Even the missile attack in Kyiv on July 8 did not slow their progress. When an air-raid alarm sounded during their meeting at the City Hotel that Monday morning, members of our Mental Health and Psychosocial Support (MHPSS) team and the other participants (including the Coordination Center for Mental Health under the Cabinet of Ministers of Ukraine, five Ukrainian universities, the Ukrainian Red Cross and Save the Children) simply picked up their things and moved from the conference room—with its large windows and view of the capital—down to the bomb shelter in the hotel’s basement. In the heat and cramped conditions, they carried on with their meeting for the rest of the day. By the time they were done, and the all-clear signal was heard, they had agreed upon a common approach to MHPSS services in Ukraine: the Integrated Model for Supervision (IMS).
According to International Medical Corps consultant and trainer Kelly McBride, the IMS is a proactive model for the supported supervision of MHPSS in humanitarian emergencies. She explained that IMS was developed specifically for MHPSS but is a flexible model that can be integrated into other sectors, group formats or one-on-one direct supervision. “One of its defining features is supervision for all,” McBride says. “It doesn’t matter if you’re practising as a volunteer or are a seasoned psychologist with 15 years of experience.”
McBride says that there has always been some kind of supervision in MHPSS in humanitarian response, but that about five years ago a noticeable gap was identified: a lack of common understanding of how to approach such services during a response. To address this gap, the International Federation of Red Cross and Red Crescent Societies’ Reference Centre for Psychosocial Support collaborated with Trinity College Dublin to create the first IMS handbook, online training and pilot testing around the world. International Medical Corps has implemented the testing in Ukraine, joined by other organisations, including Save the Children and the Ukrainian Red Cross.
McBride explains that IMS is particularly important because Ukrainians continue to face so much adversity. MHPSS workers have been struggling to provide support in their communities and sometimes lack high levels of training. They also face the same types of stress as the people they are trying to help—being displaced from their homes, being separated from loved ones or just not being able to sleep without air-raid sirens going off. “It can be hard to separate themselves as therapists from what they hear because they may have very similar stories,” McBride says. “So, they can then experience the difficult feelings of burnout.”
That’s where IMS helps, McBride continues. By enabling MHPSS specialists to share their experiences and build their skills, IMS helps them to be better equipped to help others and more satisfied. Supervisors typically help guide the process—by asking probing questions, for example—but IMS really means solving problems together. The goal, she says, is for IMS to be embedded within the MHPSS system.
In practical terms, the integrated model for supervision is varied. It can involve the live supervision of MHPSS sessions between specialists and clients. Or, without clients present, it can involve peer-to-peer supervision between specialists or one-to-one and group supervision led by colleagues in a supervisory role. In group supervision, for example, specialists may raise questions about their work and techniques, difficult or even crisis cases they have faced, or their personal challenges, and receive both support and practical suggestions in return. The group may also roleplay delivering psychological first aid, perform a relaxation exercise together and more. Regardless of the form the IMS takes, it should become a regular part of MHPSS practice by organisations involved in humanitarian emergencies.
Training Turning Heads, Opening Minds
In addition to convening IMS meetings, International Medical Corps has hosted a series of groundbreaking IMS training sessions in Kyiv, involving participants from the Cabinet of Ministers’ Coordination Center, the Ukrainian Ministries of Internal Affairs and Social Policy, the State Emergency Services, the National University of Kyiv-Mohyla Academy and universities in Kharkiv, Mykolaiv, Odesa and Sumy. Such participation is significant because, for example, the Interior Ministry is responsible for the units responding to attacks and other disasters, while the Social Policy Ministry oversees some 140 MHPSS specialists who can provide IMS support to thousands of social workers across Ukraine—professionals who, in turn, help to support the well-being of the population.
Lubov Chyhrynska, a mental health project manager at the Coordination Center, says that the IMS training she received in early July will be particularly important in supporting doctors working in frontline areas. “It will give us the chance to help those who help everyone else,” she explains. “It’s all about providing support when people feel they are burnt out and fatigued from compassion.” Chyhrynska hopes that familiarisation with IMS, plus financial support, will make this approach standard practice in Ukraine.
Ludmila Perederay, an expert at the Ministry of Social Policy, describes the IMS training as powerful. “I’m emotionally satisfied,” she adds, “and grateful to International Medical Corps for the experts and their participation in the training.” Perederay says she already recognised the value of MHPSS and now also understands that IMS will increase the capacity of specialists to help even more people. “The point is that the mental health problem in Ukraine is already a huge concern,” she says, “and we have become aware that there is the likelihood of problems remaining even after victory.”
Yevhen Pushko is one of three psychologists with the State Emergency Services in Poltavska oblast supporting hundreds of colleagues—paramedics and firefighters among them. When asked how IMS might help his team, he says, “We will leave our bubbles. Every expert will not stay in the bubble of their own experience—and it’s the chance to exchange experiences that may otherwise be lost.” Pushko says he was impressed by the practical nature of the IMS training, which features case studies and a focus on building relationships and a diverse system of support. “My colleagues are very interested and already asking me questions,” he says. “Peer-to-peer meetings are incredibly useful—and now I know much better how to organise them and teach them.”