People arriving from Ukraine - risk and need: public protection guidance

Trauma informed response

Whilst there remains uncertainty about how many families we will be required to support and what the care arrangements will be, it can be certain that many will have experienced significant trauma. Children, young people and their families may have no access to their usual informal and formal supports, suffering from significant loss (due to both bereavement and the loss of everything they have known and relied upon).

Stress in families is likely to increase with less relational supports, alongside the challenges of dealing with trauma, loss, separation, homelessness, new cultures and financial pressures to name a few. Due to trauma experienced by both children and adults, identifying needs at the earliest opportunity will be vital to reduce risk of harm.

Trauma-informed practice is an approach to care provision that considers the impact of trauma exposure on an individual’s biological, psychological and social development.  Delivering services in a trauma-informed way means understanding that individuals may have a history of traumatic experiences. These experiences may impact on their ability to feel safe and develop trusting relationships with services and healthcare professionals.

Trauma-informed practice is not intended to treat trauma-related issues. It seeks to reduce the barriers to service access for individuals affected by trauma. While more evidence is needed to gain an in-depth understanding of the effects of trauma-informed practice for migrant populations, there is evidence that services provided to vulnerable migrants without a trauma-informed approach can result in harm.

Key principles of a trauma informed approach are:

• safety
• trustworthiness
• choice
• collaboration
• empowerment

Training and support

While organisations are responding at pace there is a need to ensure staff and volunteers are suitability supported and trained in relation to Trauma Informed approaches. Organisations may wish to make use of the resources provided by the National Trauma Training Programme. For more information on trauma-informed practice, access the trauma-informed practice toolkit produced by Public Health Scotland.

Psychological Wellbeing Packs have been developed for Ukrainian arrivals, Host Families and Services.

Ukraine's mental health care system

Ukraine’s mental health care system was inherited from the Soviet era. Challenges include a large institutionalized psychiatric system associated with human rights violations, alongside public stigma, and low awareness of mental health. Social services for people with mental illness are limited or absent in the community [WHO Special Initiative Country Report 2020].

It has been reported, Ukraine has a higher estimated suicide rate than the Eastern Europe regional and global averages. The rate of suicide is particularly high among men. Men also have a higher estimated prevalence of problematic alcohol use than women. Although the majority of people arriving from Ukraine to the UK have been women, children and older people, it is important to understand the mental health indicators and level of mental health care and support available in Ukraine.

Culture, spirituality and religion

Consideration should be given to the impact of culture, spirituality, and religion. Health beliefs and values vary between and within cultures and religions. This can impact on health, behaviour and attitudes towards health and other professional services, including social work and social care, and should be taken into consideration when providing person-centred care.

The UK Government has also provided advice and guidance on the health needs of migrant patients for healthcare providers: Culture, spirituality and religion: migrant health guide - GOV.UK (www.gov.uk)