Ukraine refugee psychological wellbeing pack: guidance for services

Appendix 2: Advice pack given to host families

Psychological wellbeing advice pack for host families: introduction

Thank you for the offer to host a Ukrainian family/person in your home. The individual/s you are welcoming into your home will have their own unique emotional needs. They are arriving to a country and culture that they may be very unfamiliar with, and have life experiences or backgrounds that are very different to yours.

Due to the differing nature of experiences of each Ukrainian family, it is helpful to consider the complexity and uniqueness of these families' experiences, so that appropriate supports help reduce the effects of adversity on the family, and also reinforce the family's own positive potential to address their own needs.

Recognising that different family members may have radically different experiences of the ordeal and different journeys to Scotland is also important. This lack of shared experience is something that could cause misunderstanding.

This guide is to help you know how to manage any emotional responses of the Ukrainian people staying with you, how to look after them, and also how to look after yourself and your own family.

General principles

To support the needs of Ukrainian families arriving in Scotland, evidence tells us that people are more likely to be able to psychologically cope with and recover from traumatic life events if they:

• feel safe and are in calm supportive environments;
• have access to practical social, physical, and emotional support; and
• feel able to help themselves, as individuals and communities.

The World Health Organisation (2011) provides three principles to hold in mind when offering support to those fleeing conflict. These principles are:

• ensure safety;
• promote dignity; and
• uphold rights.

You can ensure safety by:

• avoiding putting people at further risk of harm as a result of your actions; and
• making sure, to the best of your ability, that the adults and children you help are safe and protecting them from physical or psychological harm.

You can promote dignity by:

• treating people with respect and according to their cultural and social norms.

You can uphold rights by:

• making sure people can access help fairly and without discrimination;
• helping people to claim their rights and access available support; and
• acting only in the best interest of any person you encounter.

As a host you are providing psychological safety by helping people get their basic needs met such as access to safety, food, and shelter and providing them with basic social support and information. However, you may find that those living with you are distressed, upset and not coping well.

Different kinds of crises affect people in different ways, and there are a wide range of emotional responses that people can have. Most often people respond with resilience, and in ways that are designed to protect themselves and loved ones. Some people may also want to manage difficult things on their own or find help from others that they already know or trust. Some people may show distress while others may show anger or withdraw. Each individual response will be different.

Every person has strengths and abilities to help them cope with life challenges. However, some people are particularly vulnerable in a crisis situation and may need extra help. This includes people who may be at risk or need additional support because of their age (children, elderly) because they have a mental or physical disability, or because they have been the victims of violence or discrimination.

Hosting Ukrainian people and families: what to expect when they first arrive

When they first arrive, the people you are hosting will need to feel that they are safe, to know what to expect and for things to feel predictable. They will want help to know how to access the things they immediately need for themselves and their family. They will need a calm environment and to be shown understanding.

To ensure this, some important things to think about are:

• providing secure safe and comfortable accommodation;
• being welcoming, calm, patient and kind;
• respecting their privacy and avoiding trying to make them accept your help;
• learning how to properly pronounce their names, if you can;
• trying to reduce stress by being thoughtful about people's practical needs;
• offering help, where this is wanted and accepting that not all people will want help;
• providing a private and quiet space;
• acknowledging that distress in this situation is a normal reaction – in adults, distress might come across as anger, panic, sadness, crying and withdrawal;
• understanding and accepting that those you are hosting may not feel able at this time to feel thankful or express gratitude;
• helping people to orientate to the local area, to churches, mosques, and synagogues, libraries, sports centres and to green spaces;
• letting people set their own routines; and
• providing spaces where the people you are hosting can meet together to talk over and solve the problems they are facing.

