Report on – 33rd IC Resolution 2: Addressing mental health and psychosocial needs of people affected by armed conflicts, natural disasters and other emergencies (33IC/19/R2) – Ukraine

Has your State/National Society/Institution incorporated the commitments contained in this resolution into the relevant strategic or operational plans?

The commitments are incorporated into:
Policy
Operational plan
Legislation (e.g. Law, Regulation, Statutes, Rules of Procedure etc.)

At the Regional, National level

Explanation:

The full-scale armed aggression against Ukraine has significantly affected the mental state of the Ukrainian people and highlighted the need for a strengthened focus on mental health and psychosocial support (MHPSS). More than 70% of Ukrainians experienced stress or severe anxiety. According to the Ministry of Health, around 15 million Ukrainians will need psychological support in the future, with about 3-4 million requiring medication.

Coordination Council on Mental Health Protection and National Mental Health Program

In May 2022, the Government of Ukraine established an Inter-agency Coordination Council on Mental Health Protection and Psychological Assistance to Persons Affected by the Armed Aggression of the Russian Federation against Ukraine. Co-chaired by the Deputy Prime Minister of Ukraine – Minister for the Reintegration of Temporarily Occupied Territories and the Minister of Health of Ukraine, it developed an inter-agency framework that has enabled effective coordination of multi-sectoral responses to protect and improve mental health and psychosocial well-being of the affected population.

In a short timeframe, Ukraine managed to roll out a multi-sectoral National Mental Health Program, which was initiated in May 2022 by the First Lady of Ukraine, Olena Zelenska. This Program builds upon the best practices in ensuring the most effective MHPSS assistance and services.

As part of the Program, a nationwide communication campaign “How are you?” (https://howareu.com) was launched in March 2023 to protect and improve the mental health of the affected population, focusing on MHPSS for children and adolescents, veterans, and their families, as well as outreach efforts on accessing free mental health services at primary healthcare facilities.

Through the Program`s mental health training system, more than 429,000 participants across Ukraine have already been trained.

Priority projects of Ukrainian ministries implemented within the Program include:

• “Mental Health Protection in the Structure of Medical Care” by the Ministry of Health (covering all segments of the population and promoting the accessibility of mental health services through family doctors who, if necessary, will refer patients to specialized care),
• “Creating Sustainability Centers in Ukraine” by the Ministry of Social Policy (aimed at providing psychosocial support to communities, first-line specialists, and volunteers),
• “Transition from Military Service to Civilian Life (in terms of psychological assistance)” by the Ministry of Veterans Affairs (providing support to defenders and their families during their transition to civilian life),
• “Creating a Psychological Recovery System for the Armed Forces of Ukraine (RECOVERY)” by the Ministry of Defense (focused on the psychological recovery of military personnel, including those released from captivity, and their families),
• “Algorithm for Providing Psychological Assistance and Support in Crisis and Emergency Situations” by the Ministry of Internal Affairs (to ensure that after emergency psychological assistance is provided at the scene of an incident, there is a pathway for further referral and psychosocial support for the affected persons),
• “Psychosocial Support and Psychological Assistance at All Levels of Education” by the Ministry of Education and Science (implementing psychological resilience skills at all levels of education—from preschool to higher education, as well as transforming the psychological service within the education system),
• “Youth Centers and Active Parks – Part of the Mental Health Ecosystem” by the Ministry of Youth and Sports (providing psychological support services for adults, children, and adolescents).

As an example of the implementation of a priority project by the Ministry of Health, 180,000 patients received psychosocial assistance at the primary healthcare level between 2022 and the first quarter of 2024.

Regional coordination centers for the support of the civilian population

Since the beginning of the large-scale invasion, the Government of Ukraine approved the decisions to:

• establish Coordination Centers for Civilian Support at district state (military) administrations (hereinafter – Coordination Centers).
• create working groups within the Coordination Centers, with their composition approved by the head of the local authority.
• include regional coordinators of the All-Ukrainian Mental Health Program in the Coordination Centers.

