Mental Health System Transformation in Ukraine: improving mental health services and bringing mental health care in line with international standards

10/10/2018 6777

World Mental Health Day (10 October) is a day for global mental health education, awareness and advocacy against social stigma.

Ukraine is currently implementing important health reforms, and one of the priorities is to improve mental health services. According to WHO estimates, mental or neurological disorders affect one in four people in the world at some point in their lives. In Ukraine, more than 1.6 million citizens are registered at psychiatric and narcological clinics and units nationwide. Only last year, about 185,000 of Ukrainians were diagnosed with mental health conditions and disorders. However, most people affected may not seek help at all due to lack of trust in the old system, stigma and other barriers.

Mental health reform is an integral component of the overall healthcare system transformation in Ukraine. The Ministry of Health of Ukraine has therefore developed several strategic steps to improve the quality of mental health care and services, including by:

integrating mental health care in primary care;
introducing comprehensive and evidence-based treatment options, prevention measures, early detection, timely referral to a psychiatrist;
organizing trainings for medical and multidisciplinary teams;
developing psychosocial rehabilitation centres;
addressing mental health needs among conflict-affected populations, especially veterans;
protecting persons with mental health problems from stigmatization;
implementing internationally recognized protocols and standards.

We are also making every effort to help people overcome barriers to seeking quality mental health care, including stigma and shame, lack of information and awareness, high cost of treatment, fear of having a public record as being diagnosed with mental illness, and geographical distance.

1. Ukraine abandons outdated approaches in favor of modern and evidence-based practices, and protects the rights of psychiatric patients

On June 10, 2018, Ukraine enacted the Law of Ukraine On Amendments to Certain Legislative Acts of Ukraine regarding the Provision of Mental Health Care. Pursuant to the provisions of this Law, patients can now take the initiative of asking the court for a second opinion on their mental health condition. In addition, the Law prohibits any type of forced medical sterilization.

The Ministry has also initiated the reorganization of psychiatric clinics and mental health care facilities in line with the world's best practices and international standards.

2. The Concept of the National Mental Health Program in Ukraine for the period until 2030

The new Concept was developed and approved under leadership of the MoH of Ukraine. The process consisted of several stages, including national consultations, public discussions and expert reviews, which allowed experts from all regions of Ukraine and representatives from government agencies, NGOs, international organizations, as well as academia, medical community and the civil society to comment on the document and to work together on its finalization.

The Concept focuses on several aspects of mental health care, outlines the key problems and the strategic steps to solve them, including improving accessibility of mental health services; raising awareness about mental health, common conditions and disorders; decreasing discrimination and human rights violations; promoting mental health and prevention (including suicide prevention); bringing educational standards and regulating professional activity of mental health care providers in line with international standards; supporting professional competence in mental health among specialists and generalists, as well as other professionals in related fields (primary care providers, nurses, psychologists, social workers, police officers, volunteers, teachers, etc.); ensuring high quality of care in line with international protocols and standards; tailoring approaches to the needs of certain groups (e.g., IDPs, ATO veterans, mothers and children, older persons); and improving the effectiveness of funding for mental health.

The Ministry of Health of Ukraine will start implementing the Concept immediately after its approval by other central executive authorities.

3. Quality improvement of mental health services for veterans

There has been a strong focus on trauma and PTSD in the context of the conflict in East Ukraine. At the meantime, it is still important to take a public health approach and to tailor mental health services to different population groups, especially veterans.

The Ministry of Health of Ukraine aims to ensure that veterans, regardless of their place of residence, receive high-quality psychological, psychotherapeutic, psychiatric and other types of care based on the evidence-based medicine principles. Veterans should be able to receive mental health services starting at primary care facilities (i.e. provided by a therapist or a family doctor), as well as at specialized centers or departments in clinics and hospitals.

The PTSD Center will be established to provide specialized services to veterans with severe mental illnesses and disorders, and related physical conditions.

4. Primary care mental health services

The integration of mental health services into primary care means that PHC doctors should be trained to identify the most common mental health disorders and conditions (e.g. post-trauma. anxiety, depression, etc.), to provide psycho-education and basic psychological interventions (depending on their competency), and to refer patients to specialists. It is not just about medical treatment, but also about the development of new approaches and methods.

With the support of the World Health Organization, we are introducing a new system of training in mental health for primary care physicians. Ukrainian family doctors, general practitioners and pediatricians will be trained according to the WHO Mental Health Gap Action Programme (mhGAP), which aims at scaling up services for mental, neurological and substance use. This year, the first pilot projects will be implemented in eastern Ukraine.

In addition to health workers, social workers, police officers, volunteers, and teachers will also be trained to provide basic services and support to patients with mental health conditions and disorders.

5. Suicide prevention program

Suicide as a cause of death is closely linked with common mental disorders and substance use. Ukraine has one of the highest suicide rates in the European region (15.3 per 100,000 in 2017). Although the national suicide rates have declined since 2005 (from 22.6 per 100,000 in 2005), Ukraine remains one of the 25 countries with the highest suicide rates in the world.

The Ministry of Health of Ukraine has therefore initiated the development of a National Life Line – a 24\7 hotline that anyone experiencing a personal crisis or despair can call to receive support and suicide prevention services. This service will be created based on the model of the Australia Lifeline. Last year, the Ministry of Health of Ukraine organized a working visit to Ukraine of the Australia Lifeline experts, who shared their experience and provided recommendations for the development of the Ukrainian Lifeline. The Ministry is currently working on the translation of protocols and the organization of trainings for Ukrainian specialists.

6. Creation of a national database

No qualitative change can be implemented without a thorough understanding of the real situation, or reliable feedback. The availability of accurate statistics, effective monitoring and control systems are essential to develop in the right direction. This will also allow the system managers to make informed decisions, to react in a timely manner, to prevent crises, and to ensure rational use of resources. Therefore, one of our strategic objectives at this stage is to develop common systems and procedures for collecting accurate statistics and reliable data, as well as information sharing and exchange between providers (e.g., different levels of health care, health and social services, etc.).

The Center for Mental Health and Monitoring of Drug and Alcohol Abuse of the Ministry of Health of Ukraine has already updated most statistical reporting forms and the methodology for monitoring alcohol and drug abuse in Ukraine.