Ukraine refugee psychological wellbeing pack: guidance for services

Appendix 3: Advice pack given to Ukrainian arrivals

Welcome to Scotland. This guide is here to help provide you with some simple advice and resources about psychological wellbeing and where to seek help if you need it.

Different kinds of crises affect people in different ways. There's a wide range of responses or feelings that you, your family, or friends may feel after fleeing from a dangerous situation. You may find that you have coped well, and in ways that are designed to protect yourself and your loved ones. You may also want to manage difficult things on your own or you may want to find help from others that you know and trust. You may also feel you might need help from others and this guide is to help you care for yourself and your loved ones and find the support you need.

When living with your host family it is important you feel safe and cared for. The World Health Organisation (2011) provides three principles which have been shared with host families. These principles are:

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

Safety can be ensured 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.

Dignity can be promoted by:

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

Rights can be upheld 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.

When living with a host family you should feel safe, protected from harms, and treated with respect. Feeling safe and protected can help you feel more psychologically safe and able to cope with the difficult situation you are in.

How trauma can affect you

Trauma that can cause distress, or more complex emotional reactions, refers to a wide range of upsetting 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. The events in Ukraine are also still ongoing so this is a traumatic event that is not over. You may therefore be affected by this traumatic events in different ways.

It is normal to experience distress after exposure to a crisis and conflict. This may include difficulties in sleeping, distressing thoughts and memories popping to mind, nightmares, feeling angry, reliving aspects of what has happened and thinking that you should have done more to help.

Bereavement and separation from loved ones or pets will also be something that you or your family may have experienced. You 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 and you should seek this out where possible. However, although talking about what happened can be helpful, being forced to talk about your experiences can be unhelpful. 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 upsetting feelings.

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 some normality to life. Generally it is helpful to make your own decisions about as many things as possible so you feel more in control of what is happening.

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

For children, providing open, honest and direct information to your children about what is known and explanations of their own and other adult reactions they may have seen can be helpful.

Understanding the effects of trauma can aid recovery. The experience of trauma is common after life threatening events. It can affect people differently and people can react differently as people are affected by trauma in an individual way. You will cope better if you have a sense of choice, control, and safety. Additionally, relationships and social connections are really important.

You may find that any upsetting feelings settle down and you 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.

Sometimes there is a delay in the response to the trauma. Or 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 how you are coping to see if more help is required.

For information about post-traumatic stress disorder (PTSD) and how trauma can affect you, read these free Ukrainian, Polish, And Russian translations of trauma and PTSD psychoeducational resources.

Some people can have more complex reactions to traumatic situations and distress. If you, or a family member, are experiencing more complex reactions this can require help from someone with specialist skills. Some examples of complex reactions are feeling suicidal, not eating or drinking, and feelings that you want to harm yourself. You should seek help from a professional if you are feeling this way.

The National Health Service (NHS) in Scotland can provide help if you call free on 111 or your local General Practice (GP) can also provide support if you have psychological wellbeing or mental health needs.

You can also get support from the Samaritans, 24 hours a day. You can call them free on 116 123 and find out more online about the how Samaritans can help.

Breathing Space is also a free service in Scotland and you can call them on 0800 83 85 87. You can find details online about Breathing Space's free confidential service for when you're feeling down.

Supporting your children

Advice about Children and Families

During this crisis, your children and you as their parents/carers may have experienced a wide range of very challenging events. You may have witnessed violence, disruption, leaving a loved and familiar home and country, separation from friends and family.

Children's experience of the crisis may differ from that of their families especially if family members left Ukraine at different times or by different routes. Children may be most upset by very different things to those which distress adults. They may appear fine at times and then very fragile or angry at other times. This is a normal reaction to the events they have experienced.

Regular predictable routines

Children will benefit from routines that are as normal as possible such as maintaining regular mealtimes with familiar food, chances to play with and chat to familiar friends and adults, keeping regular bedtimes and getting up routines, and the chance to attend school or college once settled in a locality.

Support from family and friends

Contact with friends and family is very important to children's wellbeing. Any opportunities to be in contact face to face or digitally with family and friends will greatly support your child's wellbeing. Social support for you as parents and carers is also important, especially as many families will be separated and you may be worrying about loved ones still in Ukraine or travelling to safety.

