
Mental health workers in Ukraine have been providing urgent psychological care since the beginning of Russia’s full-scale invasion. Their work could limit the lasting mental health repercussions of the war.
When Russia’s full-scale invasion of Ukraine broke out on 24 February 2022, Iryna Frankova, a medical doctor and clinical psychologist working at Bogomolets National Medical University in Kyiv, knew that she had to act fast. There was the need to check her loved ones were safe, and that she wasn’t in imminent danger. There was the question of whether to leave and if so, where to go.
But there was another urgent question too. Ukraine would soon be facing a crisis in mental health and, if previous conflicts were anything to go by, this was likely to be sidelined at precisely the moment when the most impactful help could be given – right at the start.
After a trauma, there is a window known as the “golden hours”, a critical period in which action to support people’s mental health can limit long-term damage, such as post-traumatic stress disorder (PTSD), anxiety and depression.
“It’s the idea is that we really need to reach people in a very early stage after the exposure to trauma, in order to be able to prevent mental health consequences,” says Frankova, speaking to BBC Future one year after the war began.
On one level, this might seem common sense: a particularly good time to offer someone comfort is when they are reeling from shock. But the evidence suggests that such small acts of support – sometimes as simple as reminding someone that they are not alone – reduces the risk of developing conditions that linger for years.
“There are some things that we can do in the golden hours which may harm and raise the risk of development of PTSD, and at the same time there are some things that we can do that may decrease those risks,” says Frankova.
The “golden hours” refer to the first few hours up to around three days after a traumatic experience, a crucial phase for memory consolidation. “It is a window of opportunity when short-term memory may not become long-term memory,” says Frankova. “Our task was to tell people exactly what would be harmful, and what would be helpful.”
The question is, when an entire country is under siege, infrastructure is being targeted, and movement in the open is dangerous or impossible, how do you provide that essential information before the golden hours are up?

For frontline mental health workers, there are two crucial phases of early support. The first is the most directly comparable to conventional, physical first aid, says Agatha Abboud, mental health and psychosocial support manager for the International Committee of the Red Cross in Kyiv.
“It’s the triage of people who need to speak to someone just to calm down, just to be grounded, to be reminded of the surroundings, of who is around them,” says Abboud. “Because this is the period where people feel most agitated or most anxious.”
After this immediate psychological first aid comes the “early intervention” phase, Abboud says. “It’s similar with any medical condition: the earlier you treat the condition the less likely that it will become complex in the future.
“If you neglect it, definitely, it could develop into something more serious. And here in Ukraine we are not speaking about one person going through a situation. It’s a whole population that is going through the same situation.”
It is a particular challenge to reach those who need early interventions the most – isolated communities on the conflict’s front lines. Here, many elderly people remain, and families, sometimes without children, and some whose jobs mean they could not or chose not to move. Because of their proximity to violence, even family members are often unable to visit. “We have trained volunteers, trained psychologists who go and visit communities, especially on the front line,” says Abboud. “So this is where we go, and we visit them, and simply check on them.”
Reinforcing a sense of community is one of the most effective strategies. “We do group sessions, where they can express their thoughts and feelings,” says Abboud. “They learn from each other, and they build a bit of connection.”
But reaching these isolated communities in person can be a big logistical challenge, especially quickly enough to provide support within the “golden hours” window.

One quick and accessible answer, Frankova says, is using digital tools.
When the war broke out, Frankova had already been working for several years with Artem Lezin, an IT specialist and app developer who had worked with a number of tech start-ups, and who had also served as Ukraine’s deputy minister for culture and information policy, and Sophiia Lahutina, a medical doctor and psychotherapist in Kyiv. All three faced an extremely challenging personal situation with the war outbreak: Lezin has two young children, Lahutina elderly grandparents and her mother to care for. Nevertheless, they chose that moment to roll out their latest project.
Together, they had been developing an evidence-based app called Friend. First Aid, to provide quick, accessible mental health support after trauma via a chatbot on the messaging service Telegram.
Lezin, the app’s founder, had been working on the chatbot since the onset of the Covid-19 pandemic. When the shells began falling on Kyiv and across the country, the team decided it was time to launch. The next day, on 25 February, the team activated the chatbot on Telegram within Ukraine.
When people accessed the chatbot, usually via word of mouth, social media or traditional media, they would first be asked questions to make sure they weren’t at immediate risk of injury or physical violence. Then users would be guided through evidence-based information and advice for the best things to do and avoid.
Mass trauma in conflict and terror
Many of the same principles are applicable in the mass trauma that comes in a conflict situation, Frankova says.
In 2022, an international group of mental health experts released the First Aid to Terror app, which distils this research on what people should and shouldn’t do in the immediate aftermath of a traumatic event, breaking down guidance on what to do in the first one to six hours, six to 12 hours, 12 to 24 hours, one day to one week, and one to four weeks.
When opening the app, after selecting your language (currently Ukrainian, Russian and English) and adding some basic information, the chatbot asks your current stress level, from “not at all” to “extremely”, then asks whether you are currently safe, with access to food and water.
Next come questions around loneliness and isolation, which is very common among people who have gone through a traumatic experience, and if unaddressed can raise the risk of developing a long-term mental health condition, such as PTSD.
Going through the app’s questions, it informs users: “You know, communication with loved ones is an important ‘weapon’ in the fight against the consequences of stress. During communication, you will be able to feel the closeness of these people and psychological support. Remember this. These people love you and want you to feel good.”
These evidence-based words of advice and encouragement were soon flashing up on people’s phones across Ukraine in the spring of 2022. Within weeks of its launch, the chatbot had 40,000 users.
“I think that our product became so popular because we launched it on the second day after the war started, while there was still a two-week period of vacuum when nobody was saying anything about mental health,” says Frankova.
“It’s obvious why. People are shocked. People are taking care of their physical safety, but at the same time they need some guidance on how to deal with a panic attack while you’re sitting in a shelter during missile attacks.”

