Two years after the 44-day Artsakh War, many soldiers are still healing not only from physical injuries, but also psychological trauma. Armenia still needs a functioning licensing unified system of psychological assistance for soldiers to cope with that task. In the interview, Davit Gevorgyan, Director of Yerevan State University’s Centre for Applied Psychology, talks about what kind of psychological help is currently provided to soldiers, what projects are being planned and how to reduce the mental health stigma in society.
Interview: Anita Mihaeljana
Last year in OC-Media, you said that many soldiers refuse to receive psychological help and that medical professionals were met even with resistance. What changes in attitudes towards psychological assistance have you observed over the past year?
There are some changes that can be seen because of symptoms of post-traumatic stress disorder (PTSD). The soldiers face more and more problems concerning PTSD. Now they go to a doctor, a neurologist and also a psychotherapist much more often. There is a sort of referral system that is now running within our system.
We also have the experience of a psychological system that will provide army-related, soldier-related therapy. There is the Homeland Defender's Rehabilitation Center in Armenia which has existed for about 2-3 years, but which did not have a section on psychological assistance. Now they work with five psychotherapists and the demand for psychological services at this facility is quite high.
It is obvious that there is a need for a psychological system, as well as recommending people, talking to each other, to go get psychological therapy.
We try to psycho-educate the population, especially soldiers and their families, through campaigns, interviews and so on. There are also targeted proposals to come and receive help in more relevant places such as hospitals, the Homeland Defender's Rehabilitation Center and via the Ministry of Defense. This kind of activity changes the situation a lot.
There are psychologists who criticize Armenia’s lack of a unified psychological assistance system for soldiers. What are your thoughts on the current situation? How would you assess the cooperation with the relevant ministries and institutions?
It definitely gets better because this kind of collaboration is needed. It is not about a system trying to develop itself, but because there is a great need for information exchange and transmission. Currently, there are several agencies that are very interested in cooperation. First of all, it is the Ministry of Defense. There is the Department of Health and Social Protection of Servicemen and Veterans. They form a kind of network with the psychological agencies, trying to bring them together both during and after the war. The other interested state party is the Ministry of Labor and Social Affairs.
In 2021, a one-year project funded by the government through the Ministry of Emergency Situations was implemented in an effort to cover all the psychological needs of war-affected people throughout our country. It was kind of a pilot project. It ended in December. Now the government has transferred this responsibility to the Ministry of Labor and Social Affairs. They are now trying to do their best to develop a more comprehensive and effective system of psychological services for people. This is definitely a step forward.
We also have very good communication with soldiers' hospitals and also with international agencies, such as the Red Cross, the UN, the UNDP and UNICEF specialists.
How would you assess psychologists' knowledge and level of training? What is missing, what is needed in order to have more knowledgeable, well-prepared professionals in Armenia?
This is a very painful question. There is no psychological licensing system. We don't have a state or any kind of umbrella organization to monitor the quality of service. The situation is still the same concerning this issue.
But there was a lot of international and local training during and after the 2020 war. There were many professionals who came to Armenia to conduct training or did it online. Their job involved lots of training on PTSD, complicated grief, rehabilitation, psychological first aid and so on. Of course, it changed the quality of services to a certain degree.
However, we do not have comprehensive studies on what the situation was before and now with regard to the quality of the services provided. There are many players in the field who do not have any kind of qualification or training, but they are still active. We have very good dynamics and also the same situation as before the war.
What is being done to improve the situation?
There are some actions organized by the Ministry of Health and Ministry of Labor and Social Affairs. They're trying to bring together the experience of all the staff and all the players in the field and create a sort of coalition of psychological services. Now the Ministry of Health has launched an initiative to create a coalition of mental health organizations. Our organization is part of this coalition. Now they are trying to figure out the main ways of the development of this field. Of course this is just the beginning of a long road.