It is also important to avoid:

• talking too much – allow space for silence, where needed;
• pressing people for information or pressuring people to talk about what they have been through;
• feeling like you need to rescue the person – try to enable people to find their own solutions where possible;
• judging people for their reactions and emotions – instead try to be alongside people who are distressed;
• feeling like you have to solve everything for the people you are hosting - instead know how to direct people to local supports and community groups;
• having the news about Ukraine on in the shared spaces in the house or in front of the those you are hosting, unless the Ukrainian family wish to watch this; and
• expecting people to fit in with your own routines.

When it comes to hosting children and young people, it is important to:

• acknowledge that young children under 2 years old might fuss more, sleep less and be harder to soothe;
• acknowledge that older children and young people might be fearful, angry, sad, find it hard to sleep or complain of physical problems;
• try to provide spaces and toys for children to play with;
• try to provide spaces and opportunities for young people to connect with each other;
• support children and teenagers to connect with friends and family where possible; and
• avoid asking for children to interpret for adults.

The people that you are hosting might want to discuss what has happened when they arrive. Usually, people recover best following crises by coming together with people from their own communities and supporting each other. When supporting Ukrainian families, the role of their own community support is of great importance. Therefore, helping them link with others and to connect with family to talk through and solve their difficulties, recognise their strengths and to offer practical and emotional support, is the best way to help. Appropriate support from their extended family and community strengthens and reduces the negative effects of the situation.

Some people may wish to talk with their host about what they have been through. Providing a listening ear, if you can, at these times can be helpful but avoid pressing for details. The role of spirituality and religious affiliation is also important for some, especially during the periods of change and relocation. This should be respected.

How those you are hosting might respond after traumatic events

The people that you are hosting have been through a traumatic event. It is normal to experience some distress after exposure to a crisis and conflict. This may include difficulties in sleeping, distressing thoughts and memories popping to mind, nightmares, irritability, reliving aspects of what has happened, and thinking that you should have done more to help.

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

Some people may want to talk and others may withdraw. 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 story reduces feelings of helplessness.

Things can feel very out of control so 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.

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

Young babies will also be impacted by crisis and parents are likely to be concerned about their wellbeing and recovery. Parent Club provide advice about mental health and wellbeing for babies through their Wellbeing for Wee Ones resource.

Pregnant women are also likely to be concerned about their own health and that of their baby and will benefit from support from local maternity services, as well as community groups. If you want to find out more, read Parent Club's advice about looking after your mental health during pregnancy.

It is helpful to allow people to make their own decisions about as many things as possible. 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.

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.

Mental health services for people who are distressed

Distress in these circumstances is normal and to be expected. Most people will not need professional support for their mental health but will get through this time with the help of their family, their friends their community and by drawing on their own established coping strategies.

If they do not have ready access to support from friends, family or their community, then having someone else to talk to who is able to be supportive can help. If you feel able as a host to provide a listening ear this can be helpful – so long as you feel able to listen actively without feeling overwhelmed.

A small number of people will benefit from being supported by someone outside their family – providing a private and quiet space with an interpreter can help in these situations. A small number of people might benefit from crisis mental health input.

People may need more specialist help if they:

• have pre-existing mental health conditions;
• are so upset they cannot care for themselves or their children;
• feel like they want to hurt themselves or hurt others;
• are not eating or attending to self-care; and
• are expressing suicidal ideas or plans.

If you are concerned about the psychological or mental health needs of a child, adult or family, you can get advice and guidance from a range of places. Once Ukrainian individuals are allocated to a GP any concerns about their health can be supported by the GP. Concerns about children under 5 can be discussed with the health visiting team and relevant health visitors if they are allocated. Out of hours advice and guidance can be accessed via NHS 24 Telephone 111. Staff there have been trained to support you as a host or they can support those you are hosting and provide advice.

How you can help those you are hosting

The general approach to helping anyone who is distressed, is to use something called Psychological First Aid (PFA). It is a way of helping people to feel calm and cope in difficult situations. PFA involves caring about the person, paying attention to their needs, using active listening and giving practical advice.

