Mental health care system and reform efforts in Ukraine

The abstract purpose is identifying the key goals of the Ukrainian MH transformation efforts according to the national legislation and the WHO trend

Depression, anxiety, suicidal ideation and social determinants of mental health of Romani in Ukraine

Research pape

Методи та методологія наукових досліджень у сфері психологічної допомоги

У статті здійснюється огляд методологічних вимог до наукових досліджень у сфері психологічної допомоги. Дається короткий екскурс в історію психотерапевтичних досліджень. Вказуються основні дослідницькі стратегії, серед яких – оцінювання "терапевтичного пакету", оцінювання внеску окремих і додаткових втручань в ефективність "терапевтичного пакету", оцінювання ролі окремих параметрів організації психотерапії та самого терапевтичного процесу, оцінювання характеристик клієнта і терапевта, порівняння ефективності окремих підходів. Коротко окреслюються перспективні напрямки досліджень, зокрема аналіз негативних ефектів психотерапії, її медіаторів та механізмів. Описується сучасний стандарт розвідок у сфері психічного здоров’я – експериментальні рандомізовані контрольовані дослідження, а також основні стратегії їх реалізації: нетерапевтичного контролю, порівняння терапевтичних та звичайних умов, порівняння з плацебо, контролю компонентів терапевтичного проекту, комбінації терапевтичних проектів, порівняння з альтернативами. Висвітлюються особливості застосування та базові кроки мета-аналітичних досліджень, зокрема такі, як концептуалізація, збір даних, кодування змінних, статистичний аналіз, мета-аналітичні висновки та узагальнення. Вказується на роль наукових досліджень у регуляції розвитку психотерапевтичної практики. Згадуються окремі наукові об’єднання та центри, які розвивають наукові дослідження у психотерапії.The overview of the methodological requirements of psychotherapy research and the brief excursion into the history of empirical base psychotherapy are presented in this article. Basic research strategies in the field of psychological help are Treatment Package Strategy, Dismantling Treatment Strategy, Constructive Treatment Strategy, Parametric treatment strategy, Comparative Treatment Strategy, Client and therapist variation strategy and process research strategy. The perspective ways of research are analysis of the negative effects of psychotherapy and investigation ofpsychotherapeutic mediators and mechanisms. Modern standard of research in the field of mental health - randomized controlled trial. Main implementation strategies of RCTs are Wait-list or no-treatment control, Treatment-as-Usual Comparison, Placebo Comparisons, Component Control Designs, Combination Treatment Designs and Comparisons With Bon а Fide Alternatives. Meta-analysis is special kind of psychotherapy research, which involves describing the results of different studies using statistical procedures. Basic steps of meta-analysis are Conceptualization, Data collection, Coding studies, Statistical procedures, Write up meta-analysis. Scientific research have significant role in the regulation of the psychotherapy practice

Mental health and homelessness in the social service providers' outlook (Luxembourg case)

Purpose The purpose of this paper is to explore the perception of the mental health problems of the homeless population in a high-income country (Luxembourg) by social service providers and to develop proposals for better inclusion of homeless people into the mental health services and homeless people with mental health issues into society. Design/methodology/approach The study was of qualitative design and conducted using a semi-structured interview method (in person). The semi-structured interviews (seven participants) were conducted to analyse the challenges, practice approaches and prospects of stakeholders or decision-makers working in housing exclusion and homelessness. A secondary thematic analysis of this content regarding mental health issues was performed. Findings Three main themes in the social providers’ perception were identified related to mental health and homelessness: the general view on the mental health problems of homeless people (accent on substance use disorders [SUDs], overshadowing of other mental health conditions by the SUDs); the positive impact of housing and social services on the mental health of the homeless per se (role of social rhythms, social connectedness and multidisciplinary approach are emphasised); and the need for improvement of mental health services in the country (need for the long-term timely continuing mental health support and recognition of the importance of complex intersectional and multidisciplinary solutions). Research limitations/implications Mental health themes were not the primary focus while research was planned and conducted. They were revealed as results of secondary qualitative data analysis. Therefore, additional mental health-focused mixed methods research is needed to verify the conclusions. The paper is written on the results of the research project “Social Housing and Homelessness” (SOHOME), implemented at the University of Luxembourg with the financial support of the Fonds National de la Recherche of Luxembourg (FNR12626464). The sponsor had no involvement in the study design, the collection, analysis and interpretation of data or the preparation of the paper. Practical implications The study brings together different perspectives from social workers, stakeholders and decision-makers. The results show that there are cross-field connections between homelessness and mental health that require specialised and coordinated services. The first existing approaches seem to be promising in their continuation but need to be promoted by social policy. Social implications To promote social cohesion in the Luxembourgish society and also to include one of the most vulnerable people, the study points to the importance of the link between homelessness and compromised mental health. Appropriate support and service provision as well as social and affordable housing play a central role. Originality/value To the best of the authors’ knowledge, this study is the first of its kind, revealing several social work stakeholders’ perspective on the mental health of homeless people in Luxembourg

