In her address to the 75th World Health Assembly, the First Lady of Ukraine, Olena Zelenska, highlighted the mental stress experienced by Ukrainians because of the war in Ukraine. She spoke of residents of Kharkiv – who had been living underground in the subway for three months while the city was being shelled – who could not “psychologically bring themselves to rise up,” leave the shelter and return to their homes.
Ukraine’s current mental health situation is mirrored across other regions affected by protracted conflicts and war. One in five (22%) people who have experienced war or other conflict in the previous 10 years, will have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia. In applying these estimates to Ukraine, WHO expects that approximately 9.6 million people in Ukraine may have a mental health condition.
Ensuring appropriate services are immediately available in complex emergencies will help to address a wide range of peoples' pre-existing and emerging mental health and psychosocial needs, as well as support the healing and rebuilding of affected communities.
Transforming mental health systems in war-affected regions
The war in Ukraine has placed additional pressure on an already strained mental health system, disrupting much needed mental health and psychosocial support (MHPSS) services for people in need. However, vital work is already ongoing to strengthen the emergency response system and build up primary and community mental health care provision.
Streamlining MHPSS emergency-response systems: Given the massive scale of Ukraine’s humanitarian response that drew support from over 270 organizations in the region, WHO worked to streamline MHPSS efforts. To ensure that the MHPSS response in Ukraine is evidence-based, equitable and makes effective use of limited resources WHO supported the development of a roadmap prioritizing actions that are urgently needed to address current MHPSS needs. Launched on 9 December 2022 by the First Lady and Ukraine’s Prime Minister, Denys Shmyhal, the operational roadmap will facilitate a humanitarian response built on existing structures, resources and innovations.
“Alignment with this roadmap will ensure that the provision of mental health services for populations in Ukraine, as well as the development of the mental health system, will be conducted in line with the best global practices and will also contribute to the effective planning and distribution of all available resources in this regard. WHO is here to stay in Ukraine and will continue working with all our partners on strengthening mental health service provision,” said Dr Jarno Habicht, WHO representative in Ukraine.
The roadmap draws on a new innovative tool: the MHPSS Minimum Service Package which outlines the basic MHPSS activities that should be implemented in emergency settings across health, protection, education and other sectors. These activities include disseminating information to raise mental health literacy; providing early childhood development activities; supporting community initiatives that promote mental health; and supporting caregivers to promote children’s mental health.
Strengthening primary mental health service provision: Recognizing that primary healthcare workers are the first point of contact in Ukraine’s health system, and as one of WHO's Special Initiative for Mental Health countries, WHO and the Ministry of Health mobilized the efforts of 14 partners to scale up Mental Health Gap Action Programme (mhGAP) activities across the country. These activities are a valuable tool in increasing services for people with mental, neurological and substance use disorders, and their families.
Since 2019, WHO and partners have trained more than 700 primary healthcare workers using WHO’s mhGAP Intervention Guide and its humanitarian emergencies edition to be able to recognize and respond to common mental health conditions. To further scale up capacity building efforts, WHO trained approximately 120 health care workers to provide training, enabling greater outreach. As a result of these efforts over 10% of Ukraine’s primary healthcare staff is due to receive mhGAP training by the end of 2023. WHO is also working with local stakeholders to launch an online, self-paced, adapted version of the training, aiming to reach up to 50,000 primary health workers across the country.
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Credits: WHO Ukraine
Expanding community-based mental health services: Originally launched in 2016 to respond to the mental health needs of internally displaced people in the east of Ukraine, Community Mental Health Teams (CMHTs) were rolled out nationally in 2021 through the WHO Special Initiative for Mental Health. Today 90 CMHTs provide person-centered and recovery-oriented care to people with severe mental disorders, particularly for people living in remote-regions with limited access to mental health services. Oleksii Kostiuchenkov, a member of one of the CMHT said, “99% of those who reach out to us have been directly affected by the ongoing military conflict.” Since the start of the war in Ukraine, CMHTs supported by WHO have provided 23,000 consultations for 1,400 people with severe mental health disorders since the start of the war.
“The work happening now during the acute response phase of the war will contribute towards strengthening Ukraine’s mental health system during the recovery phase,” said Dr Fahmy Hanna, a WHO technical officer for mental health. Efforts in Ukraine have already bolstered the capacity of health personnel and community mechanisms to provide quality MHPSS, and streamlined humanitarian responses in the country. This will ensure a stronger and more sustainable mental health system in Ukraine, and lead to better mental health for all Ukrainians.