Alyona Mazhnaya is a senior lecturer at the National University of Kyiv-Mohyla academy in Kyiv, Ukraine and a recipient of the NIH K43 Emerging Global Leader Award to examine knowledge attitudes, mental health treatment practices and implementation environment among primary healthcare providers in Ukraine. After Russia invaded Ukraine on February 24th, 2022, the project focused on characterising the emergent landscape and dynamics of mental health services providers working in response to the war in Ukraine. Alyona is interested in understanding the context for scaling-up mental health services for the people in Ukraine and other LMIC and humanitarian settings. Dr Mazhnaya has a background in Epidemiology and Behavioural sciences and completed her PhD at Johns Hopkins Bloomberg School of Public Health.
According to the WHO situation report, approximately 18 million people have been affected by the escalation of the war in Ukraine since February 24, 2022. As the war continues, the population of Ukraine continues to experience acute psychological distress, exacerbation of chronic mental health problems, and socioeconomic effects imposed by the war. In contrast, access to psychological and psychiatric support is limited. As the healthcare system has been stretched beyond capacity, multiple local and international organisations have mobilised to provide mental health services for various target groups and in many locations using different modalities. A steep increase in the number of service providers and the type of services that followed presents both: the opportunity and challenges from the perspective of scaling up mental health services to meet the needs and be sustainable. The gap remains in documenting, systematising, and analysing the implementation landscape for mental health services in Ukraine and humanitarian settings.
We conducted semi-structured interviews to gather insights about perceived features of outer context, bridging factors, and preparation and implementation of interventions according to the EPIS framework. Data collection is ongoing, with a target sample size of up to 30 participants. Completed interviews include 8 participants who are mental health service providers working on regional, national, and international levels directly providing mental health services, organising them, or funding. Data were analysed thematically by identifying deductive (stemming from EPIS framework) and inductive themes.
Several salient themes originated during analysis: recognition of mental health as a critical current and future area of public health in Ukraine, changing needs and services, and challenges to coordination and strategy-based programming. The most salient theme is the shared understanding of the critical role of mental health services for the population and the government’s commitment to reforming mental health services in Ukraine. Participants described the changing needs since the full-scale invasion, and service providers have been adapting programs and services to meet those needs. The data also highlights the need to build partnerships and find a place in the national mental health service provision system. Partnerships and referrals are largely based on ad-hoc collaborations and a need to solve particular programmatic/project goals. Initiatives, projects, programs, volunteer efforts and state-funded services are challenging to coordinate and navigate for the end user.
Currently and in the future, mental health is a central public health issue in Ukraine. Programs and services are changing in response to needs. However, they need to be integrated into a mental health government strategy to improve experiences for the end user.