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

Trauma informed response

Many displaced people who arrive in Scotland have experienced significant trauma. Children, young people, and their families may have no access to their usual informal and formal support networks, suffering from significant loss (both from bereavement, and the loss of everything they have known and relied upon).

Stress within families is likely to increase due to a reduction in relational supports, the challenges of dealing with trauma, separation, accommodation instability, unfamiliar cultures, and financial pressures. Given the 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 which considers the impact of trauma exposure on an individual’s biological, psychological, and social development. Delivering services in a trauma-informed way requires an 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  trauma-informed approaches. Organisations are encouraged to make use of the resources provided by the National Trauma Transformation Programme. For more information on trauma-informed practice, access the the Roadmap for Creating Trauma-Informed and Responsive Change, which was supported by the National Trauma Transformation Programme.

Psychological Wellbeing Packs

Resources, including translations into Ukrainian and Russian, 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 and faces significant challenges. These include a large institutionalized psychiatric system associated with human rights violations, public stigma, and low public awareness of mental health concerns. Within this context, community-based social services for people with mental illness have been limited or absent [WHO Special Initiative Country Report 2020].

It has been reported that Ukraine has a higher estimated suicide rate than the Eastern Europe regional and global averages, with rates being particularly high among men. Men also have a higher prevalence of problematic alcohol use compared to 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, to inform appropriate responses.

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.

It is recommended that any existing Ukrainian social connections are respected and are given due consideration within the family accommodation matching process. It is also recommended that Ukrainian refugees are not hosted in isolated areas on their own without the support of other Ukrainian families in the same local community.

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.