Developing the script was an iterative process, says Lahutina. “We pay a lot of attention to feedback for users. We have received over 2,000 meaningful pieces of feedback, and we are processing this.”
Much of the response from users was positive, with 84% of their users saying they loved or really loved the chatbot, Lezin says. Though the feedback also highlighted areas the app could improve.
“In the initial version, we got some feedback that it was like chatting with Wikipedia,” he says. “So we decided to change it a little bit, and to make it more user-friendly. We want to add more content for more interventions. And to make content shorter, easier to understand.”
The second version of the chatbot is now in operation, and the team are working on a third. “We are working on it all the time,” says Lezin. “It’s maybe an infinite process for us.”
A year into the war, the app has now reached 81,000 users, and the service is now expanding beyond the automated chatbot service to offer a live chat with mental health professionals. They’ve had close to 5,000 requests already, Lezin says. Now, the chatbot has become a part of a European Union-funded project on psychosocial support for Ukrainians in bordering countries. They’re soon to launch the service on WhatsApp, as well as its own standalone app. “This is a good beginning,” says Frankova.
An automated chatbot is perhaps the most accessible intervention for immediate, widespread access, but for some, in-person connection is particularly important.

This was the area of expertise of Nathalie Robelot-Timtchenko, a mental health professional specialising in expressive arts therapy based in Cambridge, Massachusetts, who lived in Kyiv from 2014 to 2021.
“When [the invasion] happened, it was around 1am, I believe, on the 24 February for us [in Cambridge], and it was shocking,” says Robelot-Timtchenko. “It was really hard to know how to help, and what would actually be impactful.”
Robelot-Timtchenko sent out a call-to-action on 25 February 2022, seeking mental health professionals who would be willing donate their time providing support to people in Ukraine. She called the initiative First Aid of the Soul from her base in Cambridge. “Within a week we had around 450 sign up,” she says, with volunteers based all over world, many in the US and Canada, but also across Europe, to Japan and Australia.
Like the “Friend. First Aid” team, a lack of resources on psychological first aid was one of the first things that struck Robelot-Timtchenko.
“That was one of our first projects, trying to make our self-help kits,” says Robelot-Timtchenko. “We had quite a large team, maybe 20 professionals working on just gathering different material.” For example, the team collated information on how to soothe your children when you’re in a stressful environment, such as a bomb shelter, with information about maintaining comforting physical touch and using simple words and phrases to discuss the situation and your feelings.
By the first weeks of March 2022, First Aid of the Soul began providing support groups in a school Robelot-Timtchenko had worked in. “By April we were offering training open to different mental health professionals in Ukraine.” One of their first focuses was psychological first aid, followed by therapies involving movement and relaxation such as yoga, before moving into other areas.
Providing in-person support has been a crucial part of supporting Ukraine’s resilience. “Just recently we were in Ukraine in January, I was able to do a workshop with children that have been displaced internally displaced in Ukraine,” says Robelot-Timtchenko. “These kids have been through hell, to say the least, but they still have smiles on their faces. They are still talking about their superhero fans, and the workshop was about finding inner strength and building resilience.
“That is what we’re trying to do, just have a little bit of hope,” she says.
In the video above from BBC Newsround, 13-year-old Viola recalls how she fled her village near Kyiv in the days after Russian soliders arrived.
Ilya Timtchenko, a Ukrainian-American and board member for First Aid of the Soul, says that this work felt personal.
“For me this is an opportunity to help to serve on two fronts,” he says. “One is helping Ukrainians with a very important topic, and something that we don’t see enough effort put into. And the second, is being able to be part of the ‘victory story’, so to speak, in terms of Ukraine being able to fight back. Russia’s war is not just a war of physical aggression, but also on Ukraine’s mental health.”
First Aid of the Soul now runs around 45 monthly workshops, both virtually and in person, and has reached about 6,000 people so far across its support groups, trainings and workshops – all on a budget of just a few thousand dollars, says Hannah Scott, First Aid of the Soul’s director of operations. “98% of people who attend our workshop say they want to come again,” she says. “That’s a pretty good number to work with.”
Scott believes the hybrid online and in-person nature of the organisation has played a key part in this. “It means that we can tap into an international network of some of the best professionals around the world,” she says. “And if people don’t have a good internet connection, we can meet them wherever they are.”

As the war passes its first year, mental health challenges in Ukraine continue to evolve. It is helping to show just how vital it is to provide not just physical first aid to those caught up in traumatic situations, but to attend to their psychological state too.
“Now, as I speak with you, there are sirens outside,” says the ICRC’s Abboud. “The minute there is a siren, people are preoccupied with finding [out] if their child in kindergarten is ok. If their husband, who is on the front line is ok.”
In such situations, remembering to attend to your own long-term mental health is a constant challenge. Factoring in support for the ICRC’s own staff is an integral part of their mission, says Abboud, often exchanging services with other professional organisations they work with in the area.
“The reality is, no one is ready to actually process what they’re going through,” says Robelot-Timtchenko. “The war is still happening. And so every day their safety is threatened.
“I think the processing will happen much later, when the war is actually – ” Robelot-Timtchenko stops and smiles. “When Ukraine wins.”