Who Heals Ukrainian Refugees’ Mental Health Wounds?

They didn’t know what to do for the woman who couldn’t stop shaking.

The aid workers wanted to help, but couldn’t agree on what approach to take: just let the shaking go? Maybe the woman was expressing emotion safely? Or should they intervene to ease her visible anxiety?

That was the dilemma described by a volunteer from an aid organization who approached Tona McGuire, PhD, and Kira Mauseth, PhD, instructors holding a training in Lublin, Poland about mental health support for Ukrainian refugees.

In this particular case, the two clinical psychologists from Washington state suggested teaching a regulated breathing technique, which can activate the parasympathetic nervous system, to calm the woman.

Since arriving in Lublin, these are the kinds of serious psychological responses they’ve addressed. McGuire, a clinical associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, and Mauseth, a senior instructor of psychology at Seattle University, are training volunteers in one of the most important tools during a crisis: mental health support.

“To have a way of approaching this wide scale, enormous disaster with a little bit of walls around it, a direction to go — that’s been amazing,” said McGuire.

Both McGuire and Mauseth arrived where they are because of a colleague’s contact connected with Caritas, a Catholic aid organization. Through Caritas and Robert Porzak, PhD, of the University of Economics and Innovation in Lublin, they were able to work at Caritas’ remote locations and at the university itself — not to provide therapy, but to actually train others in the basics of mental health support in a disaster.

“Disaster behavioral health is very, very different than traditional clinical psychology,” said Mauseth. In a large-scale disaster, all professional resources are overwhelmed, or not available at all. That means fewer doctors and psychologists, so “it really becomes important to provide accurate and evidence-based information and put it in the hands of the people who are within the affected area,” she said.

McGuire and Mauseth have extensive experience responding to disasters, but they didn’t know what to expect coming to Lublin, a city about 54 miles west of the Ukrainian border. In the past 5 weeks, over 4 million Ukrainians have fled their homes. Many leaving Ukraine have flooded into Poland, and they’ve been adopted into communities on Poland’s eastern border.

In the past few days, the two have spoken to Ukrainian mothers and children staying at Caritas’ remote locations, trained the organization’s volunteers and aid staff, and spoke at the university itself. Their audiences have included a group of mostly Ukrainian psychology students at the university who had been studying abroad when the Russian attacks began, and educators curious to learn about integrating new Ukrainian refugees into schools.

Their emphasis is on simple, concrete approaches proven to help in the emotional aftermath of disaster: active listening, deep breathing techniques, brief cognitive behavioral techniques — identifying catastrophic thinking, for example — and occasionally techniques like behavioral activation and mindfulness. When faced with so much, it’s important to remember what is and isn’t within one’s power to fix, McGuire and Mauseth said. For volunteers who aren’t clinically trained, there are still ways to help.

“You can’t problem-solve your way out of a large-scale disaster,” said Mauseth. But learning some of these tools, “creates a sense of mastery for anyone. They come into this disaster sort of panicked and terrorized in some ways, and they learn that there are things that they can do,” she added.

But there’s still trauma, both for refugees and the families that take them in — especially on the heels of a pandemic. It can manifest in many ways: a child “acting out” in school, someone that seems to just “shut down.” Grief, anger, anxiety, irritability, and even confusion are just a few of the effects.

“Everyone’s limbic system is a little bit more activated than it normally would be — we have a hard time regulating our responses, we’re more impulsive,” said Mauseth. The prefrontal cortex may not be working as well, she added — making it difficult to make rational decisions or to keep track of detail. Those who they’ve trained, who might be dealing with their own stress and trauma, are often relieved.

“Usually, when people hear that piece, they think, ‘Oh, I thought it was just me. I didn’t realize that this is the universal response in these types of events,'” she said.

Those that they train are also helping young children — like in the case of one Ukrainian mother who was concerned about her son. Children, they said, react to trauma much the same as adults, but the circumstances they react to may be very different.

In this case, the son had been placed into a Polish school, but he didn’t speak Polish. He was sitting through school, quietly following directions, but understanding little. He would explode when he came home, acting aggressively and ignoring directions.

“It’s very emotional, it’s very challenging. They’re trying to do the best they can to support their kids,” said Mauseth.

Mauseth and McGuire suggested to the mother that what might help her son was making a way for him to feel the power he was missing at home — even with small decisions, like what to eat for dinner or what to wear. “It’s a small thing. So it feels manageable, it feels like you’re not adding a whole bunch to someone’s plate,” Mauseth said.

On top of caring for their children, displaced parents may not have information on the whereabouts of their loved ones and might endlessly scroll through social media and news.

“Often, in an attempt to alleviate anxiety, people just keep watching to try and get more information,” said Mauseth. “And there really does need to be structure, time limits, and boundaries for media and social media engagement for adults as well as kids.” Mauseth and McGuire tell people to find a way to focus on the here and now. At times, what’s going to happen tomorrow or next week is unclear, Mauseth said, “But what do you need to do today? What’s something small that you can focus on?”

Sitting in a kindergarten classroom on a Zoom call, McGuire and Mauseth were both tired from their training. They had given a lecture earlier to 80 people who would deploy these tools in their communities, and were getting ready to leave for the next one. But they were ready.

“We’ve been incredibly busy all week, which is equal parts rewarding and tiring,” said Mauseth. “We do this because we love to do it. It’s tough, but we love it.”