Before the Toils of War: Mental Health in Ukraine

Ukraine has become the center of global attention as Russia wages war. The trauma, fear, and anguish Ukrainians are facing must place an enormous strain on the people’s mental health. But what was the country’s mental health like prior to current warfare? Investigators took a look.

Dregs of a Previous Era

In comparison to other countries, Ukraine carries a high burden of mental illness and a particularly high prevalence of depression, alcohol use disorder, and suicide.¹ Mental health disorders are the country’s second leading cause of disability burden and affect up to 30% of the population.² Major barriers to mental health care in Ukraine include lack of trust in the psychiatry system, stigma, and lack of awareness and understanding.³

These barriers to care may be a result of the country’s Soviet past: Psychiatry was used as a tool of repression during the Soviet era, leading to those who opposed the Soviet regime being deemed ‘mentally ill’ and imprisoned in psychiatric hospitals.⁴ As a result, Ukrainian older generations are more reluctant to seek mental health care than their youth, remembering the dark history of psychiatry.²

“…We are looking at a professional field that has far from recovered from Soviet rule, is lagging far behind in the understanding of, and adhering to international human rights standards and professional ethics, is rampant with corruption (eg, by selling false diagnoses) and is strongly influenced by the pharmaceutical industry that is in fact only interested in commercial gain,” wrote Van Voren.⁴

Additionally, Ukrainians may not trust mental health professionals because of reports of negative encounters from their community members.² The high stigma and shame may prevent people from seeking care, or force them to do so anonymously, as they fear being negatively labelled by their communities, and thus reduce their chances of employment opportunities.²

The lack of understanding and awareness around mental illness further intensifies stigma. Individuals can struggle to distinguish the level of care needed for their mental disorder and may assume that any diagnosis will result in hospitalization.²

WHO’s Special Initiative for Mental Health

In 2020, Ukraine was chosen as a priority country for the World Health Organization’s (WHO) Special Initiative for Mental Health. The initiative has helped build a renewed political commitment to mental health policy, expansion of services, and a growing public interest in mental health.⁵

Unfortunately, as is the case for the entire world, COVID-19 drastically changed health priorities. In 2021, Ukraine entered its second year of WHO Special Initiative funding and decided to revisit their prepandemic policy reform agenda.⁵

“Ukraine is well-situated to continue along the trajectory of transformations around mental health. Consistent implementation of the national policies and plans related to mental health may facilitate improved wellbeing of the population across the lifespan, greater treatment coverage, as well as promote respect and dignity of people with mental health conditions,” wrote WHO investigators.¹

However, the investigators also pointed out, “The protracted conflict in eastern Ukraine followed by humanitarian crisis has led to negative consequences for population's wellbeing, and the need for mental health and psychosocial support remain high. However, these events have also raised public interest in mental health issues, pushed the reforms in many sectors and brought a number of evidence-based practices introduced by international organizations.”¹

Do you have first-hand experience with mental health care in the Ukraine that you can share with your colleagues and readers of Psychiatric Times^TM? Write to us at PTeditor@mmhgroup.com.

References

1. Ukraine WHO Special Initiative for Mental Health situational assessment. World Health Organization, University of Washington. July 2020. Accessed February 28, 2022. https://cdn.who.int/media/docs/default-source/mental-health/who-special-initiative-country-report---ukraine---2020.pdf?sfvrsn=ad137e9_4

2. Mental health in transition: assessment and guidance for strengthening integration of mental health into primary health care and community-based service platforms in Ukraine. World Bank Group. 2017. Accessed February 28, 2022. http://documents1.worldbank.org/curated/en/310711509516280173/pdf/120767-WP-Revised-WBGUkraineMentalHealthFINALwebvpdfnov.pdf

3. Romaniuk P, Semigina T. Ukrainian health care system and its chances for successful transition from Soviet legacies. Global Health. 2018;14:116.

4. Van Voren R. Psychiatry as a tool for coercion in post-Soviet countries. European Parliament Directorate General for External Policies. 2003. Accessed February 28, 2022. https://geohistory.today/wp-content/uploads/2016/04/EXPO-DROI_ET28201329433723_EN.pdf 

5. Mental health in Ukraine. Yale Institute for Global Health. 2021. Accessed February 28, 2022. https://medicine.yale.edu/yigh/students/case-competition/2021YIGHCase_Final_407033_46325_v1.pdf