A group of experts proposed a shift toward community-based mental health care, as well as legal reform and workforce development.
ADVERTISINGAlthough Ukrainians have found ways to continue with their lives, the constant bombingsthe lows and the uncertainties of war times have taken their toll. Studies conducted shortly after Russia launched its full-scale invasion in February 2022 revealed that 55% of Ukrainians were suffering from a significant increase in anxiety and 26% disorder post-traumatic stress (PTSD).
“Our fight for freedom and democracy has a high price, a price we pay not only in lives, but also in the mental and emotional toll of our people,” he said on Wednesday Oksana Zbitnievawho heads the Ukrainian government’s coordinating center for mental health. “This is the reality we face in the heart of 21st century Europe”he added.
However, restoring mental health in Ukraine is about much more than winning the war: it also involves rethink the entire systemincluding patient care, staff training, scientific research and legal reform, according to a group of mental health experts from 12 countries who have worked with Ukrainian psychiatrists to formulate recommendations published in the medical journal The Lancet Psychiatry.
Much of that work involves including the mental health on the agenda. According to the The Lancet Commission on PsychiatryUkraine currently spends around 8% of its gross domestic product (GDP) in healthcareof which approximately 2.5% is allocated to mental health, mainly for patients in psychiatric hospitals and long-term care.
The Ukrainian institutional approach to mental health care is a relic of the soviet erawhen the State weaponized the system confining political dissidents in psychiatric hospitals. According to the Commission’s report, these facilities can currently house around 30,000 people.
Today, Ukraine must move, experts say, toward a more community-based model, in which people with common mental health problems, such as depression and anxiety, can receive help in non-specialist settings, such as their GP surgery, while people with more serious conditions receive care through mental health centers and other partners.
These services should also be tailored to specific groups of patientsas veteransancient prisoners of war and displaced people from their homes and communities, they noted.
That work is already underway, with a mental health law which the Ukrainian government is studying. “The ongoing reform will replace the outdated Soviet psychiatry with a modern system,” Zbitnieva declared.
The Commission established some goals for this transition in the next five to ten years. According to experts, in addition to reducing the number of people admitted to hospitals and other centers by 50%, the capacity of primary care will have to be multiplied by 16, triple community-based mental health services (from 65 to 185 programs) and double the capacity of outpatient centers.
According to Dan Chisholm, head of Mental Health at the World Health Organization (WHO) for Europe, This would mean a 45% increase in public spending on mental health, but also a 37% decrease in patients’ out-of-pocket spending.. Total public spending on mental health would amount to 4.5% of the budget.
Training and research
According to experts, Ukrainian health personnel must also be strengthened to meet the needs of the population, especially considering that the coronavirus pandemic COVID-19 and the war with Russiadisrupted the education system and reduced the pool of future mental health workers.
They recommend that the residency programs of the new psychiatrists they expand two to five years, to bring them in line with European standards and indicate that workforce development should also be accompanied by improvements in high-level research.
Currently, less than 0.5% of public budgets are allocated to mental health researcha level that must be increased so that both the most experienced and up-and-coming scientists can compete on the international stage.
The Commission of experts wants Ukrainian research on mental health to be supported and integrated with the rest of the European scientific community by 2030. The road could be long, since the number of applications for entry into the Ukrainian medical faculties has gone from 25,200 in 2019 to around 19,900 in 2023, which represents a 21% decrease.
Furthermore, the Commission said, a increased government funding Legal reform is likely to be necessary to achieve all of these goals. This includes the application of mental health laws that limit involuntary interventions, such as institutionalization, as well as review of Ukraine’s guardianship systemthat legally incapacitates people with mental health problems.
ADVERTISINGIrina Pinchuk, president of the Ukrainian Psychiatric Association and co-chair of the new Lancet Commission on Psychiatry, acknowledged that “the plan for Ukrainian mental health is ambitious”.
But The Lancet experts don’t just want Ukrainians to psychologically recover from the war: They want the new system to become an example for other countries who are rethinking their own approaches to mental health care. “It is important that we build this system based on the best global data and practices,” Zbitnieva said.