Psychological services should be affordable, high-quality and free of charge, says Viktor Liashko

Psychological services should be affordable, high-quality and free of charge. This is the task underlying the priority project of the Ministry of Health "Mental Health Care in the Structure of Medical Care", which was presented by the Minister of Health of Ukraine Viktor Lyashko at an expanded meeting of the Interagency Coordination Council on Mental Health Care and Psychological Assistance to Persons Affected by the Armed Aggression of the russian federation against Ukraine (hereinafter - the meeting of the ICC).

According to a survey conducted by Gradus in September 2022, more than 70% of Ukrainians experience stress or severe nervousness. At the same time, more than 90% of our citizens have at least one of the symptoms of anxiety disorders. The development of mental disorders has a significant impact on the productivity of individuals and communities and the economy as a whole. Losses from mental health problems can reach 4-5% of GDP. Therefore, when we talk about human recovery, which is inextricably linked to mental health, it has a direct impact on economic recovery and the recovery of the country as a whole. At the state level, there is a clear understanding of the importance of this issue, and mental health care should be a priority for every Ukrainian.

Further development of a high-quality system of mental health services and psychosocial support was discussed at the ICC meeting "All-Ukrainian Mental Health Programme "How are you?": Status, Action Plan, Implementation".

"The war affects the general mental state of Ukrainians. Meanwhile, we have a high level of stigma and often pay insufficient attention to our mental state. However, we understand that the mental health of Ukrainians, along with physical health, is an integral part of overall health. That is why the issue of its preservation is of utmost importance. "By taking care of mental health, we nurture our resilience," says Viktor Liashko, Minister of Health of Ukraine, "We have set ourselves the goal of improving the system of psychological assistance. And we are already doing it - to ensure that psychological services are accessible, high-quality and free of charge for everyone who needs them."

The priority project of the Ministry of Health of Ukraine "Mental Health Care in the Structure of Medical Care" aims to build the capacity of primary and specialised (outpatient) healthcare facilities to provide accessible, timely, high-quality and free mental health services.

To implement this, the first steps were identified - the project roadmap. Among other things, the Minister named the following:

• Scaling up mhGAP² training,
• informing patients and reducing stigma in the medical environment,
• updating the patient's clinical track and planned referral map,
• implementation of a guaranteed package of services at the primary and secondary/outpatient levels of care and dynamic improvement,
• development and implementation of a package of services at the secondary/outpatient level,
• establishing interaction between the primary and secondary levels and integration with community services, developing effective patient referral algorithms.

Patients will benefit from the implementation of the MoH project in specific and tangible ways, such as psychological support from a family doctor and access to services at their place of residence.

To this end, healthcare workers are being actively trained in the basics of psychological care. For example, between June 2022 and April 2023, more than 10,000 family doctors and 13,000 other specialists were trained in mhGAP. And by the end of this year, according to the plans, 15,000 (60%) family doctors and 20,000 other specialists will have completed online training. Another 1,500 family doctors will undergo mhGAP training offline. Plans for the period until the end of 2024: more than 70% of trained specialists and building a capable network of 1,000 institutions contracted with the NHSU.

The psychosocial service delivery system is being renovated under the slogan of interagency unity and coordination. After all, the mental health component is ubiquitous, equally important in the educational, social, security and defence, and cultural sectors. Psychosocial services should be close to the person - in the family doctor's office, school, CASP, employment centre, tax office, police, social services centre, etc.

During the meeting, the ICC members also considered the draft resolution of the Cabinet of Ministers of Ukraine "On the establishment of Civilian Support Centres in the context of armed conflict". In addition, other ministries presented their priority projects in the field of mental health care.

These priority projects of the ministries are like puzzles that create a chain of the entire psychosocial service system, providing a person with comprehensive support.

The mhGAP global training programme for family doctors was developed and launched to facilitate the patient's track and make psychological assistance as accessible as possible to those who need it.