Applying the national mental health policy in conflict-affected regions: towards better social inclusion (Ukrainian case)

Abstract

Purpose The ongoing armed conflict in Ukraine has had wide-ranging health, social and economic consequences for the civilian population. It has emphasised the need for comprehensive and sustainable reform of the Ukrainian mental health system. The Ukrainian Government has approved a vision for national mental health reform. This study aims to draw on the lessons of mental health reform in other conflict-affected settings to identify areas of priority for applying the national mental health policy in conflict-affected regions in the direction of better social inclusion of people with mental health conditions (Donetsk and Luhansk regions, directly affected by the conflict). Design/methodology/approach A literature review was conducted to identify lessons from implementing mental health reform in other conflict-affected settings. Findings were summarized, and best practices were applied to the national and regional policy context. Findings The literature described emergencies as an opportunity to build sustainable mental health systems. A systematic and long-term view for reform is required to capitalise on this opportunity. For better social inclusion, implementation of the concept for mental health and mental health action plans in Donetsk and Luhansk regions should prioritise raising mental health awareness and reducing stigma; developing the capacity of local authorities in the development and coordination of services; tailoring mental health service provision according to the availability of services and population need; targeting the needs of particularly vulnerable groups and embedding the activities of humanitarian actors in local care pathways. Research limitations/implications This study summarises the literature on mental health reform in conflict-affected settings and applies key findings to Eastern Ukraine. This study has drawn on various sources, including peer-reviewed journals and grey literature and made several practical recommendations. Nevertheless, potentially relevant information could have been contained in sources that were excluded based on their publication in another language (i.e. not in English). Indeed, while the included studies provided rich examples of mental health reform implemented in conflict-affected settings, further research is required to better understand the mechanisms for effecting sustainable mental health reform in conflict-affected settings Originality/value The paper describes opportunities for developing a local community-based mental health-care system in Ukraine, despite the devastating effects of the ongoing war.

Bridging gaps: improving the access of primary health care in rural Ukraine through mobile health units

“…Because of the hostilities and population displacement, the conventional primary healthcare infrastructure has proved insufficient in meeting healthcare requirements in certain rural areas [3]. Although we do not advocate for the complete abandonment of reforming traditional primary healthcare delivery methods, the implementation of mobile health units within the government-funded program «Medical guarantees» could expeditiously address the most pressing healthcare needs of the rural population.…”

Factors Associated With People’s Accessibility to Mental Healthcare Services in Ukraine: Focusing on Household Head Vulnerability

“…Since socioeconomic constraints can be risk factors for depression and anxiety, the provision of mental health support to vulnerable Ukrainians must be emphasized [4,5]. In Ukraine, the mental healthcare system focuses on inpatient care, with approximately 89% of the total mental health expenditure being allocated to inpatient services [9,10]. Currently, the provision of mental health services in primary care and community settings is limited [9,10].…”

“…In Ukraine, the mental healthcare system focuses on inpatient care, with approximately 89% of the total mental health expenditure being allocated to inpatient services [9,10]. Currently, the provision of mental health services in primary care and community settings is limited [9,10]. Since 2014, the need for psychological assistance among the conflict-affected population has changed, and the prevalence of individuals experiencing the effects of violence has increased.…”

“…The war imposed a substantial burden on the system and damaged or destroyed health facilities, such as secondary and tertiary mental health facilities. In the Donetsk and Luhansk regions, 77 of 350 and 26 of 250 healthcare facilities were damaged and destroyed, respectively [9]. According to an earlier study, the access to mental healthcare services in the Donetsk and Luhansk regions has been limited by travel and other constraints [9].…”

Decentralisation and community stakeholders’ engagement for better mental health services development in the conflict-affected regions of Ukraine

“…That is especially important in conflict-affected regions. They are more deprived in financial and infrastructural terms and less equipped with modern attitudes towards human rights protection and mental health awareness (Quirke et al , 2022). At the same time, they have more needs for community-based services precisely because of this situation and have resources not available elsewhere – international and national humanitarian non-governmental organisation (NGOs) active in the region.…”