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Lives On The Line: Ukraine Mental-Health Call Center Seeks To Lower The Human Cost Of War


Paul Niland, the founder and director of Lifeline Ukraine in Kyiv. Over the U.S. Thanksgiving holiday, the American of Chamber of Commerce in Ukraine recognized Niland with its annual achievement award for creating the help line. 

KYIV -- On the second floor of an unassuming, white, two-story building in an industrial section of Ukraine’s capital, operators answer calls whose outcome may be a matter of life or death.

One afternoon not long ago, for example, a staffer spoke to a caller who was on the line for almost an hour, weeping as he described the pain of informing loved ones that their son, husband, or father was killed in the war against Russia-backed forces in the eastern region known as the Donbas.

On another day, an operator patiently encouraged a caller who struggled to begin speaking. “Just start when you’re ready,” she said every 10 to 20 seconds. “I’m here to listen.”

For the staffers fielding the calls, the goal is to help people in their “dark moments…and stabilize them,” said Paul Niland, founder and director of Lifeline Ukraine, the country’s first nationwide 24-hour suicide-prevention and mental-health support helpline.

Established in October 2019, the hotline is an effort to address the problems faced by soldiers and other combatants in the war, which has killed more than 13,000 people and clouded the lives of many others, from relatives and friends of the victims to those seeking to readjust after returning from the front.

The war began in April 2014 and still simmers despite repeated cease-fire deals. Many of its veterans were trained how to aim, shoot, and kill, but few have been shown how to handle the potential psychological effects or to deal with the stresses of civilian life after armed conflict.

A Ukrainian soldier looks for dead bodies at the Donetsk airport in October 2015.
A Ukrainian soldier looks for dead bodies at the Donetsk airport in October 2015.

“They go from a military hierarchy taking orders…doing abnormal things to then returning to a setting where people go about their normal daily business,” said Niland, a native of Dublin who has lived in Kyiv since 2003.

He started off drawing foreign investment in the commercial real estate market and in late 2008 purchased What’s On magazine and published the glossy in-flight magazine for Ukraine International Airlines.

Upon returning to civilian life after months on the front line, veterans often have an ultrasensitive sense of “hypervigilance” because they haven’t properly “decompressed,” Niland told RFE/RL during a recent visit to the call center.

'You Have Saved A Life'

A caller’s emotional state is often on a downward, spiraling trajectory affected by “compounding problems,” Niland said. “It’s a frequent situation when somebody returns [from war]. They have family difficulties, relationships might break up, they start drinking more, lose their job…”

The roughly 400,000 veterans of the Donbas war are Lifeline Ukraine’s raison d’etre, and about 20 percent of the 7,000 or so calls to the hotline since it was established in October 2019 have been from that group, Niland said. A slightly larger proportion come from relatives of veterans, some seeking referrals to services such as legal advice or domestic-abuse hotlines.

If the caller is distraught, the aim is pretty much the same regardless of their identity, Niland suggested: “If you can talk them out of their current mindset over a 15-minute period, you have saved a life.”

Experts emphasize that the urge to end one’s life is emotional, he said, so “this ‘golden window’ helps to dismantle that thought path they’re on and let their natural will for survival regain control.”

Paul Niland stands in the stairwell of Lifeline Ukraine. where pictures of Donbas war veterans hang, many of whom work as operators at the suicide-prevention call center.
Paul Niland stands in the stairwell of Lifeline Ukraine. where pictures of Donbas war veterans hang, many of whom work as operators at the suicide-prevention call center.

While the war in eastern Ukraine is in its seventh year, systemic psychological support for veterans is in its infancy, Ulana Suprun, a native of the U.S. state of Michigan who was Ukraine’s acting health minister from July 2016 to August 2019, told RFE/RL.

Suprun, who now heads Arc.UA, a think tank she founded, said she saw a need for psychological support for Ukrainians struggling to cope following violent crackdowns on the pro-Europe, anti-corruption Maidan protests on 2013-14, in which more than 100 people were killed.

Then-President Viktor Yanukovych fled to Russia in the face of the protests and Moscow responded to the departure of the Kremlin-friendly leader by seizing the Crimean Peninsula from Ukraine and helping separatists take parts of the eastern Donetsk and Luhansk regions, contributing heavily to the outbreak of war in the Donbas.

