Mental health care system: key achievements and plans
Mental health care system: key achievements and plans
During the war, Ukraine faces serious challenges in the field of mental health. In 2024, the Ministry of Health, together with its partners, took further important steps to build a modern mental health system, integrating services at all levels of care. The goal is to ensure that every Ukrainian has access to the help they need.
1. Primary level of medical care
In 2024, a record number of Ukrainians were covered by mental health services at the primary level. Thus, this year, more than 500 thousand patients have been registered with the EHCS, who received assistance under the package of the medical guarantees program “Support and treatment of adults and children with mental disorders at the primary level”. This is four times more than in 2023 (135 thousand patients).
The NHSU paid UAH 80.8 million for these services (as of 15/12/24), which is significantly higher than last year’s expenses of UAH 21.5 million.
One of the main drivers of change is the training of primary care physicians under the WHO mhGAP* program, which helps family doctors better identify and treat mental disorders.
To date, more than 25,000 primary care physicians have been trained under the mhGAP program.
*mhGAP (Mental Health Gap Action Program) is a global flagship program of the WHO aimed at increasing access to mental health services by involving non-specialized mental health workers (e.g., family doctors and pediatricians) in the care of people with mental disorders.
Starting from 1 January 2025, mental health services will become mandatory for all primary healthcare facilities contracted with the NHSU, regardless of ownership.
2. Specialized medical care
In 2024, the first 31 mental health centers were established. In total, it is planned to create at least 200 such centers that will provide outpatient and inpatient psychosocial support throughout the country.
The centers will be staffed by psychiatrists, psychologists, psychotherapists, medical and social workers. They will also have multidisciplinary mobile psychiatric care teams that will provide services at the patient’s place of residence (stay).
Due to changes in regulations, the capacity of mobile multidisciplinary teams has been strengthened. Thus, starting from 1 July 2024, mental health care services for adults and children are provided by mobile multidisciplinary teams at the rate of one team per 150 thousand people in the region (instead of 200 thousand as before). This made it possible to create such teams not only in supercluster hospitals, but also in cluster hospitals, and their number increased from 60 to 100.
As part of the joint project of the Ministry of Health of Ukraine and the World Bank “Health Enhancement and Lifesaving” (HEAL Ukraine) in the mental health area, UAH 124.5 million is planned to be allocated for the development of 60 psychological relief spaces, which will also help bring mental health services closer to communities.
3. Legislative regulation of the mental health care system in Ukraine
In 2024, the Verkhovna Rada supported in the first reading the draft law No. 12030 “On the Mental Health Care System in Ukraine.” Its goal is to create an accessible, efficient, and well-coordinated system that will work for all citizens of the country. The document envisages the integration of the principle of “Mental Health in All Policies” to consider the impact of each decision on the population's mental health.
4. Improving the quality of inpatient care
The Ministry of Health has approved a new Procedure for the provision of psychiatric care in inpatient settings, which ensures the observance of patients’ rights:
· prohibition on closing ward doors,
· access to water and the Internet,
· creating comfortable conditions for treatment, etc.
The approved order protects the rights of patients to decent conditions of stay and treatment; prevention of any form of physical, psychological or exploitative violence against patients.
5. Integration of mhGAP into medical education
The first steps have been taken to implement the WHO mhGAP program in undergraduate and postgraduate medical education at pilot universities. The professional community is talking about the need to further implement the program as a full-fledged part of the system of training future healthcare professionals on an ongoing basis. This will increase patients’ access to psychological services by involving general practitioners in helping people with mental disorders.
6. Adoption of a unified PTSD protocol
Order of the Ministry of Health of Ukraine No. 1265 dated 19.07.2024 approved the Unified Clinical Protocol of primary and specialized medical care “Acute stress response. Post-traumatic stress disorder. Disorders of adaptation”. It describes uniform principles for the prevention, diagnosis, treatment, and monitoring of patients.
The document was developed taking into account the modern requirements of evidence-based medicine to improve the results of medical care for patients with acute stress reaction and PTSD.
7. Improving the quality of psychiatric examinations
The Ministry of Health of Ukraine, by Order No. 1759 of 15.10.2024, amended the Procedure for conducting preliminary, periodic and extraordinary psychiatric examinations, including for the use of psychoactive substances. This will prevent abuse, for example, when certificates of such examinations are issued without the examination itself, and the institutions that conduct them do not have the appropriate specialists.
These steps and changes ensure the integration of mental health services at all levels of the health care system. This will create a holistic, sustainable system where mental health is an integral part of general medical care, with a focus on prevention and support for the most vulnerable populations.
The changes are part of the Ministry of Health’s priority project “Mental Health Care in the Structure of Medical Care” and the All-Ukrainian Mental Health Program “How Are You?” initiated by Olena Zelenska.