Interpersonal Psychotherapy in Ukraine

editorial reviewedInterpersonal Psychotherapy: A Global Reach describes the rapidly expanding global dissemination of IPT, including the development of new training, technologies, and the use of IPT all over the world and in diverse populations. This book covers training considerations, especially for task-shifted or lay providers, certification in delivery of IPT, use of technology for training and implementation, and the continuing evidence base of IPT. The book includes implementation in high-income countries and low- and middle-income countries (LMICs) and humanitarian settings that have limited funds for research and dissemination. Providing practical guidance and experience, experts from 31 different countries from Africa, Asia, Europe, Middle East, North America, South America, and Oceania describe challenges and facilitators of implementing IPT in their settings, share templates of training and adaptation, and provide practical case examples. Additionally, authors detail adaptations of IPT for different disorders, such as borderline personality disorder and PTSD, and many diverse populations across the lifespan from preadolescents to older adults. Implementation of IPT with diverse communities globally includes descriptions of work with African American girls, Indigenous people, Latinx people, refugees, sexual and gender minority individuals, those with perinatal depression, and veterans, among others

Decentralisation and community engagement for better mental health services development in the conflict-affected regions of Ukraine

Purpose: The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The main interest focuses on communities' perception of their problems and solutions that communities can create to achieve better mental health coverage. Design: /methodology/approach Series of roundtables (4 roundtables, 62 participants overall), accompanied by interactive brainstorming techniques, were conducted with communities' representatives from the East of Ukraine (Lugansk region, government-controlled area). Participants were provided with the opportunity to discuss mental health services development challenges and create affordable solutions for their communities. Results of discussions were submitted to qualitative analysis and offered to review by participants. Findings: Decentralisation in Ukraine led to allocating funds alongside responsibilities for developing the services to communities. Most of the communities appear not to be ready to acknowledge the role of mental health services, entirely relying on the existing weak psychiatric hospital-based system. Rising-awareness interactive capacity-building activities for the community leaders and decision-makers effectively promote community-based mental health services development. Five clusters of challenges were identified: leadership, coordination, and collaboration problems; infrastructure, physical accessibility, and financial problems; mental health and primary healthcare workforce shortage and lack of competencies; low awareness in mental health, available services, and high stigma; war, crises, and pandemic-related problems. Communities foresaw seven domains of actions: increasing the role of communities and service users in the initiatives of governmental bodies; establishing in the communities local coordination/working groups dedicated to mental health service development; developing the community-based spaces (hubs) for integrated services provision; embedding the mental health services in the existing services (social, administrative, healthcare); mental health advocacy and lobby lead by local leaders and service users; increasing capacity of communities in financial management, fundraising; developing of services by combining efforts and budgets of neighbouring communities. Originality The paper is original in terms of its topic (connecting decentralisation and community engagement for understanding the challenges of mental health services development) and research strategy (engagement of Ukrainian communities, qualitative analysis of the discussion results and applying the best practices and international recommendations to the local context)

Prevalence of alcohol use and depressive/anxiety symptoms among patients of opioid agonist treatment programs in Ukraine

peer reviewedThis cross-sectional study explores the prevalence of alcohol use problems, depression/anxiety symptoms, and suicidal ideations among patients of the opioid agonist treatment (OAT) programs in Ukraine and their co-occurrence. AUDIT, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were used to measure mental health conditions. In addition, the number of missed visits on site for substitute medication for the last month was counted, and blood alcohol levels were recorded (Drager Alcotest 6820, Draeger, Lübeck, Germany). Data were collected from October 2021 to January 2022 (before the full-scale Russian invasion) based on OAT centers in Kyiv, Sumy, and Lviv. The sample size was 999 patients. The overall rate of signs of alcohol-related problems (AUDIT), depression symptoms (PHQ-9), and anxiety symptoms (GAD-7) in the sample was 3.8 (SD 5.424), –7.42 (SD 5.336), and 5.058 (SD 4.264), respectively. For alcohol-related problems, 16.4% of the participants reported harmful drinking (one-month prevalence). Depression symptoms from moderate to severe were found in 26.73% of cases, and generalized anxiety symptoms from moderate to severe levels were found in 14.71% of patients (2-week prevalence). The 2-week suicide ideation prevalence was 24.9% (a quarter of all OAT patients). General co-occurrence of depression and anxiety symptoms was equal to 13.31% of all patients who participated in the study (32.13% of all patients having depression or anxiety symptoms). There was an increase in the general co-occurrence ratio with an increase in the severity of alcohol-related problems from 10.66% to 54.55%