PFA is not professional therapy or encouraging conversations about the cause of distress. Offering formal therapy can actually cause psychological harm if offered too soon during an ongoing traumatic situation. PFA is a way of helping people cope with distress and it is something anyone can do. It is also important to note that not everyone who is in distress may need or want PFA. You should not also feel that you have to be the person to provide psychological support. If you want to help the person/people you are hosting cope better, you should:

• be calm;
• pay attention to their needs and your own;
• listen to them without needing to offer advice;
• show empathy and kindness; and
• give practical advice and support where needed.

The seven principles of Psychological First Aid that you can use to help yourself and the people you are hosting in your home are (NHS Education for Scotland, 2021):

• help people care for their immediate needs;
• protect them from further risk of threats or harm;
• comfort and console them;
• support people with practical tasks;
• provide information so they know where to get help;
• help them connect to their own social supports; and
• educate people about normal emotional reactions and responses.

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

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 impacts on emotional, social, spiritual and physical wellbeing. We are all affected by traumatic events in different ways.

Using a 'Trauma Informed' approach can also be very helpful. This means being able to recognise when someone, including yourself, 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.

In a few people, the problems persist or get more intense. When this happens, people may:

• experience a delay in the response to the traumatic experiences they have had; and/or
• begin to experience other difficulties such as avoiding people and places or developing anxiety when faced with reminders of what happened (high buildings, fire sirens, etc.).

Ukrainian families/people staying with you will still be experiencing ongoing trauma as the war is not over so it is expected they will still show signs of distress. Some people may be experiencing complex post-traumatic stress disorder (PTSD) or other mental health disorders, and for these people access to timely specialist help is recommended. Some people can have more complex reactions to trauma and distress. A person with more severe reactions can require specialist help. Some examples of complex reactions are feeling suicidal, not eating or drinking, or harming themselves.

If those you are hosting are feeling that they are at risk of harm, please encourage them to get help from the local GP, or by calling NHS 24 on 111, the Samaritans on 116 123, or Breathing Space on 0800 83 85 87.

Taking care of yourself and your family

Hosting displaced Ukrainian's in your home is an important humanitarian role. However, as well as thinking about the needs of the person(s) you are hosting it will also be important to pay extra attention to your own health and wellbeing – for the benefit of all concerned. As a host you or your family may feel affected by the distress the person(s) you are hosting are feeling or the stories they tell about what they have been through.

You may start to feel responsible for the safety or care of the people you are hosting and want to help them to make contact with loved ones. You may feel a tension between giving time to your role as host and the usual demands of family life. You may feel disappointed or sad that they are not thankful or happy to be here.

You may also find it hard to understand their culture or ways of coping. All of these responses are normal, expected and understandable. For this reason it is important that you recognise any impacts of the role on you and your family, take time to attend to your own wellbeing and manage your own stress.

To help with managing your own emotions, you should:

• try to keep your usual routines as far as possible;
• try to schedule and take time to eat, rest and relax;
• think about what has helped you and your family cope during challenging times in the past and try to do these things;
• access support for yourself by talking to friends, loved ones or other people you trust;
• recognise your own reactions and frustrations and remind yourself that your role as host does not mean you need to solve all of the problems;
• enable the people you are hosting to access other sources of support;
• connect with other hosts to see how they are doing;
• access additional support for yourself if you need this;
• try not to watch or listen to too much news about Ukraine, especially in front of the people you are hosting; and
• try to keep up your own normal family activities.

