In 2020, the resurgence of conflict in the Karabakh region of the South Caucasus led to 91,000people seeking refuge in Armenia, many of whom urgently required mental health support [1]. Compounded by the COVID-19 pandemic, this placed an enormous strain on Armenia's healthcare infrastructure, particularly its mental health services. Needs assessments conducted during and after the conflict emphasized the crucial necessity of Mental Health and Psychosocial Support (MHPSS) for both displaced individuals and host communities,[2][3][4][5] Originally centralized, Armenia's mental health system primarily delivered MHPSS services to refugees through urban facilities. [6] Recognizing the need for broader geographic reach, a concerted effort was initiated to decentralize healthcare services, integrating mental health support into the existing primary health care (PHC) system. In 2022, the mental health Gap Action Programme (mhGAP) project was launched in Armenia to train PHC doctors across four regions (Kotayk, Gegharkunik, Ararat, and Syunik) and the capital city, Yerevan.[7] This initiative substantially improved access to quality MHPSS support, reducing societal stigma and offering crucial care to over ten thousand individuals, including refugees and host community members. The provision of MHPSS services contributed to achieving the results in Armenia mentioned in Output 2.3.3. “Essential health services and systems maintained and strengthened in fragile, conflict and vulnerable settings”, in line with outcome 1 on health in the United Nations Sustainable Development Cooperation Framework for Armenia. It is also a good example of putting “Delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region” into practice, through mobilizing resources and partnerships, and providing accessible, flexible support to build country capacity. 

How did Armenia, with the support of WHO, achieve this?

There is an acute, urgent need for MHPSS in Armenia, especially among displaced people dealing with emergency-induced social challenges such as family separation, lack of safety, and disrupted social networks. Studies suggest that in the longer term, almost everyone affected by emergencies will experience some form of psychological distress, with an estimated 22% of people who have experienced war or other conflict in the previous 10 years, going on to experience depression, anxiety, post-traumatic stress disorder, bipolar disorder, or schizophrenia. WHO therefore estimates that 22 500 Armenian refugees may experience a mental health condition.[8] 

With the slogan – Mental Health for All! – the mhGAP programme in Armenia aimed to strengthen community-based mental health care to reduce mental health and psychosocial suffering and promote the well-being of population affected by armed conflict, thus improving their access to mental health and psychosocial support. In the programme’s target regions, it sought to ensure that 20% of primary health care facilities were enabled to provide quality and evidence-based community mental health and psychosocial support.[9]

^{Mental health and psychosocial support training of healthcare providers in Aghveran, Armenia.}
Photo credit: WHO Armenia/Marietta Khurshudyan

This cooperative endeavour between WHO, the European Commission, and the Ministry of Health of Armenia was launched in June 2022 and then followed by a stakeholder meeting in the presence of MoH and WHO representatives. Between 2022 and 2023, during the project's initial phase, the programme emphasized enhancing the skills of PHC doctors through specialized training sessions. With the support of the European Commission’s Civil Protection and Humanitarian Aid department, WHO Armenia tailored WHO’s global training materials to suit the local context, ensuring they addressed the unique needs of Armenia’s doctors and making them accessible in Armenian language. WHO, in collaboration with the Armenian Psychiatric Association (ArPA), organized Training of Trainer (ToT) sessions and provided supportive supervision in the community. These self-care training sessions for medical doctors aimed to help safeguard them from burn-out and were held in-person, in open-air settings. 

After undergoing the specialized training, PHC doctors were much better able to assess, diagnose, manage, and refer individuals with common mental health conditions. Crucially, integrating mental health services into PHC settings helped to reduce societal stigma surrounding mental health. 

"The knowledge gained via the training, first, had an impact on myself. I started to observe the patients with mental disorders from a different perspective. I developed my own plan on the provision of (psychosocial) services․ I learned how to listen to the patient, acknowledge their state and allow them to have an equal voice in making decisions on their treatment options."

- Anush Nersisyan, a PHC doctor from Syunik

Although the original target was to train 20 percent of PHC doctors in the designated five regions, the project's success and urgency led to full training coverage for all PHC doctors. 

Additionally, WHO Armenia collaborated with the Republic of Armenia Ministry of Health to conduct technical meetings, developing a well-defined referral system between PHC services and specialized mental health services. This integration is a crucial component of Armenia's National Action Plan for the Maintenance and Promotion of Mental Health for 2022-2026. [10]

“Now it is easier to access mental health services available at our local primary health centre with guidance from  doctors I trust, unlike before when we had to reach Yerevan, where these services were usually centralized.”

- Member of a host community, Kotayk region, Armenia

As the immediate need for MHPSS in Armenia is acute, in addition to health workers, WHO is training volunteer community members and psychologists and working to establish a mental health helpline, offering callers empathy, and helping to defuse painful feelings related to the crisis.[11] WHO launched an emergency donor appeal for Armenia for a total of US$ 2.9 million, running from September 2023 through February 2024, that will ensure that the MHPSS activities can continue for refugee and host populations. [12]

Armenia, with support from WHO, has successfully reoriented its healthcare system to meet an immediate and growing need. The project has not only improved accessibility to mental health services but has also played a pivotal role in reducing societal stigma, laying the groundwork for a more holistic and sustainable mental health infrastructure in the future.