Institute of Global Health Innovation

Two years on from the invasion of Ukraine, we publish a series of blog posts sharing insights from our Ukraine Health Summit, hosted in partnership with the British Red Cross to further efforts in supporting the delivery and restoration of health services in Ukraine.

The first post addresses the importance of mental health services in post-conflict Ukraine, and is written by Melanie Leis, Institute of Global Health Innovation, Imperial College London, with colleagues.

On April 25^th 2023, Imperial College London hosted the first Ukraine Health Summit. This event presented an opportunity to discuss how Ukraine’s health system must be re-built to ensure it addresses the needs of its population in a post-conflict setting. A focal point of the discussion was around the provision of mental health services.

The WHO projects that, of populations affected by conflict at any time during the prior 10 years, 22% will develop a mental health condition. Applying these estimates to the population of Ukraine (44M), this would lead to approximately 10M who will have a mental health condition such as depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia, in addition to existing mental health cases1. Estimates by Ukraine’s government suggest that over 60% of its soldiers are affected by post-traumatic stress disorder, and approximately 50% of the population needs mental health services to cope with the impact of the war^2.

Mental health experts at the Ukraine Health Summit agreed that post-conflict mental health service provision should be planned and coordinated across three key themes: policy and regulation, training and education, and family support.

Policy and regulation

The healthcare system in Ukraine, including its mental health services, is a legacy of its Soviet past. Prior to the war, there had been a trend towards reform of the mental health system to address challenges such as limited social services for people with mental health disorders, large institutionalised psychiatric populations (at times associated with human rights violations), and public stigma around mental health^3. 

In December 2022, Ukraine’s First Lady launched the Ukrainian Prioritized Multisectoral Mental Health and Psychosocial Support Actions During and After the War: Operational Roadmap^4. This roadmap, informed by international and national policies and best practice, aims to provide an overview of mental health and psychosocial priorities to stakeholders involved in the immediate response and the recovery efforts in Ukraine.

One of the issues in the provision of healthcare services in the current conflict setting is the lack of coordination between Government, international organisations and NGO activities. To effectively deliver mental health and psychosocial support in a post-conflict setting the Government must coordinate service delivery. This includes providing greater clarity on service availability, treatment pathways and enforcing regulation to ensure that the services that are delivered meet the highest quality standards. At the same time, non-public sector mental health providers must follow the Government’s leadership.

Training and education

Raising public awareness about mental health issues in the Ukraine is of paramount importance. This includes launching information campaigns and educating the general public about PTSD, depression, panic attacks, and other mental health conditions likely to affect the population.

Crucially, the conflict will have decreased the number of staff available to deliver mental health and psychosocial services. Effective psychosocial support can be delivered by professionals who do not necessarily have to be mental health specialists, but they must be adequately trained. Volunteers who are deployed with no training and are exposed to traumatic events risk developing their own mental health disorders. Furthermore, the impact of inadequately delivered mental health interventions can range from ineffective to ultimately harmful5.

Additionally, those providing mental health and psychosocial support services must have their own mental health needs adequately supported to deliver these services effectively and sustainably. One approach to do this is through mental health providers becoming “trauma informed organisations”, where safeguards are in place to provide physical and emotional safety to staff and avoid re-traumatisation^6.

Family support

Mental health needs vary significantly across different population groups. People with pre-existing mental health conditions may have deteriorated during the war, both due to the direct impact of the conflict and to the decrease in access to care. Additional groups that require mental health services include active military personnel and their families, veterans and their families, bereaved families, children exposed to war, and relocated/displaced families. An individual may be part of several of these groups at once.

There is an opportunity to leverage digital mental health interventions to support families. A scoping review7.identified 36 studies of these interventions, the majority of which targeted young people and parents/carers. These were self-guided, potentially improving access to psychological support without increasing demand on limited clinical services. Most of the interventions tested were associated with improved psychopathology.

Mental wellbeing is strongly associated with a person’s basic needs being met. This is even more the case in a post-conflict setting. One study that looked at the use of healthcare and community-based services in war-affected regions of Croatia found that, although a variety of services were put in place to help the affected population, only the solution of housing (accommodation support) significantly predicted traumatic stress recovery^8.

The importance of safety and stability for the affected populations cannot be overstated, as these are crucial to people’s mental well-being. For some specific populations, a key factor in mental health recovery will the passage of time and the return to a safe and predictable routine.

Government leadership, well supported frontline mental health workers and a focus on wider societal support will create the conditions for successful mental health service in post-conflict Ukraine.