Diana Chamrad, Ph.D.
Senior Technical Advisor, Vulnerable Children and Families, Mental Health
Imagine taking a road trip. A long drive to someplace new, where you can enjoy the scenery, make discoveries, and simply decompress.
If you’re like me, you’ll need to pull up a map on your phone for step-by-step instructions on how to get to where you decided to go. But now imagine as you’re already driving that you come across highway construction, and you need to take detours not shown on the map or you lose reception completely and can’t see the map at all.
That’s how I imagine the current situation in Ukraine as the country’s citizens are subjected to bomb threats, work disruptions, loss of life, changing institutions, loss of conveniences like electricity and food supplies, and the constant threat to their safety. What once was familiar and predictable has been dramatically impacted by the war. The path is no longer so clear.
As a clinical psychologist who has spent time in Ukraine, one concern takes precedence. How does a country at war battle not only a physical military but also an intangible war with the potential to ultimately weaken the psychological and spiritual wellbeing of a whole country? It has become clear that addressing mental health issues is critical for the well-being of the Ukrainian people, both in the short- and long-term.
The Challenges
Before Russia’s full-scale invasion of Ukraine in February 2022, an estimated 10 percent of Ukrainians were living with some degree of mental health concerns. By all reports, that percentage is escalating as the continued war erodes the psychological wellbeing of the people. Undeniable challenges exist, including ever-increasing rates of post-traumatic stress disorder, chronic stress, grief, co-existing health conditions and associated risk factors, gender-based and sexual violence, increased economic insecurity, and the impact of having basic needs including safety, shelter, food, water, and health care unmet under terrifying conditions.
Ukraine, like many other countries in the region, inherited a Soviet healthcare system that focused heavily on institutionalizing those who needed or sought mental health support. About seven years ago the country began moving more towards community-based care, but those efforts stalled with the full-scale Russian invasion in 2022. The First Lady’s Initiative on Mental Health soon after the invasion, has reinvigorated Ukraine’s efforts to improve and de-stigmatize mental health care.
But the road to quality mental health care is long. Mental health services are fragmented with limited referral mechanisms in place. It is difficult for people to find evidence-trained practitioners, especially in rural areas or areas closer to the frontlines. The mental health professionals who are available are experiencing the effects of the war themselves and may be displaced. And widespread stigma, limited information on mental health, and distrust of the system prevent people from seeking out mental health services.
Beyond the human cost there lies the very real economic costs. USAID and the Ukrainian government have directly tied economic stability to mental health. A healthy workforce is integral to the eventual recovery and rebirth of this war-torn country. Getting there, determining priorities, and finding the necessary funds offer both challenges and opportunities.
So how do we build the path to better, more realistic, mental health programs?
The Opportunities
Not just more, but better.
Building an effective mental health system of care in Ukraine does not simply mean adding more mental health providers to offer support. It means focusing on quality of care, care that is people-centered, based on evidence of what works, and is sustainable in the current context of the overall Ukrainian health system. Leaders can take small, immediate steps: upgrade training of health care professionals and introduce screening for mental health at the primary care level and in community settings. Building a system of care that integrates mental health across multiple sectors, including health, education, economic growth, veteran affairs, and justice, is equally critical.
URC has seen documented success in addressing mental health concerns in the Philippines, especially, where community-based mental health services have been implemented. The USAID RenewHealth project has demonstrated global best practices that align with USAID’s recently released position paper on mental health care, which argued for:
- Promoting sustainable enabling environments that support mental health
- Applying contextually relevant approaches in partnership with local mental health actors
- Addressing barriers to care seeking such as stigma
- Promoting ethical, quality standards focused on upholding human rights
Quality care is safe, effective, patient-centered, timely, efficient, and equitable. As Ukraine’s mental health system shifts from response to recovery, some of the mental health care gaps previously identified will need to be addressed by applying quality care standards to the development of a sustainable, community-based mental health and psychosocial support system.
As a mental health professional, my hope is that mental health will continue to gain attention globally and will become as important as physical health. Integrating mental and physical health is essential as we advance globally towards patient-centered care, aligning with One Health and universal health care goals.
