To support primary health-care professionals to provide mental health services in eastern Ukraine, 12 teams of family doctors and nurses from Kramatorsk in the Donetsk region were trained to identify the symptoms of widespread mental conditions such as depression, acute stress, grief, post-traumatic stress disorder, self-harm and substance use disorders, and to provide basic mental health care. The training took place on 21–24 May 2019.
“There is a widespread misconception that all the interventions for mental health issues are complex and can only be delivered by highly specialized health professionals,” said Dr Jarno Habicht, WHO Representative and Head of the WHO Country Office in Ukraine. “Recent studies have shown the feasibility of delivering pharmacological and psychosocial interventions in non-specialized health-care settings.”
As part of its support to the Ministry of Health of Ukraine in implementing the National Mental Health Concept, WHO provides stewardship in reorienting the mental health-care system from an institutionalized model to one that is patient-oriented and accessible on a community level.
“A key strategy for achieving universal health coverage for people with mental, neurological and substance use disorders is the integration of mental health services into community-based services and primary health care,” added Dr Habicht.
As a part of the ongoing health-care transformation, the Cabinet of the Ministers of Ukraine approved the Mental Health Development Concept. The Ministry of Health is also currently finalizing the country’s mental health action plan up to 2030. Both documents aim to develop community-based mental health services and integrate mental health services into primary care and other sectors.
Integrating mental health into primary care through the WHO Mental Health Gap Action Programme (mhGAP)
In close cooperation with the Ministry of Health, WHO introduced a new approach for the integration of mental health into primary care through the implementation of mhGAP. The training in May marked the rollout of the programme at the subnational level in Ukraine.
mhGap aims at scaling up services for mental, neurological and substance use disorders, especially for low- and middle-income countries. The programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia and epilepsy, prevented from committing suicide and supported to lead normal lives – even where resources are scarce.
“Despite the high level of interest in the topic of mental health in Ukraine, many important issues in this area still remain unaddressed. These are issues such as high suicide rates, depression, alcohol-related problems and highly institutionalized psychiatric care,” said Mr Sergii Shum, Director of the Centre for Mental Health and Monitoring of Drug and Alcohol Abuse of the Ministry of Health of Ukraine.
“We are confident that through the implementation of mhGAP, family doctors can help resolve many of these issues. The integration of mental health into the general health system is a long process that requires joint efforts of various specialists,” continued Mr Shum.
Prioritizing eastern Ukraine
Following a national mhGAP planning and adaptation workshop held in October 2018, the Donetsk region, which is affected by armed conflict, was prioritized for mhGAP implementation. As part of its humanitarian response to the crisis in eastern Ukraine, WHO provides support in organizing mhGAP trainings and supervision for health-care workers. It aims to ensure the sustainability of a newly established service model to address the needs of the conflict-affected population.
Knowing how to ask the right questions and manage patients
The 4-day training focused on identifying mental health conditions and equipping health workers with the tools to manage patients.
For Ms Tetyana Ivanchenko, a primary care nurse, the recommendations regarding communication with a patient who displays the symptoms of a mental disorder were key. “Of course, it is not difficult to ask about the life situation that a patient is going through, what personal problems they are experiencing. However, you need to know how to ask the right questions, so that the patient is not offended. During the training, we learned about the importance of visual contact, empathy and the tone of voice of a health worker,” she said.
“We need to treat all people with dignity and respect. I have noted that when we manage to establish personal contact, patients do not skip follow-up visits and parents do not miss regular check-ups of their children,” Ms Ivanchenko added.
Family doctors such Dr Yevhen Yatsura from Kramatorsk often encounter people with mental disorders in their daily practice. Acquiring the tools to manage such cases and sharing experiences with other primary care professionals during the training provided invaluable insight.
“Cases of panic attacks and depression often occur in patients who come to me with complaints of high blood pressure and frequent irregular heartbeat,” highlighted Dr Yatsura. “The training provided clear tools for managing patients with similar symptoms as well as referring mechanisms. I especially liked that during the training we worked in teams with nurses and psychiatrists. This way we discussed practical cases and shared our experiences with each other.”
In line with WHO recommendations, continuous technical support will be provided to the trained health-care providers and local and national health authorities as the mhGAP model is tested in the Donetsk region and other regions of Ukraine for further scale up.