During 2023 and the first half of 2024, a network of over 1,000 Coordination Centers for Civilian Support was created, including:

• 25 centers at the regional state (military) administrations and the Kyiv City State Administration;
• 65 centers at the district state (military) administrations;
• more than 900 centers in territorial communities;
• 10 centers at the district level in Kyiv (the capital of Ukraine).

Coordination Centers have established thematic working groups on mental health (or psychosocial support).

Improvement of procedures for psychosocial assistance and services

To improve procedures for psychosocial assistance and services the Ministry of Health approved the following documents:

1. Order dated 13 December 2024, No. 2118 “On psychosocial assistance to the population”, which determines:

• the procedure for providing psychosocial assistance and services on mental health issues, including suicide prevention and the psychosocial component of rehabilitation of war veterans and other groups of the population.
• list of psychosocial services and assistance.
• a list of valid psychological diagnostic methods that can be used for psychological diagnosis and assessment of the quality of psychological care.
• list of psychotherapy methods with proven effectiveness.

2. Order dated 7 December 2023, No. 2085 “On Approval of the Procedure for Providing Psychiatric Care in Inpatient Settings”. This comprehensive document defines the procedure for providing psychiatric care in inpatient settings and is based on international standards for the treatment of people suffering from mental disorders, taking into account the priority of human rights and dignity as set out in the Convention for the Protection of Human Rights and Fundamental Freedoms of 1950, the Laws of Ukraine “On Psychiatric Care”, “On Rehabilitation in Health Care”, “Fundamentals of the Legislation of Ukraine on Health Care”.

Psychological assistance to persons released from captivity

The Government of Ukraine has attached particular attention to providing psychological assistance to Ukrainian military personnel who have been released from captivity. This is because most of them were subjected to systematic torture and other cruel, inhuman, or degrading treatment and tortures by the enemy Power, which is a violation of the norms of the 1949 Third Geneva Convention and its 1977 Additional Protocol I. All this has had a significant negative impact on their mental health.

In this regard, the Law of Ukraine “On Social and Legal Protection of Persons Recognized as Deprived of Personal Liberty as a Result of the Armed Aggression Against Ukraine and Members of Their Families” grants the Government the authority to establish procedures for conducting recovery (post-isolation, reintegration) measures, adaptation measures, and support (accompaniment) of persons recognized as deprived of personal liberty due to the armed aggression against Ukraine after their release. Exercising these powers, on March 15, 2024, the Government of Ukraine adopted Resolution No. 296 with the same title. This act established a national system of medical, physiological, and social assistance as a continuous process for Ukrainians who have returned from the places of detention in the enemy Power. This system is a synergy of activities by both the state and non-governmental organizations and consists of three main pillars:

• modern diagnostic health assessment,
• the creation of a specialized rehabilitation institution, its regional branches, and the implementation of unified standards and protocols,
• the creation of an information system for providing personalized post-isolation recovery services.

“The Formation of Vitality “ program

The Ministry of Social Policy of Ukraine has initiated the implementation of a new comprehensive service aimed at building resilience. This service focuses on supporting and strengthening the mental health of the population, reducing overall levels of stress and anxiety among the population, adapting people in territorial communities, especially internally displaced persons, to crisis situations, forming skills for providing first psychological aid to loved ones, teaching stress resistance as a set of personal qualities, preventing psychological trauma, providing psychological support to parents, developing parenting skills and caring for children, helping to build relationships with children at different stages of their growth, and conducting psychological work with families most affected by the war, including military personnel, veterans, and other groups of the population, particularly those who have been deprived of personal liberty due to the armed aggression against Ukraine.

Additionally, the service includes training volunteers and assisting in coordinating their activities. The implementation of this pilot project is planned from December 2023 to December 2024.

The Ministry of Social Policy is implementing this pilot project with the support of international partners: the World Health Organization, UNICEF, the United Nations Development Program, and others.

