As need for mental health services soars in Ukraine and beyond, Pact and our partners deliver

Tetiana Petrova knows from personal experience how difficult it can be to cope with war. Twice she has been displaced by conflict, first from Luhansk, in eastern Ukraine, where she was living when Russia invaded in 2014. She moved to the outskirts of Kyiv, to the village of Mykhailivka-Rubezhivka, where she resumed her decades of work as a family doctor. 

When Russia’s wider invasion began in early 2022, Petrova served at a military hospital until she again had to flee. She returned to Mykhailivka-Rubezhivka immediately after the village was liberated, and was soon asked to work as a family doctor in the local primary health care facility.

Petrova says that in the first months of the war, the support she received often from complete strangers gave her strength and hope. It left a deep impression on her about people’s needs amid war.

“I am an ordinary person, yet I was not left alone in difficult times,” she says. “People have to know they are cared for. They need to feel support.”

It’s a lesson she brings to bear each day in her work at the local health clinic, which, with support from Pact and USAID, now includes a dedicated center for psychological services. It’s the first “Taking Care of Myself” center, with at least 10 more set to open this year at primary health clinics in Ukraine through the USAID-funded, Pact-led Public Health System Recovery and Resilience project.

"I am not exaggerating when I say that every other patient who comes to me needs psychological support,” Petrova says. “The worst thing is that people have uncertainty. They don't know what to expect tomorrow – bombings, blackouts or something else.”

The Public Health System Recovery and Resilience project, or PHS R&R, was designed before Russia’s 2022 invasion and included a mental health component, but this was quickly, significantly expanded in order to increase access to mental health and psychosocial support services, or MHPSS. The project’s work includes expanding access to community-based mental health services, strengthening the country’s mental health workforce, promoting care seeking for mental health, and strengthening sustainable systems for comprehensive, evidence-based MHPSS. 

“Mental health is absolutely a public health issue, and especially now in Ukraine,” says Alyona Gerasimova, Pact’s Ukraine country director. “The need is outstanding, and with our partners, we are doing all we can to meet that need.”

MHPSS is a growing area of focus for USAID and for Pact, says Shirley Ko, Pact’s senior director for global health. Pact is implementing mental health and psychosocial support work across Africa as well as in Asia, Latin America and Ukraine. Beyond integrating mental health components into health and HIV/AIDS programming, Pact’s governance work includes mental health interventions within the framework of trauma healing in peacebuilding processes.

“We see this as a very positive step forward in development, as it gives us the opportunity to address individual and community health and well-being more holistically,” Ko says.

Pact’s MHPSS work focuses on making mental health and psychosocial services more accessible in community settings through trained local partners and lay providers, as well as on addressing stigma and misconceptions about mental health that often keep people from seeking care.

“At the foundation of this is mental health systems strengthening – the systems, capacities and collaboration that need to be in place for people to access the right level of mental health care for their needs,” Ko says. “We are addressing mental health as a public health issue, with emphasis on prevention and early detection and intervention.”

Ko notes that the situation in Ukraine is especially dire. “As this brutal war continues, communities are facing a build-up of mental health challenges such as ongoing trauma, stress, anxiety, depression and grief.”

Under the PHS R&R project, Pact works at all levels of the mental health care system – national, regional, community – to increase capacities to meet the surge in need, with a focus on priority populations including internally displaced people, veterans and their families, and survivors of war-related sexual violence, occupation, captivity and torture. PHS R&R has become a platform for all USAID-supported efforts in scaling up access to MHPSS services in Ukraine.

At the national level, the project works in close partnership with Ukraine’s Health Ministry and First Lady’s Office. Pact began by supporting an audit of mental health needs and resources, determining that at least 50% of Ukraine’s population will need mental health support because of the war. Pact is working to decrease stigma around mental health by supporting campaigns that raise awareness of mental health and encourage Ukrainians to seek help, such as the First Lady's national How are U? campaign. We are also documenting and packaging promising service delivery models and responding to immediate needs through countrywide access to trauma-focused cognitive behavioral therapy.

At the community level, our work is expanding and strengthening Ukraine’s mental health workforce as well as access to community-based, step-wise MHPSS services. Dr. Petrova is one of more than 1,000 physicians and nurses who have been trained through PHS R&R in the World Health Organization’s mhGAP program, which is aimed at managing mental health and neurological disorders in non-specialized facilities. This has increased access to mental health services for nearly 1 million Ukrainians.

For Petrova, the training has been critical. She sees many patients whose chronic illnesses have significantly worsened during the war, and says the success of their recovery depends on psychological assistance.

“People turn to us [family doctors] first,” she says. “We are the first to do screenings and see who needs help.”

By participating in PHS R&R, the staff of the Mykhailivka-Rubezhivka clinic, which serves about 3,900 residents, have also learned a mind-body medicine program, which has proven effective in other war contexts for reducing the impact of trauma and preventing the development of post-traumatic stress disorders. The Taking Care of Myself center in Mykhailivka-Rubezhivka is equipped for mind-body medicine group sessions as well as individual counseling, including online access to trauma-focused cognitive behavioral therapy. So far, through PHS R&R, 140 facilitators at 90 sites have been trained in mind-body medicine.

Gerasimova says the move toward community-based MHPSS services – a key to Pact’s approach – has been critical in increasing access, though there is much work left to transition from the traditional, medicalized system for mental health care.

Through innovations like the Taking Care of Myself service sites, Pact and USAID have been able to meet people where they already are and increase reach. “We focus on broad access to services, and then stepped up levels of care for those who need it,” Gerasimova says.

“In everything we do, we are thinking about sustainable impact and what Ukrainians will need to thrive going forward. We are looking toward the best future for Ukraine.”