This separation may mean family roles need to change and having the chance to speak to others in a similar situation is likely to be really helpful to you as parents and caregivers to help you adjust to your new living situation.

Loss and Bereavement

Where children have been bereaved during the conflict they may have had little chance to grieve and participate in mourning with their family. They may worry about upsetting family members by letting them know how sad or upset they are feeling. Children may also be worried about family members who are still in a dangerous situation and may need a chance to talk about these fears.

Let children take the lead and if they do want to talk, it is usually most helpful to listen carefully to what the child or young person is feeling and worrying about. You can support children by helping them to identify what and who helps them to feel better. There are resources about listening to children from Parent Club.

Children may also feel very angry about the crisis and being able to talk about this and to be listened to carefully can help them to manage feelings and thoughts. It is important to remember that these are all normal reactions to terrible events. Children and young people might feel very overwhelmed by their feelings and reactions, and it will be important to listen to them carefully and help them talk about their feelings.

There a number of useful ISC resources relating to the current Ukrainian situation and specifically to children.

How children react to a crisis depends on their age and developmental stage. All the ordinary needs and interests that children have will continue to be important.

Their reaction to the crisis will be affected by the ways their caregivers and other adults interact with them and it's important to give them space to be children, to have their needs met, be loved and cared for and have time for play and enjoying the activities they usually take part in where possible.

Young children may not fully understand what is happening around them, and may show distress through changes in behaviour, such as:

• bed wetting or nightmares;
• complaining of physical aches and pains; and
• being especially worried about being separated from close family.

It is a normal reaction for children who have experienced a distressing situation to regress and begin to show behaviours associated with younger age groups. Younger children will be especially in need of support from caregivers. In general, all children cope better when they have a stable, calm adult around them. In order to provide this support, it's important that you look after your own wellbeing and make sure you have support systems in place for yourself. It is also helpful to protect them from watching or hearing the news so they can feel calm and safe where they are now.

If your child seems distressed, and you think they need help, a helpful thing to use is called Psychological First Aid (PFA). PFA involves caring about the child, 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.

Babies may also become more unsettled or have other changes in their behaviour. The 'wellbeing for Wee Ones' campaign provides practical advice to support the ways parents and caregivers interact with babies and very young children. For babies and toddlers, the more predictable you can make their worlds the more they will feel safe so thinking about things like feeding routines and nappy changing routines and the rhythm of calm talking, singing and telling stories will all help the baby to feel more settled.

Psychological first aid for everyone

Psychological First Aid (PFA) is a way of helping both adults and children cope with distress and it is something anyone can do. The focus is to help you and your children get basic needs met such as access to safety, food, and shelter and getting access to social support and information. The social support is best provided by people that you know and/or have similar experiences to you. It is also important to note that not everyone who is in distress may need or want PFA.

The seven principles of PFA, as provided by NHS Education for Scotland 2021, that you can use to help yourself and others are:

• care for your immediate needs;
• protect yourself from risk of further harms;
• be comforted;
• get support for practical tasks;
• get information you need on how to cope;
• connect with people you know; and
• be educated about normal psychological responses.

In summary, you and your family are more likely to be able to psychologically cope with and recover from the trauma you have experienced if you:

• feel safe and are in calm supportive environments;
• have access to practical social, physical, and emotional support that is not intrusive;
• feel able to help yourself, as an individual and in your local connections and communities; and
• you feel listened to them but do not feel pressurised to talk.

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

Parent Club provides some very helpful ideas for supporting children's play. Also, Child Friendly Spaces At Home Activity Cards (English) offers ideas for play activities that can help children talk about and manage feelings and develop ways to cope. To read advice about supporting babies and younger children, see the 'Wellbeing for Wee Ones' campaign.

Remember…

Everyone will respond in very different ways to the very difficult situation you have been through – there is no wrong or right way to feel or react. Be kind to yourself, and those you love, and give yourself time to adjust to this difficult situation. Seek out support from those who know you the best and keep connected with family and friends as best as you can. Seek specialist help if you feel you need and try not to judge your own emotional reactions to an understandably very difficult situation.

We hope this guide helps you find the information, support, and help you may need.