To provide social services under martial law, the Law of Ukraine No. 2193-IX “On Amendments to Certain Laws of Ukraine Regarding the Provision of Social Services in Case of Emergency or Martial Law in Ukraine or its Separate Areas” dated 14 April 2022, introduced changes to the laws of Ukraine “On Social Services” and “On the Legal Regime of Martial Law.” These amendments regulate the procedure for providing urgent social services (in crisis situations) — decisions are made immediately, including directly by the provider of social services; social services are provided within one day; the procedure for making decisions on the provision of social services has been simplified — decisions on the provision of social services are made based on a single application with subsequent restoration of documents.

Art and mental health

The Ministry of Culture and Information Policy of Ukraine has developed a presentation for the priority project “The Art of Helping” as part of the implementation of the All-Ukrainian Mental Health Program and the communication campaign “How are you?”.

Within the structure of the Ministry of Culture and Information Policy, a Department for Barrier-Free Policies, Gender Equality, and Mental Health has been established. The priority project “The Art of Helping” on mental health has been analyzed and supplemented. The presentation materials and the Project Implementation Concept have been updated.

The first stage of psychological first aid training for specialists in higher education institutions in the field of arts education has been completed within the framework of the “The Art of Helping” project in cooperation with the Ukrainian Red Cross Society. The main goal of the training is to increase the awareness of educators on how to timely and correctly provide psychological first aid; how to support the emotional state of students who need it; how to identify the presence of acute or accumulated stress in students, and how to take care of their mental health and the mental health of others. As a result of the first stage, 140 participants took part in the training. The training sessions were held in Kyiv, Kharkiv, Odesa, Kropyvnytskyi, and Lviv. The training was conducted jointly with the Ukrainian Red Cross Society and the State Agency of Ukraine for Arts and Art Education.

A working meeting was held with representatives of the Ukrainian Red Cross regarding the preparation of the second stage of psychological first aid training for specialists and students of educational institutions in the field of arts education as part of the implementation of the “The Art of Helping” project. The main workstreams and further steps for cooperation were determined.

Mental health and psychosocial well-being of staff and volunteers in the Ministry of Internal Affairs

The Ministry of Internal Affairs of Ukraine ensures the coordination of psychological support for servicemen of the National Guard of Ukraine, the Administration of the State Border Guard Service of Ukraine, rank-and-file and senior officers of the Civil Protection Service, police officers who have been released from captivity, injured personnel, and their family members (if necessary), including family members of the missing persons.

In July 2023, the Ministry of Internal Affairs of Ukraine approved the Procedure for Interaction between Psychologists of the State Emergency Service of Ukraine and the National Police of Ukraine in providing assistance to victims of emergencies. Additionally, to meet the needs of the affected population, identify their social issues, and further refer them to the social policy departments of state (military) administrations in the regions and Kyiv, psychologists of the State Emergency Service of Ukraine and the National Police of Ukraine provide first psychological aid to the affected population and collect necessary information at the scene of the incident using the “Emergency Victim Questionnaire” developed by the Ministry of Internal Affairs.

Since July 2023, specialists from the psychological support services of the State Emergency Service of Ukraine and the National Police of Ukraine, who were involved in providing emergency psychological assistance due to emergencies, have assisted 3,679 civilians and 722 rescuers and police officers. Civil protection specialists have been involved in providing such assistance more than 90 times, 34 of which were in collaboration with specialists from the psychological support units. During this period, they completed 176 Victim Questionnaires for Emergency Situations, which were submitted to the relevant local authorities for further processing.

To support the mental health of victims and their families, as well as the civilian population, the “Psychological Practices Point” project is being implemented, which includes master classes. As part of the “Psychological Practices Point” project, nearly 1,900 events have been held, reaching out to 42,261 people. These included 756 interactive mini-lectures, 343 art therapy events, and 350 master classes.

The National Police implements a peer-to-peer psychological support program aimed at maintaining the mental health of personnel. This program involves ongoing educational activities, selecting and training employees who wish to provide psychological support to their colleagues, and conducting psychoprophylactic activities.

A Plan for the Psychological Support of Servicemen of the National Guard of Ukraine, the Administration of the State Border Guard Service, police officers, and civil protection personnel, as well as their family members during martial law, has been implemented by the Ministry of Internal Affairs psychological services. In particular, 221 specialists were selected from among the staff psychologists of the Ministry of Internal Affairs system who are highly motivated and ready to perform the functions of psychologists (mental tutors). Additionally, monitoring and enhanced psychological support are provided as needed for those who have performed combat tasks, sustained injuries, or were released from captivity.