Another interesting situation is with some professional associations that are now quite active in Armenia. They are also trying to have their input in this problematic field of creating a licensing system in Armenia. My personal perspective is that we will have something in two to five years at the earliest. But of course it's better than it was.
During and after the 2020 Nagorno-Karabakh war, students were recruited to provide psychological assistance. Are they still involved?
Some of them are involved, they are not volunteers now, they are psychologists. But we also have many volunteers who are partially involved or ready to show up any time and do their work. We try to do our job in a much more organized way than two years ago. We're not trying to hecticly involve everyone who wants to be there. We're trying to select people, to train them, and to provide targeted service delivery.
That is why I mentioned that a psychological service has been established at Homeland Defender's Rehabilitation Center now. We also have very good mobile groups with two or three psychologists. They work in the regions.
We are now recruiting a group of psychologists for another, hopefully, effective project. The project is in cooperation with the Armenian Apostolic Church. We are trying to develop a psychological service that will bring together psychologists, priests and supervisors who will try to do everything possible to reach in villages and regions all those who have not been involved in any psychological help.
Have you noticed an increase in the interest of young people to study psychology?
Yes, definitely. Many young people are very interested in training; psychological knowledge is gained not only in an academic environment, but also in semi-academic training, workshops, and master classes. They try to combine theoretical and practical knowledge. We can now see a good increase in this interest.
There is also a hotline available for psychological help. How much demand is there for such online sessions?
In the first half of 2021, in cooperation with our US colleagues, we launched a hotline for soldiers and their families. Unfortunately, its efficiency is rather limited. I guess it's a mentality issue. In Armenia, it is not very common to call somewhere, talk to someone you don't see and don't know. But still it works, and hopefully with the second phase of the project, we think the hotline will work better.
How many therapy sessions does one person need on average?
It depends on the situation, on the chronicity of the problem, on the assistance they received or did not receive in those two years. In general, we are talking about 10 to 16 psychological sessions to cope with the first line symptoms. Of course, now there are much deeper symptoms, because time has passed and some of them have a very problematic situation now, they need much longer psychotherapy. All these projects that I am talking about are focused on 16 psychological sessions.
You mentioned first line symptoms. Could you please describe them a bit more?
Depression, anxiety symptoms, panic disorder, PTSD symptoms and some somatic disorders or problems concerning sleep disorders, eating disorders.
But of course there are much more problematic situations involving personality issues. This will unfortunately develop. We are trying to somehow figure out these more vulnerable patients and create some kind of system for them.
What are the consequences if assistance is not provided or not provided as soon as possible? How will this be reflected in people's daily lives?
There are several types of patients affected by war. The most vulnerable are the families of missing soldiers, those who have lost their family members, and prisoners of war and their families. These groups are much more vulnerable. There are many complex and multi-layered issues concerning their psychological state, the social perception of their situation. These people have generally avoided psychological assistance.
The main problem is that these people are much more at risk of developing psychological or mental disorders, and more severe kinds of them, as well as social disadaptation
Now we see such cases mainly in villages, regions, where there are very conservative families. They have very bad cases of several psychotic or other psychiatric symptoms.
What can be done to help war veterans return to a normal life? How to reduce the stigma surrounding mental health?
There must be some kind of state approach to these people, welcoming them back into society, providing them with relevant work, making them feel their value in society. How to do this is a difficult question.
Some kind of psycho-educational campaigns are now very much needed. It needs to be on TV, on the Internet. Many people who need psychological assistance do not know who to turn to, who can provide the most relevant assistance. We need to educate society about what it means to have nightmares for months, and what it means to not want to communicate. This does not mean that there is something wrong with the person's mind, it is about his psychological state. There are many problematic and conflict-promoting situations that are not within the person, they are the manifestation of his symptoms.
So we have to figure out in very simple terms what PTSD is, what depression is, what anxiety is, why it happens, and what we can do about it. If I'm not mistaken, there is no constant campaign of this kind in the media. I think it's the best we can do.