By the time she was appointed acting health minister, the war was more than two years old -- and Suprun noticed what she said was a lack of psychological support for soldiers at all stages, from pre-deployment to service to discharge following long periods of exposure to combat.

“Hardly any preventive psychological training was being done,” she said, in part because it had been “nonexistent” in the Ukrainian military’s inherited “Soviet system, which had no understanding that it’s necessary.”

A cat looks down at a Ukrainian soldier resting in a trench on the front line with Russia-backed separatists near the village of Krasnohorivka in February.
A cat looks down at a Ukrainian soldier resting in a trench on the front line with Russia-backed separatists near the village of Krasnohorivka in February.

Soldiers were being sent to the front with hardly any military training, let alone psychological preparation, she said. Volunteers, meanwhile, had no formal training at all.

Suprun noted that, unlike the United States, where many military families live on bases with support groups and soldiers fight overseas, Ukrainians were “fighting on their own soil” and would “come home on weekend leave without an interim time to ‘decompress’.”

Some would spend six months in active deployment -- far too long, according to Suprun and others -- “and be released from duty with no time for adjustment to civilian life,” she said.

It’s a frequent situation when somebody returns [from war]. They have family difficulties, relationships might break up, they start drinking more, lose their job…”
-- Paul Niland, Lifeline Ukraine

Niland took on the task took of setting up the hotline after attending a meeting that Suprun had called in June 2018 to address the problem.

Both believed it would be better to do this through a nongovernmental organization, as association with the state could create two disincentives for potential callers -- fears of a Soviet-style stigmatization of a mental-health issue and concerns that the authorities would use a hotline to collect their personal information.

'A Great Sense Of Urgency'

The conflict in Ukraine is one of just two wars to break out in Europe in the past decade, but reintegrating veterans into civilian life poses a challenge in all societies.

Since 1980, strides have been made worldwide to provide comprehensive psychological support to mitigate the stress felt in combat, including early detection of more severe symptoms associated with post-traumatic stress disorder (PTSD), said April Naturale, a leading U.S. traumatic stress specialist who helped train Niland’s staff of more than 30 operators.

In 2016, Naturale started working with Ukrainian military psychologists who had “a great sense of urgency” to understand what needed to be done to address issues related to PTSD and suicide among veterans.

Relatives and members of a Ukrainian military medical unit comfort each other while mourning for four comrades killed near Debaltseve in February 2015.
Relatives and members of a Ukrainian military medical unit comfort each other while mourning for four comrades killed near Debaltseve in February 2015.

A 2017 study of 941 combatants by the Ukrainian Health Ministry’s Research Institute of Social and Forensic Psychiatry and Drug Abuse found that 34 percent were diagnosed with PTSD and an additional 38 percent with “adjustment disorder (AD).”

The average training period before deployment to a combat zone was one month, the study said, and more than 95 percent of soldiers “indicated the lack of psychological training and support.”

Nearly 20 percent of those with PTSD or AD expressed having “suicidal ideations,” it said.

I kept forcing myself to get used to strangers standing behind me by taking repeat visits to the grocery store to buy small items like gum."
-- Former Ukrainian Marine Vasyl Bondar

As a rule, the Ukrainian military does not disclose statistics about suicide among in-service and discharged personnel.

In April 2018, Oleksandr Tretyakov, the chairman of the parliamentary committee on veterans, said that more than 1,000 veterans of combat in the Donbas had taken their own lives. The head of the Veteran Affairs Ministry’s department of medical care and social rehabilitation of veterans, former colonel and physician Vsevolod Steblyuk, told RFE/RL that 560 suicides were reported from 2014 to 2018 “on the front and upon returning.”

An additional 72 suicides were recorded among discharged military personnel in he last two years, Steblyuk said earlier in November.

In the early years of the Donbas war, when combat was at its deadliest, “an army of chaplains” -- many of them trained psychologists -- were sent to the front lines to support the troops, said Andriy Zelenskiy, the deputy chief of the department of military chaplaincy of the Ukrainian Greek-Catholic Church.

Starting in 2014, Zelenskiy spent a total of more than three years in the combat zone, including in hot spots such as Pisky near the Donetsk airport and Debaltseve, both the sites of bloody battles in which Ukraine suffered major losses.

