The Silent Frontline

Robert Schuett and Susanne Schuett argue that the war in Ukraine shows why mental health carries high-stakes strategic and policy relevance.

Linking the human psyche to the hard realities of international relations is nothing new. Yet it has never been more urgent. As global governance drifts toward a future that is unstable, undefined, and unforgiving, the psychological dimensions of geopolitics demand renewed attention.

Virtually every 20th-century foreign policy realist grappled with the intricacies of individual and social psychology and their relevance to political behaviour. Perhaps the most consequential of these earlier political realists, the German-American international relations scholar Hans J. Morgenthau, flirted with Freudian analysis in the 1930s in his effort to trace the roots of power and peace to what was then still called “human nature.” In Politics Among Nations—his classic 1948 work that shaped generations of Cold War theorists and practitioners—Morgenthau argued that national power is not merely a function of GDP and weaponry.

In essence, the balance of power in global affairs is not merely a mathematical equation of industrial output and military strength; it is equally a matter of the heart and soul. The real debate in global policy is over relative priority and balance.

Today, classical realism or not, it is impossible to ignore that geopolitical dynamics shape the mental health of individuals and entire populations. From war and forced displacement to economic precarity and democratic erosion, the stressors generated by international disorder manifest not only in headlines, but in hospitals, schools, and homes. The mental health toll is not a by-product of geopolitics; rather, it is one of its core consequences.

Recognising these geopolitical determinants is no longer optional. It is essential to advancing evidence, advocacy, and effective policy in global health, particularly in an era of fierce great power competition, increasingly and precariously driven by technological and AI prowess.

Research and policy communities are beginning to confront the mental health consequences of geopolitical disruption with greater clarity and intent. The World Psychiatric Association’s establishment of a dedicated Working Group on Geopsychiatry in 2023, along with the launch of a new academic journal, Geopsychiatry, in 2025, signals a growing determination to understand how political, environmental, and social forces shape mental health and well-being.

In parallel, institutional developments within the European Union (EU) aim to embed mental health more firmly into cross-sectoral policy frameworks. The momentum is shifting decisively—and quite rightly so—toward a comprehensive bio-psycho-social understanding of mental health, one that recognises its deep entanglement with economic conditions, social cohesion, political context, and the lived reality of conventional warfare.

Nowhere is the link between violent geopolitics and mental health more immediate and far-reaching than in Ukraine. Ukraine’s First Lady, Olena Zelenska, has made clear that the fight for the nation does not end at the frontlines; it extends into every household, every school, and every mind. The battle for mental health is not secondary; it is part of Ukraine’s fight for its future.

To be sure, the physical reconstruction of Ukraine will one day be complete. But the mental health impact of war will endure far longer, making the battle for mental health as urgent as the fight for the nation’s survival.

Mental health challenges are pervasive and long-lasting in post-war societies, often linked to intra-familial violence, substance abuse, and social breakdown. In Ukraine, the burden was already high before the full-scale Russian invasion in 2022. Contributing factors include the lingering trauma of the Soviet era, the 2014 annexation of Crimea and conflict in Donbas, and the destabilising effects of the COVID-19 pandemic. Prior to the war, Ukraine’s prevalence of most mental health conditions was comparable to that of other Eastern European countries.

The ongoing war has only deepened the public mental health crisis. According to World Health Organisation (WHO) estimates, in conflict-affected areas, one in five people is expected to suffer from a mental health condition at any time in the subsequent decade, with nearly one in ten living with a moderate to severe disorder.

Applied to Ukraine’s population of 43.7 million, this translates to approximately 9.6 million people with mild mental health conditions and nearly 4 million with more serious mental health needs. Beyond these clinical categories, an even larger share of the population is likely to experience significant distress—manifesting as anxiety, sadness, hopelessness, insomnia, fatigue, irritability, and emotional exhaustion.

A recent 2025 review confirms what many already feel on the ground: symptoms of anxiety, post-traumatic stress, depression, and insomnia have surged in the general population since the escalation of the war. Refugees and internally displaced people experience especially high rates of mental distress, and the war has triggered the largest and fastest displacement of people in Europe since the Second World War. Veterans and active military personnel—and by extension, their families—form another high-risk group. Many face chronic mental health conditions, including post-traumatic stress disorder (PTSD), suicide, substance use disorders, and other self-destructive behaviours. Healthcare workers are also increasingly affected. So too are children, the elderly, people with disabilities, and women—each facing distinct, often compounding risks. Women, in particular, are exposed to gender-specific threats such as sexual violence, widowhood, and disrupted maternal care in frontline regions. Across all groups, female gender is associated with a higher severity of new-onset mental illness.

The scale and diversity of mental health needs have been formally acknowledged in Ukraine’s Operational Roadmap, Ukrainian Prioritized Multisectoral Mental Health and Psychosocial Support Actions During and After the War. Indeed, mental health is not a post-conflict luxury; it is a core condition for national recovery, social cohesion, and long-term development.

What’s required is a combination of strategic policy planning and the delivery of care under the conditions of active warfare. Ukraine is already acting on this imperative. Since the publication of the Operational Roadmap—pro-actively endorsed by the First Lady and supported by the WHO—the country has framed mental health as a national priority and a “second front” in the war.

First, to address Ukraine’s growing mental health crisis—during the war and in its aftermath—national and international actors across the public, private, and non-governmental sectors must align around a clear set of strategic priorities. Building a resilient, responsive, and sustainable mental health system is not only a humanitarian imperative, but a cornerstone of long-term recovery, resilience, and national security.

Second, while precise predictions are difficult, experts generally anticipate that Ukraine’s mental health needs will remain elevated for at least three to five years after the war ends, and potentially much longer if the conflict continues in any form. The Lancet Psychiatry Commission has underscored the urgency of rapidly scaling up services as a way to prevent a deeper and more protracted crisis.

Third, coordination is critical: between ministries, NGOs, and international donors, and across the patchwork of pre-existing and newly established mental health services. Without it, service duplication and systemic gaps become inevitable.

Fourth, in mental healthcare, speed matters, and in wartime, it matters even more. The focus must be on early detection and early intervention. Even basic mental health first aid, delivered at scale, can mitigate suffering and prevent deterioration. This must go hand in hand with public health campaigns that promote prevention, self-care, and mental health literacy.

Fifth, all efforts that improve the detection of mental health problems and encourage help-seeking, especially within vulnerable communities, must be strengthened. Nationally coordinated services must be delivered regionally, embedded in communities, and easy to access. Mental and physical healthcare as well as social care must be integrated within a stepped-care model for global mental health that is both scalable and sustainable.

On the silent frontline of mental health, policy must be as determined as military strategy.

Robert Schuett is co-founder and managing partner at STK Powerhouse, a global risk advisory firm. A former Defence civil servant, he also serves as Chairman of the Austrian Political Science Association and is a long-standing Honorary Fellow at Durham University.

Susanne Schuett is a senior executive at a Viennese outpatient mental health clinic. A psychologist by training, she holds the habilitation (venia docendi) in psychiatry from the Medical University of Vienna and serves on the advisory board of STK Powerhouse.

Photo by Maisa Borges