. Their answers were basically the same, only in different sequence. Here are some of the answers.
- The three reasons are: incompetence of experts, lack of time, certainty that I don’t need this;
- I’d like to see a psychologist.
- I doubt his skills. I’m a military man, and the psychologist is a civilian. I’m my own shrink;
- Psychologists lack qualification and experience; I’m uncomfortable about revealing my weaknesses to a stranger; I’m not sure my secrets will remain confidential. I don’t believe talking to a shrink will help me.
- I doubt his professional training; if he makes a record in my record book, it can affect my future career with the military; if he helps me for money, I’d rather die than pay; I’d better talk to a cat.
- I don’t have time for this; that makes no sense for me; no one cares about my problems.
Psychologist Kateryna Pronoza explains that a lot depends on the expert who motivates his patient for getting help. If he shows his good skills and empathy, there’s a decent chances that the patient will turn for help again. ‘However, there are certain biases still preserved in our society; ‘if you see a shrink, you must be insane’, they say sometimes. Besides, there are issues when a patient suffers from negative experience of communication with a psychologist; he feels dissatisfied and he does not believe that someone can understand his problem. One of typical manifestations of PTSD syndrome is avoidance; an individual avoids getting some help just like he escapes thoughts and memories of the horrific event. This is another reason why veterans refuse working with psychologists,’ Pronoza says.
Defence Ministry → Social Policy Ministry. It’s essential!
As soon as you quit the army or your contract is expired, you go back to civilian life… forget everything you’ve just read. It’s not for you anymore. As soon as the serviceman leaves the army and becomes a civilian, he cannot anymore enjoy the benefits of supplies and assistance from the defense ministry, including the rehabilitation programs. From now on, he or she should seek help from ministry for Social Policy (de jure) and volunteer and civil organizations, veteran unions and their comrades in arms (de facto).
‘It’s important for us now to perform rehabilitation procedures for those who carry on with military service; but, unfortunately, we cannot take care of those who left the army and went on with a different, civilian job’, military psychologist Serhiy Hrylyuk said.
Now, we reached the point where we see the biggest problem in the entire rehabilitation process in Ukraine – there is no such thing as one systematic approach or a single process, approved by the Ukrainian government. Since 2014, the army, the National Guard, the State Security Service and the State Emergency Service have been trying to create the united system, which would serve all law power-wielding agencies in this country. So far, there is no result.
According to Social Policy Ministry, currently, over 296,000 participants of Donbas conflict enjoy the social benefits and guarantees from the government (but there’s much more veterans than this). About 5,000 veterans received the status of people with special needs. There’s a lack of rehabilitation centers; facilities are out of date; besides, not many people appreciate the idea to spend their time off in a recreation centre built and used back in the days of the USSR.
Back in December 2015, the World Health Organization and the International Society of Physical and Rehabilitation Medicine evaluated the level of rehabilitation assistance in Ukraine – specifically, the legal framework and its compatibility with international standards. The results were, and remain, quite deplorable; the legal framework was considered ‘partial’ and ‘not meeting the international requirements’, the rehabilitation facilities were defined as ‘outdated’, and so on.
In summer 2017, Ukraine’s government released the law, which approved the special-purpose program of physical, medical and psychological rehabilitation for participants in Donbas conflict. It is to be running from 2018 till 2022; authors of the bill claimed they had taken into account all remarks made by the experts in their 2015 evaluation. The document states that the special-purpose program will create enough opportunities to assist over 350,000 people. The officials count on the U.S., Croatian and Israeli experience in such areas as opening target-oriented rehab centers for veterans and creating the nation-wide network of maintaining stress resistance centers.
Recently, the presidential administration released the draft law ‘On the rehabilitation system in Ukraine’; it focuses on creating of special rehabilitation centers, which would employ multidisciplinary teams.
As we get back to the special-purpose program of the Government, we’ll see that the Cabinet plans to take measures, allowing psychological assistance for 30,000 veterans in 2018 alone. In the period from 2019 till 2022, the government plans to help another 67,000 veterans annually. Speaking about medical and physical rehabilitation, the Cabinet offers to gradually cover the needs of up to 98 percent of the combat veterans who suffered injuries due to their part in the armed conflict. It is also scheduled that In 2021-2022, ‘100 percent of individuals who enjoy the right or want to undergo re-adaptation procedures’ will be able to do so.
Resume and lyricism
It’s a lot of time before 2022 comes, and there are many more veterans to come as well. There are many stories of these veterans – bad ones and good ones alike. They start their own businesses, their own organizations, helping other veterans.
The most serious problem in this regard, which the government has so far failed to solve since 2014, is total absence of order and cooperation among state authorities and the ‘fragmented’ legal framework concerning the rehabilitation of combat veterans. There are certain factors, which complicate things even more: few rehab centers and outdated equipment as a part of the Soviet Union’s heritage; lack of experts and trust for psychologists among common Ukrainians; absence of civility and under-education of those working with the military and veterans.
Once, a reporter asked a serviceman fighting on a frontline: ‘Will your son recognize you?’. He dared to ask him that question on the frontline, as the man served in a hot spot! What I’m saying it is not about one particular ministry or any particular official. The mission of the entire society is to learn how to live in different reality – during and after the war. We’re not the first ones, to face it, and, sadly, we’re not going to be the last, either. And I can’t help but remember the words of Andriy Kozynchuk, the veteran and military psychologist, who urges to use the word ‘adaptation’ instead of ‘rehabilitation’. He insists that veterans are common people who just had a specific experience. So we should not put labels on them or demand any sort of heroism, or whatever we usually imagine when it comes to veterans.