The Lancet Psychiatry Commission on mental health in Ukraine

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Executive summary

The Russian invasion and annexation of eastern Ukraine and Crimea in 2014, along with the ongoing war since February, 2022, have inflicted incalculable damage to Ukraine with many deaths and injuries, massive population displacement, and extensive physical and emotional trauma. These events put an immense strain on the general health-care and mental health-care systems. For many years the mental health-care system in Ukraine was dominated by large psychiatric hospitals and residential

Introduction: History and vision for change

Ukraine, the largest democratic country in Europe, has been faced with a perfect storm of challenges. From 1922 to 1991, it was part of the Soviet Union where the mental health-care system was dominated by large psychiatric hospitals and residential institutions focusing almost exclusively on biological therapies. The system was well known for neglect, abuses, and human rights violations.1, 2 As Ukraine emerged from the Soviet era into independence, it underwent massive political, economic, and

Part 1: Community-based mental health care and a vision for a new network of Ukrainian mental health-care services

The Commission developed a consensus that Ukraine should develop a network of community-based mental health-care services. A sequence of incremental steps of change should be designed to facilitate progression from the current system towards a community-based mental health-care system.Before 2017, the Ukrainian mental health-care system focused on treatment and tracking (called dispanserisation) of people with severe mental disorders. This strategy was delivered through a network of inpatient

Part 2: Training and education of the mental health workforce

A 21st century mental health-care system requires an enabled and skilled multidisciplinary workforce that meets the immediate and emerging needs of the settings in both primary care and specialist mental health-care systems. Nurses, psychologists, allied health professionals, family doctors, and specialists in psychiatry are the core of this mental health workforce. This diverse group requires broad, overlapping capabilities and discipline-specific competencies to function as an integrated and

Part 3: Rebuilding mental health research capacity and infrastructure

Historically, Soviet models have dominated Ukrainian mental health research, leaving the country lagging behind European, US, and other models. Since Ukraine gained independence, with the assistance of international colleagues, creative leaders in Ukrainian psychiatry have initiated efforts to remedy these problems. However, the Russian invasion of eastern Ukraine and Crimea in 2014, and the full-scale war in 2022, led to the massive destruction of Ukrainian universities and research

Part 4: Reform of advocacy and legal principles regarding mental health

Mental health regulations in Ukraine are steeped in outdated concepts. These include a deficit focus, limitations on legal capacity, and criminalilisation of mental disorders. These all serve to reinforce stigma and promote the image of those with mental disorders as being second class citizens. Although Ukraine's First Lady and many NGOs, among others, are raising awareness about the prevention of mental health impairments during the war, the likelihood of war-related serious trauma is growing

Part 5: Resourcing the future of mental health

Similar to many mental health-care systems inherited from the Soviet era, mental health-care services in Ukraine have been delivered using a predominantly biomedical approach that relied on a specialist, institution-based model of care. The Ukrainian Government's Concept Note (2017)⁷ and Action Plan (2021)¹⁰⁷ for mental health set out a very different, more contemporary vision for Ukraine, including legislation that aligns with international human rights, new mental health promotion and

Commission conclusion

The Lancet Psychiatry Commission on mental health in Ukraine offers recommendations for further development of the Ukrainian mental health-care system that ensure relevant interventions and services can be provided for all population groups, at all stages of life, in health and disease. The envisioned network of services includes: basic psychosocial support and brief psychological interventions provided by non-specialised staff in the community; management of common mental disorders in primary

Declaration of interests

MCD declares support from the Commission for travel expenses to attend research group meetings; she is President of the European Union of Medical Specialists Section of Psychiatry, a European Exam Board member, Secretary of the European Psychiatric Association Section on Women's Mental Health, and a Member of the European Psychiatric Association Publications Committee. NS declares being a member of Executive Board and Secretary for Education and Scientific Publications of the World Psychiatric

Acknowledgments

We thank Tsuyoshi Akiyama, Geert Dom, Semen Gluzman, Helen Herrman, Christina W Hoven, Afzal Javed, Vinay Lakra, Norman Sartorius, Danuta Wasserman, and Oksana Zbitnieva for their valuable suggestions and participation as Advisory Board members. We thank Marianne Schulze for the valuable contribution to the Legal and Advocacy group. We also thank Devora Kestel and Jarno Habicht for their leadership and administrative support.