Ukraine refugee psychological wellbeing pack: guidance for services

Trauma informed framework

Trauma that can cause distress, or more complex reactions, refers to a wide range of traumatic events or series of events that are experienced as being emotionally or physically harmful or life-threatening. Whether an event is traumatic depends not only on individual experience of the event, but also how it negatively impacts on emotional, social, spiritual and physical wellbeing. We are all affected by traumatic events in different ways.

Psychological trauma can be understood in terms of the 3 E's:

• the Event;
• how it is Experienced; and
• its Effect.

Using a 'Trauma Informed' approach to care can be very helpful. This means being able to recognise when someone may be affected by trauma, and adjusting how we take this into account. This way of responding supports recovery, does no harm, and recognises and supports people's natural resilience. To learn more about using a Trauma Informed approach, read the National Trauma Training Programme.

Being 'Trauma Informed' is underpinned by the 5 R's, which are:

• realising the experience of trauma is common after life threatening events;
• recognising the different ways that trauma can affect people;
• responding by taking account of the ways that people can be affected by trauma to support their recovery;
• allowing for opportunities to resist re-traumatisation and offer a greater sense of choice and control, empowerment, collaboration and safety; and
• recognising the central importance of Relationship and social connection.

If you are interested in learning more about Psychological First Aid, sign up to TURAS. Anyone can sign up using an email address.

There are some experiences that are common in the first few days after the traumatic event. It is normal for people to experience some distress after exposure to a crisis and conflict. This may include difficulties sleeping, distressing thoughts and memories popping to mind, nightmares, irritability, feelings of helplessness, reliving aspects of what has happened, and thinking that you should have done more to help.

Bereavement and separation from loved ones will also be something that many adults and children will be processing. They may have had little opportunity to grieve and participate in family mourning rituals.

Social support from family, friends and people that are known and trusted is important. However, although talking about what happened can be helpful, no-one should be forced to talk about their experiences. For some, it is important to have quiet time to think things through but for others the opportunity to organise what has happened into a coherent story reduces feelings of helplessness.

Trying to get back to the routine things in life can be helpful, for example having times for getting up, going to bed and eating can give a sense of normality to life. Generally, it is helpful to allow people to make their own decisions about as many things as possible.

Spiritual beliefs can be strengthened and tested by disasters. For some people faith groups can be a source of support.

For parents and child carers providing open, honest and direct information to children about what is known and explanations of their own and other adult reactions they may have seen can be helpful in the following weeks and months.

When supporting people arriving from Ukraine, the role of community support is of paramount importance. Appropriate support from the extended family and community strengthens these families and reduces the negative effects. To learn more about this read the British Psychological Society's Guidelines for working with refugees and asylum seekers .

The role of spirituality and religious affiliation is also of great importance for some especially during periods of dislocation and relocation. Due to the differing nature of experiences of each Ukrainian family, it is also helpful to consider the complexity and uniqueness of these families' experiences, so that appropriate supports are aimed at not only minimising the destructive effects of adversity on the family, but also reinforcing the family's own positive potential to address their own needs. This includes recognising that different family members may have radically different experiences of the ordeal and different journeys to the UK. This lack of shared experience is something that could cause misunderstanding if not recognised.

Many people find that their initial difficulties settle down, and they are able to return to a more normal life within a few weeks. The World Health Organisation have developed helpful resources for individuals affected by stress and adversity, including those fleeing war. These provide information and evidence based practical skills to help with coping. You can read these in English, Ukrainian and Russian.

However, for some people, the problems persist or get more intense. For example, sometimes there is a delay in the response to the trauma. Additionally, people can begin to experience other difficulties such as avoiding people or places or developing panic attacks or anxiety when faced with reminders of what happened (high buildings, fire sirens, etc.). It is important to check regularly to see how people are coping to see if more help is required.

Some people can have more complex reactions to trauma, however care should be taken to monitor for severe psychological disorder, whether pre-existing or caused by the current crisis. Some examples of severe reactions are feeling suicidal, not eating or drinking, or having ongoing flashbacks. Those with prolonged and more complex difficulties, especially where there are elements of risk such as feeling suicidal, should be supported by clinical services where appropriate.

A list of support services is provided in Appendix 1. A guidance pack has also been provided for host families (see Appendix 2) and also for those arriving from Ukraine (see Appendix 3). It is important that these guides get to those that need them so that they can understand psychological and emotional reactions and what can help. Resources can also be found in Appendix 4.