A dedicated section on psychological support has been created in the unified information system of the Ministry of Internal Affairs, based on the functional subsystem “Social and Legal Protection of Victims and Their Families.”

Has your State/National Society/Institution been working with other partners to implement the commitments contained in this resolution?

Partner with:
National Red Cross or Red Crescent Society in your country
ICRC/IFRC
Humanitarian and development partners (e.g. UN, NGOs etc.)
Other

Examples of cooperation:

The All-Ukrainian Mental Health Program has received support not only from top officials and governments of other countries but also from international organizations: World Health Organization, United Nations Children`s Fund, USAID, International Organization for Migration, International Medical Corps, World Bank, Doctors Without Borders, and UNDP. As a result, Ukrainian experts have gained numerous new opportunities on the international stage, including knowledge exchange, training, implementation of best practices in assistance, and joint research initiatives. Both global and specialized projects have been implemented, such as peer support group training, innovative methodologies for PTSD treatment and rehabilitation, scientific and research collaborations, among others.

In May 2024, the 77th World Health Assembly adopted the resolution “Strengthening Mental Health and Psychosocial Support before, during, and after Armed Conflicts, Natural and Human-Made Disasters, and Medical Emergencies” initiated by Ukraine and the Netherlands.

MHPSS projects are implemented by responsible state agencies with the support of international partners, such as the World Health Organization, United Nations Children’s Fund, United Nations Development Programme, and others.

“Mental Health for Ukraine” was supported by the Government of the Swiss Confederation through the Swiss Agency for Development and Cooperation  and contributed to strengthening the mental health system to improve the quality of services and life for people with mental health disorders in Ukraine;

“Cooperation with Ukraine in Health Care”, funded by the Government of Norway through the Ministry of Foreign Affairs of Norway and aimed at improving mental and physical health, strengthening the capacity of the healthcare sector, and building a public health system to assess the health status of the strategic population and promptly identify threats to Ukrainians;

“Simulation medicine and scenario-based training in emergency care”, supported by the European Union and aimed at improving training in first aid and emergency medical care through the simultaneous introduction of innovative technologies of scenario-based training, simulation medicine, competent psychological support for doctors, first responders and all participants in the event.

Additionally, police psychologists throughout 2023 took part in training sessions organized by the International Medical Corps (IMC) on topics such as “Helper’s Help” (17 psychologists trained), ” Indefinite Loss,” and “Trauma and PTSD” (10 psychologists each). To disseminate the psychological knowledge acquired from IMC among the personnel of the National Police of Ukraine, psychologists in regional police units conducted 14 training sessions for 160 police officers.

Under the auspices of the European Union Advisory Mission on the reform of the civil security sector in Ukraine, a corresponding project on psychological rehabilitation is planned for the Border Guard Service personnel who participated in combat operations.

Interaction with national and international partners is carried out within the framework of the Technical Working Group on Mental Health and Psychosocial Support (MHPSS), which currently brings together over 300 international and Ukrainian non-governmental partner organizations and is coordinated by the WHO Country Office in Ukraine and the International Medical Corps.

As part of the activities of this Technical Working Group, following consultations with Ukrainian government authorities and national and international organizations working on MHPSS and involved in emergency response in Ukraine, an Operational Roadmap “Priority Multisectoral Actions on Mental Health and Psychosocial Support in Ukraine During and After the War” was developed in 2022. In addition to situational information in Ukraine, the Roadmap includes a list of evidence-based MHPSS interventions and services contextualized and implemented in Ukraine in recent years, along with a set of multisectoral actions to scale up MHPSS services in both short-term and long-term perspectives based on available evidence, international technical recommendations, and expert consensus.

Have you encountered any challenges in implementing the commitments contained in this resolution?