Holding your own children in mind when hosting

If you have your own children in the house, then it might be helpful to think about:

• keeping all the things that are usually helpful and important to your children as a priority;
• maintaining your children's routine as much as possible including things such as bedtime routines, meals, education, chance to see loved family and spending time having fun with friends;
• the challenges that come with welcoming new people into your home, alongside the excitements;
• challenges such as sharing space, toys and technology or devices with new people, which come with the opportunity to get to know and play with new people;
• finding good times and ways to listen to your children and explore how they are making sense of the changes;
• accessing resources on Parent club Scotland which offer ideas on how to listen and talk to children and young people;
• communicating with your children's school, college, early learning or childcare provider so that they know you are hosting Ukrainian people/families, just in case your child would benefit from extra support;
• taking breaks from social media, as children and teenagers will learn from your behaviour and copy what you do;
• accessing resources on Mind Yer Time to support healthy social media and screen time;
• explaining what is happening and why simply and calmly to your children;
• listening to any concerns your children might have about sharing their home with others;
• ensuring children have their own space and privacy;
• not expecting children to care for the people you are hosting;
• protecting children as far as possible from seeing or hearing high distress;
• trying to ensure that traumatic events are not discussed in front of children;
• trying, where possible, to keep the news off in front your children and taking time to discuss with your child about how they are feeling about the things they may be hearing; and
• accessing resources on the IFRC Reference Centre for Psychosocial Support to help with managing your exposure to news, events and social media.

How to get help for those you are hosting

Scottish Refugee Council

The Scottish Refugee Council's helpline service provides information and initial advice on housing, education, health, learning English and building social connections in Scotland for refugees. They can also help people access legal advice on immigration issues. An interpreter can be requested. The helpline advisers carry out initial diagnostic assessments, identify needs and advice, refer and signpost people to right services. They are there to listen, provide a safe space for families and help people navigate the challenging circumstances they may be experiencing.

Scottish Refugee Council can also identify the support needed by hosts and provide initial and essential information to you as needed.

You can contact the Scottish Refugee Council helpline on 0808 196 7274. To learn more about this service, read the information on the freephone helpline.

Barnardo's

Ukrainian people can get help from a telephone helpline at Barnardo's. Barnardo's have set up a Ukrainian Support Helpline to provide a holistic support service. The Helpline is available to anyone fleeing the conflict in Ukraine. All services include access to interpreters in Ukrainian and Russian. The Barnardo's Helpline is open: Monday – Friday 10.00am - 8.00pm and Saturday 10.00am - 3.00pm. People can get in touch if they need support with:

• therapy with a qualified psychotherapist – delivered via the phone or online, with access to interpreters;
• advice on a range of issues, for example housing, accessing key health services, education, employment and more via our trained helpline support workers; and/or
• practical support - access to digital devices to ensure families stay connected to loved ones during this worrying time, as well as stimulating toys for children, vital baby items and more.

British Red Cross

The British Red Cross supports people from Ukraine who are in the UK. For any more information about British Red Cross, or for emotional support please call the free British Red Cross support line on 0808 196 3651. The support line is open between 10am - 6pm daily.

Parentline

Parentline's support for asylum seeking and refugee families can provide advice for parents. If you live in Scotland, you can call 08000 28 22 33 for free. For advice and support, read their support for asylum seeking and refugee families. To chat with someone online, use the web chat in the bottom right corner of the website. They are open seven days a week Monday to Friday, 9am to 9pm and Saturday to Sunday, 9am to noon.

Your Local Authority contacts, NHS telephone 111 or your local General Practice (GP) can also provide help and support.

Accessing support for your own mental health and wellbeing

A wide range of advice on maintaining positive mental wellbeing can be found through the Clear Your Head and NHS Inform websites.

If, in your role as a host, you are feeling overwhelmed, having trouble sleeping, are using alcohol more than usual or just feel it would help to talk to someone, you can contact:

• the NHS 24 Mental Health Hub on 111, available to provide urgent care advice and mental health support day or night;
• Breathing Space by calling 0800 83 85 87, Scotland's national mental health phone line which is free, confidential, available out of hours and offers advice around wellbeing and coping with low mood, depression and anxiety - open from Monday to Thursday 6pm to 2am and weekends from 6pm on Friday to 6am on Monday; and/or
• Samaritans by calling 116 123, available 24 hours a day 365 days a year to support to anyone in emotional distress or at risk of suicide