“The Ukrainian Army wasn’t prepared tactically, spiritually, and psychologically” for supporting its soldiers, Zelenskiy said. “Chaplains were among the first to provide the psychological component of spiritual support with how to deal with stress,” he said.

A trained psychologist, Zelenskiy said he tries to help soldiers stave off PTSD by encouraging them to be “aware of their senses.” He said that if the problem is not addressed adequately, “there will be serious challenges with respect to the mental health of our veterans.”

Ukrainian soldiers patrol at the front line with Russia-backed separatists in Shyrokyne in November 2018.
Ukrainian soldiers patrol at the front line with Russia-backed separatists in Shyrokyne in November 2018.

Steblyuk, of the Veterans Affairs Ministry, said that deployment to combat areas is now limited to a maximum of three months, down from six and even nine in the past. He said that shorter deployments were often unrealistic earlier, in the “active phase” of the war, because the military did not have enough personnel to throw against separatists who enjoyed strong support from Russian weapons, soldiers, and command personnel.

Former Ukrainian Marine Vasyl Bondar, 45, spent 8 1/2 months on the front line in Shyrokyne, the site of fighting near the key port city of Mariupol, and his position a few hundred meters from the enemy was frequently targeted with shelling and gunfire. Upon discharge in 2017, he was not given a psychological evaluation.

Every country in the world that finds itself in a position when it’s at war has to deal with the aftermath of that, and Ukraine only established the ministry four years into the war.… To me, that’s negligence.”
-- Paul Niland, Lifeline Ukraine

The platoon he was in was stretched along almost 3 kilometers of the front line and his battalion didn’t rotate for a year and a half, Bondar told RFE/RL.

By the time he and others were taken off the front and sent to a base further west, “our psyches had caught up with us.… They were mush. They were ruined,” he said. Some in his unit “started to desert without waiting for demobilization.”

Bondar, who had been called up at the age of 40, said it took him about a year to adapt to civilian life in Kyiv. “I kept forcing myself to get used to strangers standing behind me by taking repeat visits to the grocery store to buy small items like gum,” he said.

He still has occasional “flashbacks,” he said, and at first “if somebody insulted you or something…it would rip your mind off.”

Every unit has a psychologist attached to it now, according to Zelenskiy, and Steblyuk said that soldiers go through a three-day mandatory decompression period upon discharge, with an optional 18-day leave before entering civilian life.

Long Road Ahead

The Veterans Affairs Ministry, established only two years ago, is pushing for legislation to homogenize psychological standards, said Steblyuk.

The military has a long way to go, the Atlantic Council said in a September report titled The Trip From Donbas: Ukraine’s Pressing Need To Defend Its Veterans.

Several “crises” confront veterans due to the lack of care, “including high rates of suicide, under- and unemployment, divorce, and domestic violence,” the report from the U.S.-based think tank said.

It lauded the creation of the Veterans Affairs Ministry but said that “politicians and civil society leaders agree that the country needs a comprehensive strategy for veterans care.”

In Niland’s view, the ministry was set up “far too late.” He said that “every country in the world that finds itself in a position when it’s at war has to deal with the aftermath of that, and Ukraine only established the ministry four years into the war.… To me, that’s negligence.”

Meanwhile, Lifeline Ukraine has evolved since its inception a little over a year ago.

After finding rent-free space from the CEO of a car dealership whose son-in-law had fought in the war, getting mobile-phone providers to list the number toll-free at little expense, and starting off with only four mobile phones, Niland’s hotline has a computerized customer-relations management system and the number is listed on the Veteran Affairs Ministry website.

Over the U.S. Thanksgiving holiday, the American of Chamber of Commerce in Ukraine recognized Niland with its annual achievement award for creating the help line.

Niland said that its operators, some of them Donbas veterans themselves, answer incoming calls -- some of which are from distraught adolescents, domestic-abuse victims, and others who are not back from the war -- within seven seconds on average.

When it comes to veterans and others diagnosed with PTSD, he takes issue with the “D” for disorder.

He recalls what a U.S. Vietnam War veteran who became a psychologist and helped train Lifeline Ukraine staffers once told him: “I don’t have a disorder…. I have a normal reaction after being in abnormal circumstances.”

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