With challenges on:
Competing priorities
Other

Details about challenges:

As a result of the full-scale armed aggression against Ukraine, the number of patients receiving psychiatric care in hospitals increased by 3.2 times in Ukraine. By the end of 2023, this number reached 173,414 individuals. Support and treatment for adults and children with mental disorders at the primary healthcare level were provided by 890 healthcare facilities in the first quarter of 2024, with 75.7 thousand patients seeking assistance. Funding for psychiatric care under the Medical Guarantees Program increased from UAH 2.5 billion in 2021 to UAH 3.8 billion in 2023.

To address these negative impacts of the armed aggression on mental health, the Target Model “System in the Field of Mental Health and Psychosocial Support in Ukraine” was developed – a long-term approach to change that defines the national direction for creating an optimally functioning comprehensive mental health and psychosocial support system in Ukraine. This model recognizes and responds to the needs of all Ukrainians, providing support to individuals and their families at the right place and time.

The Target Model is based on the best global knowledge, international standards, and WHO recommendations on MHPSS in emergencies, as well as Ukraine’s extensive experience in health system and mental health reforms during emergencies. The model includes a comprehensive overview of the envisioned national mental health system in Ukraine, encompassing promotion, prevention, further development of the mental health service network, and engagement of all relevant sectors at national and local levels. Its goal is to ensure proper coordination among all stakeholders involved in meeting the wide range of mental health needs of Ukraine’s population during wartime and recovery periods.

Have the commitments contained in this resolution had an impact on the work and direction of your State/National Society/Institution?

Type of Impact:
Programming and operations have become more effective and efficient
Innovative tools/methodologies have been developed and are utilized
Partnerships with other humanitarian actors have been created or enhanced

Details about the impact:

Steps to implement the Action Plan for 2021-2023 to implement the Concept for the Development of Mental Health Care in Ukraine until 2030, in particular, included:

–        preparation of a roadmap to reform mental health services for the period 2023-2025;

–        development of regional mental health plans for 2022-2023;

–        integration of mental health services at the primary level of health care; “;

–        development of professional standards for mental health professionals, a standard for the provision of mental health services, regulations on supervision of mental health professionals, and monitoring of the provision of such services;

–        revision of training programs for mental health professionals in higher medical education institutions, as well as inclusion of psychological care components in the training programs for students of other specialties, taking into account international experience and WHO recommendations;

–        developing a model for transforming specialized and regional mental health care institutions into regional mental health centers;

–        improving mental health services for children and adolescents with mental disorders, etc.

The Action Plan of the All-Ukrainian Mental Health Program “How are you?” for 2023-2025 was approved, considering the Concept of Mental Health Development in Ukraine until 2030.

By Government Resolution No. 539 dated 7 May 2022, the Inter-Agency Coordination Council on Mental Health Care and Psychological Support for Persons Affected by the Armed Aggression of the Russian Federation against Ukraine was established. Its main tasks include:

• Facilitating inter-agency coordination in providing psychological assistance to the affected persons.
• Identifying ways, mechanisms, and methods to address problematic issues related to providing psychological assistance to affected individuals.
• Enhancing the effectiveness of the response. Developing proposals to improve the legal framework for enhancing psychological assistance and support to the affected persons.

The Inter-Agency Coordination Council serves as a platform for coordinating the Government`s efforts in MHPSS and decision-making on the implementation of projects and programs under the All-Ukrainian Mental Health Program. As of 20 June 2024, 10 meetings of the Inter-Agency Coordination Council were held, focusing on analytical and strategic documents as well as MHPSS priority projects.

Have the commitments contained in this resolution had an impact on the communities that your State/National Society/Institution serves?

Description of the impact:

To meet the needs in MHPSS, social services have been provided at the community level by state (municipal) or non-governmental providers of social services. Additionally, there are coordination centers for civilian support under local authorities, involving also regional coordinators of the All-Ukrainian Mental Health Program.

Psychosocial support can be provided either as standalone counseling services or as components of broader social services, including social support, home care, daycare, supported living, social adaptation, social integration and reintegration, shelter provision, emergency (crisis) intervention, social prevention, care and upbringing of children in family-like conditions, social support for families raising orphaned children or children deprived of parental care, support during inclusive education, and others.

