The rise in aggression by Vladimir Putin against Ukraine is likely to have multiple impacts on the country’s mental health and suicidality. And, to save more lives, a stepped-up response from the public authorities and those of good will in Ukrainian business and civil society is now needed.
When we look at the available evidence and expert views about Ukraine and suicide, we see a two-sided picture.
On the one hand, Putin’s hybrid war on Ukraine – and the social and political uncertainty associated with it – is likely to lead to more suicidality among Ukrainians, especially in some cohorts of society.
On the other hand, it is believed that resistance to Putin’s aggression – or a commitment to and belief in Ukraine’s sovereignty and democracy – is likely to be a “protective factor” against suicide among some people.
In terms of the dark side of the picture, crucial among the cohorts impacted by suicide are Ukraine’s very brave soldiers and veterans. Studies have found that the leading cause of death among those who serve or have served in their country’s defence may in fact be suicide. The average age of military personnel dying by suicide is less than 20-years old.
Military-related suicidality – shaped by exposure to violence and death, isolation and difficult living conditions, including difficulty in re-adapting to a non-warring lifestyle post-service, and perhaps out-dated views about mental health – appears to be a key contributor to Ukraine’s overall suicide rate being comparatively very high. In 2019, according to the World Health Organisation, some 21.6 people per 100,000 population died by suicide in Ukraine. That’s compared to: 25.1 for Russia; around 11.0 for Poland and the rest of the EU, and 9.2 globally.
When we further look at the available statistics – and let’s never forget we are talking about people’s lives here – on a geographical and economic basis, a worrisome pattern emerges in Ukraine. Suicide is some four to five times higher in the oblasts bordering the occupied war zone than it is in Kyiv and Lviv. This may be a combined effect of the psychological cost of war, a larger proportion of locals serving in Ukraine’s defence, and lower access to suitable services.
It does not appear to be a function of poverty; internationally, higher income societies have higher suicidality than lower income societies. Rather, in addition to war factors, it could be that the post-Soviet (or “Sovok”) mentality – and all the stigmas and myths it put on mental health and the distrust it created in services – is embedded in those areas and contributes to poor outcomes, as argued by researcher Alexander Mokhovivkov.
But there is the other, brighter and more hopeful side of the picture too. Regardless of the war, and particularly the spike in suicides when Putin started his deadly incursions in 2014, suicide rates have actually fallen in Ukraine over the course of the period of independence.
The rallying social themes of independence, sovereignty and democracy – or simply put, belief in a better or “normal” life – can be life-supporting.
Dr Serhiy Maksymenko, Director of the Institute of Psychology and Chairman of the Society of Psychologists of Ukraine, has said: “Volunteers, that is, politically and ideologically convinced people, suffer from depression, disorientation and desocialization much less.”
Additionally, while it’s not a smooth process, Ukrainian society is undergoing a transformation in its views and behaviours about mental health and suicide prevention. I was honoured to be consulted about Ukraine’s new mental health policy – which calls for non-judgement, putting the client’s needs first, and holistic treatment – when it was developed by former Acting Minister for Health Dr. Ulana Suprun.
More importantly, as they continually and resiliently do, Ukrainians at the grass-roots levels are developing better approaches. The most important of those has been the recent birth of Ukraine’s first national 24/7 hotline for crisis support for people suffering from suicidality – Lifeline Ukraine.
Paul Niland, Kyiv businessman, journalist, and now key founder and CEO of Lifeline Ukraine, recently said:
We began operations in October 2019. Since then we have received more than 17,500 calls or messages from people from across Ukraine seeking our support.
“No two calls are the same. The only standard phrase used on the hotline is ‘Lifeline Ukraine, I’m listening to you’ as a call begins.“
According to Dr Maksymenko, people on the verge of suicide are often deprived of the belief that someone can help them solve their problems, or that there is a real solution. That’s exactly the gap that Lifeline Ukraine is filling, especially through its outreach to and strong acceptance by veterans. Niland believes the service has potentially contributed to saving some 2,000 lives to date.
Lifeline Ukraine shows that, while Ukraine’s military personnel and veterans may not be able to always avoid the enemy’s snipers and artillery, or the ravages of post-traumatic stress, or while the community also cannot avoid war’s cost, the tragedy of suicide in Ukraine can in fact be abated.
Saving lives takes recognition that there is nothing wrong per se with those suffering from suicidality – rather, they have likely been overwhelmed by some series of factors. It takes recognition that connection, compassion and active listening are critical to recovery. It takes the provision of and access to dedicated services, and in particular a national 24/7 crisis line staffed by highly empathetic professionals trained to the best international standards in this area.
Lifeline Ukraine needs some UAH 5 million to continue to save lives over the next two critical years. To date, while the Ministry for Veterans Affairs has been morally supportive, the Ukrainian Government has provided no funding. Public funding, which is the norm for similar crisis lines around the world, would be a welcome change, a huge investment in life, and even part of Ukraine’s defence against Putin’s hybrid war. While we wait, and there is little time to do so, the generous support of Ukraine’s business community and diaspora is really needed to save Ukrainian lives from suicide. To this end, convenient ways so that anyone can support Lifeline Ukraine on a one-off (via PayPal) or on a monthly basis (via Patreon) will soon be announced via social media.
Kyiv Post asked the CEO of Lifeline Ukraine, Paul Niland, for a comment to follow this piece.
In addition to the PayPal and Patreon donation options, Lifeline Ukraine has embarked on a fundraising drive, asking members of Ukraine's business community to support this service that is, in turn, supporting people from across Ukraine in times of need.
“From day one I knew that we would evolve from our initial focus to help Ukraine's military and veteran community, and that Lifeline Ukraine would be the single national suicide prevention service for anyone in need.“
Niland said. "When we crossed the Rubicon, I don't know. It didn't register with me. We work on a principle of one, one person, one call, the next one. That is the focus when we answer a call, whoever it may be from."
"The veteran community knows that we are there for them. We remain, as we are staffed by veterans alongside mental health professionals (many colleagues, in fact, have both of these attributes), best positioned to support this community. But as an example of veterans providing ongoing service to their country, Lifeline Ukraine is a special success story. Here we are, veterans answering the call of duty day and night, to help anyone in need." Niland went on to say. "As for me, it's really a privilege to do this work. My dedication to Ukraine, and background of charitable work here, they're on the record, but nothing in my professional life comes close to this. Our success is rooted in the dedication of the team to our mission. One call at a time."
If you know someone who may be in need of emotional support, please encourage them to call 7333 from any mobile operator in Ukraine. The call is free and there's someone to listen and help 24/7.