Universal mental health training for frontline professionals (UMHT)’s feasibility analysis

peer reviewedBackground Universal Mental Health Training for Frontline Professionals (UMHT) is an educational programme developed and piloted in Ukraine in 2021-2023 to bridge the mental health treatment gap. The UMHT trains frontline professionals (FLPs) to interact with, support, and refer individuals with mental health conditions for professional help. Methods To assess the UMHT feasibility, we used statistics on the actual use of the programme, as well as data from satisfaction and usability surveying of 144 programme deliverers and 714 trained frontline professionals. A combination of Kruskal-Wallis and Post Hoc Dunn tests was used to identify statistically significant intergroup differences in the UMHT usability. Results All the characteristics defined to assess the UMHT showed its feasibility. Programme’s demand increased through years of implementation (2021, 2022, 2023) in terms of the numbers of training events (27, 35, 90), trained frontline professionals (596, 779, 1548), involved donors and supporters (1, 4, 9) and local and countrywide implementers (2, 10, 18). The UMHT acceptability as satisfaction with the programme content and delivery is 4.81 (0.291) for the UMHT trainers and 4.78 (0.434) for trained FLPs. The UMHT preparedness to use trained skills after participation in the training events is 4.57 (0.438) for the UMHT trainers and 4.46 (0.650) for trained FLPs. The highest rates of usability of all UMHT skills were found for educators (0.68 [0.118]), police officers (0.67 [0.098]), and social workers (0.66 [0.113]). Conclusions The UMHT offers a universal frame of interaction with people with mental health conditions for frontline professionals. Assessment of the UMHT feasibility shows the programme’s potential for further development and implementation. Programme trainers as its deliverers and frontline professionals as its recipients report high satisfaction with training content and delivery as well as preparedness to apply gained knowledge and skills in practice.</ns4:p

Mental Health and The City: A Tribute to Mariupol, the City that will be Reborn

peer reviewedThis paper aims to pay tribute to Mariupol and its inhabitants, the Ukrainian city which was entirely destroyed by the Russian army. Before the full-scale invasion, significant developments were happening in the field of mental health. The experience gained in that city, examples of good practices and active collaboration between the city administration, local professionals and the international development project “Mental Health for Ukraine”, formed the foundation of interventions that were transferred to other regions in Ukraine. This paper describes the key steps, actions undertaken in 2019 to 2021 and achievements of the programme. Personal reflections also describe the context and experiences

Predictors of Satisfaction and Value of Advanced Training for Mental Health Professionals in Wartime Ukraine.

peer reviewedThe full-scale escalation of Russia's war against Ukraine in 2022 created a surge of mental health issues, requiring urgent, evidence-based interventions to reduce trauma and mitigate stress. Reflecting recommendations from leading specialists in the field, Ukrainian mental health professionals sought to develop appropriate skills and knowledge for working in wartime through advanced training programs. This study aimed to investigate the experiences of Ukrainian mental health professionals having completed advanced training in mental health topics in wartime. A survey design was adopted, using the purposefully developed, and validated 'Wartime Learning Satisfaction Scale'. Regression analysis assessed the hypothesized contribution of four scales (Education, Educator, Learner, and War) to the perceived value of advanced training and learners' satisfaction. Respondents (n = 271) were trained in up to 30 courses (M = 4.27, SD = 3.03) lasting from two to over 120 h. Regression analysis revealed different predictors for satisfaction and value of the courses. Advanced training resulted in higher satisfaction with learning if it matched professional goals of mental health professionals and perceived higher value when relevant to societal demand, consistently constructed, practically useful, and not solely focusing on war-related issues. Respondents who completed all advanced training courses they were interested demonstrated significantly higher confidence in working in wartime. These findings are essential for effective mental health practice during wartime