Mental Health: A Neglected Component of Peace

“At this time, anxiety increases, there are sleep disturbances, the condition of some people does not allow them to work and live fully. There is already the development of depressive disorders,” says Tetiana Bohuslavska, who is working as a psychologist for the Swiss-Ukrainian Act for Health project in the war-torn Ukraine. According to the World Health Organization (WHO), one in five people who have experienced war or other conflict in the previous 10 years will have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia. On the other hand, sustained peace requires a healthy mental condition. This is only possible when the different aspects of psychosocial needs are addressed.

Traditionally reluctant to seek psychosocial support, millions of Ukrainians are starting to look for help to cope with excessive stress, which they have been going through for years. Tetiana, who was forced to flee her hometown in the eastern Ukraine, also sees her efforts to restore people's mental health as a new roadmap to lasting peace. “For me personally, the concepts of mental health and peace are inseparable. And it is not only about the state of absence of war. It is about a peaceful environment that that supports people affected by the war.” This is why the United Nations have lately emphasised a clear ambition towards enhancing the integration of mental health and psychosocial support (MHPSS) into peacebuilding, in order to increase the resilience and agency of people and communities and the potential for future reconciliation processes. The importance of this approach goes beyond the period of conflict, as scientific research clearly identifies mental health issues as a major obstacle to sustained peace and reconciliation.

Dealing with often invisible scars of war is proving to be crucial for Ukraine’s future. Massive shelling and destruction, violence, family separations, displacement, loss of loved ones and uncertainty have put an enormous burden on the mental state of Ukrainians. Although the true scale of the problem will only be revealed over time, already now the WHO estimates that 9.6 million Ukrainians may have mental health problems. Foreseeing the possible devastating consequences for the very fabric of society, the government is putting a spotlight on the psychosocial well-being and the resilience of people. Therefore, mental health is a nation-wide priority since 2014.

The SDC complements and supports systemic Ukrainian efforts with lasting effects, building upon its experience worldwide. Launched in 2018, the Swiss-Ukrainian Mental Health for Ukraine project is supporting the reform of the mental health system in Ukraine and establishing mental health centres in the regions in collaboration with the authorities, the Ukrainian Catholic University, as well as Swiss mental health experts from the Psychiatric University Clinic in Zurich and the University of Zurich. The project was recently extended until 2028, with adaptations to the rapidly changed context and increased psychosocial needs. Important new priorities are the reintegration of people with mental illness, the provision of psychosocial support for people in frontline areas or internally displaced people and improved coordination between mental health providers.

“Mental health is a very important but very vulnerable part of our life, especially during the wartime. We will need to rebuild not only the infrastructure and the cities in Ukraine, but also our inner mental health and connections between people. And what we are doing now to cope with the consequences of war, stress and trauma is already a step towards recovery and building peace,” explained Orest Suvalo, the psychiatrist and the project manager of the Mental Health for Ukraine project.

Five days a week, Tetiana Bohuslavska and a medical mobile team visit remote villages and centres for displaced people. They do so as part of the Act for Health project, which is coordinated with the national action plan and complements the Mental Health for Ukraine project. In this way, they fill the gaps in the public service provision in Ukraine and bring health and psychosocial services closer to people. While medics are performing medical check-ups, Tetiana is providing private psychosocial consultations.

“The modern approach should take into account a biological component of health, a healthy body, a mental component of health, mental comfort, and a social component, integration into the environment. Mental health services are in great demand now. We are using the recovery approach. It means not treating and curing completely, but teaching a person to live a full life with the disorder they have or in the conditions they are in,” Tetiana explains.

It is developing local capacities to create sustainable and flexible systems that will work in the long run. The Geneva University Hospitals contribute Swiss expertise where needed. To improve the provision of health and mental health services on the local level, the Act for Health project establishes knowledge hubs for non-communicable diseases, among which mental health issues, in four regions. It thereby promotes lasting yet flexibly deployable infrastructure and expertise for the provision of mental health services.

Switzerland is one of few countries that support mental health interventions at the country level, e.g., in Ukraine, Bosnia and Herzegovina, Moldova and countries in the Great Lakes Region, while simultaneously engaging in global advocacy and policy dialogue for advancing the mental health agenda.

The 'Special Initiative for Mental Health' was co-shaped with the WHO to improve the access to quality and affordable community-based mental health services. Since its launch in 2019, it contributed to advance mental health policy, advocacy and human rights, and scaling up interventions in 9 countries, among which Bangladesh, Nepal, and Zimbabwe. It reached to date 44.7 million people. It gained more interest from additional low- and middle-income countries in the face of the consequences of the Covid-19 pandemic.

The evidence gathered at the country level is used for normative work at the global level, such as the Mental Health Atlas (2019/2020), WHO interventions guidelines for countries (Mental Health Gap Action Programme, 2023), and the landmark World Mental Health Report 2022.

The burden of mental disorder in Bosnia and Herzegovina (BiH) is considerable due to still present psychological scars from the war, social deprivation and difficult economic situations. The Mental Health Project, which was successfully concluded in 2023, has supported the country’s reform of mental health care services since 2009. The project was implemented by a local partner organisation in close cooperation with local institutions and its initiators, the entity Ministries of Health.

Focusing on decentralisation of service provision from hospitals to Community Mental Health Centres (CMHCs) the project supported the establishment of a network of 74 CMHCs with multidisciplinary teams. Today, almost all of them are fully financed from the public health budgets and intend to continue their work.

The Great Lakes region has been marked by a history of mass violence since the colonial period. SDC promotes a community-based "Healing Together" approach in Burundi, Rwanda and the Democratic Republic of Congo that works on the cycle of violence, including gender-based violence (GBV), which is a corollary of conflict. Additionally, political dialogue focuses on messages to combat GBV and the implementation of commitments made by heads of state at the Kampala Declaration, for the integration of the approach into policies and strategies. Ultimately, this leads to a lasting reduction of violence, rebuilding of shared values in the community and improved social cohesion, which are prerequisites of sustainable peace.

Despite considerable macroeconomic progress, Latin America is a region where sustainable development faces huge challenges due to the tense relationship between armed conflict, violence, fragility, and very high levels of inequality. Against this background, the SDC cooperation office in Honduras decided to mainstream the Psychosocial approach throughout its portfolio based on the recognition that long-lasting conflicts and endemic violence had led to a culture of fear and collective trauma, which represented obstacles to sustainable development. This approach links the personal dimension (feelings, beliefs, values), the social dimension (culture, relationships) and the material dimension (poverty, natural and structural environment) and aims to help overcoming the culture of violence, polarization, and social conflicts, by strengthening social cohesion and empowerment of the organizations and communities.