Psychotherapy and psychiatry in wartime Ukraine

Tuesday 5 May 2026

The war in Ukraine has been fought not only across trenches, minefields and shattered cities, but within the minds of those who endure it. The visible destruction of buildings and infrastructure is matched by a quieter, less measurable devastation — the erosion of psychological resilience amongst soldiers at the front, civilians under bombardment and a growing population of veterans returning to uncertain futures. The need for psychotherapy and psychiatric care has expanded dramatically since the full-scale invasion of 2022. Yet the country’s capacity to respond remains constrained by structural deficiencies, economic pressures and a historical legacy that continues to distort public attitudes towards mental illness.

At the front line Ukrainian soldiers operate under conditions that would test even the most robust psyche. Constant exposure to artillery fire, drone surveillance and the ever-present threat of death creates an environment of sustained hypervigilance. Rotations away from the front are often brief, and the transition between combat and civilian settings can be abrupt and disorientating. Symptoms consistent with what is clinically recognised as Post-Traumatic Stress Disorder— intrusive memories, emotional numbing, insomnia and heightened irritability — are widely reported, even if not always formally diagnosed. Yet diagnosis itself is part of the problem. Many soldiers resist seeking help, fearing that acknowledgement of psychological distress may be perceived as weakness or may affect their deployment status.

Amongst civilians, the psychological burden is different but no less severe. Prolonged exposure to air raid sirens, displacement from home regions and the fragmentation of families have produced a pervasive sense of instability. Children grow up in environments shaped by uncertainty and fear, while adults must balance survival with caregiving responsibilities under extreme strain. The cumulative effect is a society in which anxiety and depression are no longer exceptional conditions but increasingly normative responses to daily life.

Ukraine’s healthcare system, already under pressure before the war, has struggled to adapt to this surge in mental health needs. Public psychiatric facilities are limited in number and unevenly distributed, with a concentration in larger urban centres. Many have been damaged or disrupted by the conflict. Those that remain operational are often understaffed and reliant on outdated treatment models. The legacy of Soviet-era psychiatry lingers in institutional cultures that prioritise pharmacological intervention and hospitalisation over modern, community-based therapeutic approaches.

Private provision of psychotherapy has expanded in recent years, particularly in cities such as Kyiv and Lviv. However access is sharply constrained by cost. A single session with a qualified psychotherapist can exceed the monthly disposable income of many Ukrainians, especially internally displaced persons and demobilised soldiers. Insurance coverage for mental health services is limited, and charitable initiatives, while valuable, are insufficient to meet nationwide demand. The result is a two-tier system in which those with financial means may obtain sustained care, while others rely on sporadic support or none at all.

Compounding these structural barriers is a deep-rooted social stigma surrounding psychiatric treatment. This stigma has historical origins in the practices of the Soviet Union, where psychiatric diagnosis was at times weaponised as an instrument of political repression. The most notorious example was the use of psychiatric institutions to detain dissidents under fabricated diagnoses, a practice associated with bodies such as the KGB. Within this system, to be labelled mentally ill was not merely a medical judgement but a form of social and political discreditation.

The psychological residue of that period endures. For many Ukrainians, particularly older generations, psychiatric institutions remain associated with coercion, loss of autonomy and social exclusion. Seeking help is therefore fraught with symbolic risk — an admission that may carry connotations of instability or unreliability. Amongst military personnel, this stigma is reinforced by martial cultures that prize endurance and emotional control. Even when services are available, utilisation remains uneven because the act of seeking help itself is culturally contested.

Veterans represent a particularly vulnerable group. As they transition out of military service, they encounter a civilian environment that may struggle to understand their experiences. Employment opportunities can be limited, social networks disrupted and family relationships strained. Without adequate psychological support, the risk of long-term mental health conditions increases, with potential consequences for social cohesion and economic recovery. The challenge is not only clinical but societal — how to reintegrate individuals whose wartime experiences have reshaped their identities.

Efforts are being made to address these issues. International organisations and Ukrainian civil society groups have begun to introduce training programmes in trauma-informed care, and there is a gradual shift towards recognising mental health as a central component of national resilience. Digital platforms have also emerged, offering remote counselling services that can reach individuals in areas where physical infrastructure is lacking. However these initiatives remain fragmented and dependent on external funding, raising questions about their sustainability.

What is required is a systemic transformation. This would involve expanding public investment in mental health services, integrating psychological care into primary healthcare systems and developing training pipelines for therapists and psychiatrists. Equally important is a cultural shift — a redefinition of mental health care not as a marker of weakness but as a necessary response to extraordinary circumstances. Public education campaigns, led by trusted figures including military veterans themselves, may play a crucial role in reshaping perceptions.

The war has exposed the extent to which psychological resilience underpins national endurance. Ukraine’s ability to sustain her defence effort and to rebuild in its aftermath will depend not only on material resources but on the mental well-being of her people. Addressing the silent wounds of war is therefore not a secondary concern, but a central strategic imperative.