Strengthening Mental Health Support in the Wake of War
An international group of experts has devised a comprehensive plan to modernize Ukraine’s mental health system, severely strained by nearly three years of war with Russia. The continuous exposure to shelling, fatalities, and uncertainty has left profound emotional and psychological scars on Ukrainians. Studies conducted after Russia’s full-scale invasion in February 2022 revealed that more than half of Ukrainians experienced a sharp rise in anxiety levels, while a quarter of the population met the criteria for post-traumatic stress disorder (PTSD).
Oksana Zbitnieva, the head of Ukraine’s mental health coordinating center, emphasized the deep toll the war is taking not only in lives but in the mental and emotional health of the nation. As she explained, the fight for freedom has come at a steep price. The experts, in a report published in The Lancet Psychiatry, argue that restoring Ukraine’s mental health system goes beyond simply winning the war. It necessitates a complete overhaul of the system, including patient care, workforce development, legal reforms, and scientific research.
Ukraine’s mental health care system is still largely a remnant of the Soviet era, with much of its approach focused on institutionalization. Psychiatric hospitals today can house around 30,000 individuals, a model rooted in Soviet policies that at times weaponized psychiatry for political repression. The commission is calling for a shift to a community-based care model. In this model, individuals with common mental health conditions such as anxiety and depression can seek treatment at non-specialized settings like general practitioners’ offices. Those with more severe conditions would receive care at mental health centers or through community partners.
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Additionally, the recommendations emphasize the need to cater to specific groups, such as veterans, former prisoners of war, and internally displaced persons. This shift toward community-based care is already being addressed by Ukraine’s government, with new mental health legislation under consideration. The commission outlined ambitious targets for the next five to ten years, including halving the number of people housed in psychiatric hospitals, significantly expanding primary care services, and tripling the number of community-based mental health programs.
Achieving these targets would require a significant increase in mental health funding, which currently constitutes only 2.5% of Ukraine’s total healthcare budget, itself about 8% of GDP. Dan Chisholm, WHO’s mental health lead for Europe, noted that while achieving these changes would involve a 45% increase in public mental health spending, it could reduce out-of-pocket costs for patients by 37%.
Ukraine’s mental health workforce also requires urgent attention. The war with Russia and the COVID-19 pandemic have disrupted the country’s education system and reduced the pool of future mental health professionals. The commission recommends extending psychiatric residency programs to five years, aligning them with European standards. The report also highlights the need to increase government support for mental health research, which is currently less than 0.5% of relevant budgets. A strong research foundation is critical for integrating Ukraine’s mental health system with European counterparts by 2030.
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Legal reforms are another key component of the proposed mental health overhaul. The experts call for new laws to limit involuntary institutionalization and reforms to Ukraine’s guardianship system, which restricts the rights of people with mental health conditions. These changes are necessary to modernize Ukraine’s mental health care system and make it more patient-centered, equitable, and integrated with international best practices.
Dr. Irina Pinchuk, president of the Ukrainian Psychiatric Association and co-lead of the expert commission
Ukraine’s mental health system, rooted in institutional models, is outdated, and the ongoing conflict with Russia has only exacerbated its challenges. While Ukraine currently spends around 8% of its GDP on healthcare, only a fraction of that is allocated to mental health services, which are largely focused on institutional care. This legacy from the Soviet era persists, with psychiatric hospitals still housing around 30,000 people.
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Dr. Irina Pinchuk, president of the Ukrainian Psychiatric Association and co-lead of the expert commission, acknowledged that the proposed reforms are ambitious but vital. The goal is not only to help Ukrainians recover from the psychological toll of the war but also to build a mental health system that can serve as a model for other countries. Zbitnieva echoed this sentiment, stressing the importance of building Ukraine’s mental health system on the best global evidence and practices.
The experts recommend a shift toward community-based mental health care, where people with common mental health issues, such as depression and anxiety, can receive treatment in non-specialized settings like general practitioners’ offices. Meanwhile, individuals with more severe conditions would receive care in specialized mental health centers. This approach is designed to reduce reliance on psychiatric institutions and create more accessible mental health services for the population.
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The proposed reforms are already taking shape, with new mental health legislation being considered by the Ukrainian government. The legislation aims to update the country’s mental health laws and bring them in line with modern, evidence-based practices. Zbitnieva highlighted the importance of this legal reform, noting that it would replace outdated Soviet-era practices with a modern mental health system focused on patient-centered care.
The commission’s targets for the next five to ten years include reducing the number of people in psychiatric hospitals by 50%, increasing primary care capacity by 16 times, tripling the number of community-based mental health services, and doubling outpatient care capacity. Achieving these goals would require a 45% increase in public spending on mental health, but it would also reduce the financial burden on patients.
To meet the needs of the population, Ukraine’s health workforce must be bolstered, particularly in the mental health sector. The COVID-19 pandemic and the ongoing war have disrupted medical education, leading to a decline in the number of students entering the field. The commission recommends extending psychiatric residency programs from two to five years to meet European standards. Workforce development is crucial, as is investment in high-level research to ensure Ukraine remains competitive on the international stage.
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Mental health research in Ukraine is currently underfunded, with less than 0.5% of relevant budgets allocated to this area. The commission emphasizes the need to increase funding for research to support both senior and emerging scientists in the field. Strengthening Ukraine’s mental health research capacity is essential for integrating the country into the broader European scientific community by 2030.
While the path to reforming Ukraine’s mental health system is long, the commission’s recommendations provide a roadmap for change. Legal reforms will be critical to achieving these goals, particularly in areas such as involuntary treatment and guardianship laws, which currently limit the rights of individuals with mental health conditions.
The challenges facing Ukraine’s mental health system are immense, but the proposed reforms are a vital step toward creating a more resilient, patient-centered system. The experts’ vision is not only to help Ukrainians recover from the psychological impact of the war but also to build a mental health system that can serve as a model for other countries rethinking their own approaches to mental health.