About 3,589 social workers have been delivering social services and psychosocial support to the vulnerable population, including internally displaced persons/families.

Psychosocial support can be individual or group-based, such as seminars, trainings, art therapy sessions, support groups, etc.

The provision of psychosocial support within social services is carried out through social service centers, social service delivery centers, territorial centers (of social services), and other providers of social services. In 2022, over 160,000 families received psychosocial support through the network of social service centers, including more than 89,000 war-affected families, among which approximately 84,000 families were internally displaced.

By 2023, about 184,000 families received such assistance, including over 84,000 war-affected families, among which about 57,000 families were internally displaced.

Supporting mental health in the Donetsk region

In June 2023, the Coordination Center for Civilian Population Support was established under the Head of the Regional State Administration – Chief of the Regional Military Administration of the Donetsk region. Within its framework, a working group on mental health and psychosocial support was created, involving representatives of territorial communities and non-governmental organizations.

The activities of this working group are guided by the Coordination Center for Mental Health under the Cabinet of Ministers of Ukraine, ensuring weekly reporting on work conducted in this area.

The region has rolled out an information campaign as part of the All-Ukrainian Mental Health Program “How Are You?”. In total, 259 publications were made on social media platforms by administrations, 1166 publications on other resources, and 33 other activities were undertaken, reaching a total of 403,848 individuals.

During 2023, in the Donetsk region, the following activities were organized and conducted:

• Surveying of service providers and recipients of psychosocial support services,
• Mapping of mental health and psychosocial support services at the level of territorial communities,
• Creating a roadmap that will guide the provision of psychological assistance to various categories of people.

Currently, work is also underway to provide mental health and psychosocial support services to veterans and their families.

In the Donetsk region, services continue to be provided at the primary level of medical care for psychosocial support to the population. Fifteen primary-level healthcare facilities have signed contracts with the National Health Service under the medical guarantees program “Support and Treatment for Adults and Children with Mental Disorders at the Primary Level of Medical Care.”

To deepen knowledge regarding the assessment and management of common mental disorders and to provide professional assistance, approximately 800 healthcare workers have completed face-to-face training under the mhGAP program, as well as the online course “Management of Common Mental Disorders at the Primary Level of Medical Care using the mhGAP guideline” receiving corresponding certification. There is an ongoing need to enhance and expand knowledge of mental health, with training planned for an additional 317 medical professionals.

Clinical psychologists work in specialized hospitals and psychological assistance centers, providing individual and group support to children and adults, IDPs, veterans, and their families in need of psycho-emotional stabilization and support. Since the beginning of 2023, 11.9 thousand patients have received psychological assistance at the primary level, 203 consultations with a psychologist have been conducted, and 2.4 thousand patients have been referred to a psychiatrist who received specialized care in a timely manner. Over 5.3 thousand families/individuals have received psychological assistance in social service centers/social service delivery centers.

Thirteen specialists from social service centers/social service delivery centers have undergone training through the online course “Stress Management Skills Training in Social Work Practice and Provision of Social Services.”

Based on the analysis of consultations, educational and methodological information on psychological topics that concern parents is continuously provided through two Viber groups and three Telegram groups.

Seven educational and methodological events were also held. 403 specialists of the psychological service of the region were covered, including 260 specialists – practical psychologists, 93 specialists – social pedagogues, and 50 responsible persons for the activities of the psychological service.

Supporting mental health in the Luhansk region

The Regional Coordination Council for the Development of Mental Health Care was established in the Luhansk region. In 2023, the Regional Development Plan for Mental Health Care was approved by the Head of the Regional State Administration – Chief of the Regional Military Administration. In each territorial community of the region, mobile multidisciplinary teams have been formed, mandatory including a family doctor who has undergone appropriate training and a social worker. A training system for service providers in various sectors has been established in the region. Psychosocial support services for internally displaced persons are provided in 35 humanitarian hubs, and shelters located across almost the entire territory of Ukraine. Training seminars are conducted on the principles and methods of providing first psychological aid, personal resilience, and psychosocial support to children. 130 family doctors, 162 social sector specialists, and 680 educators have received training.