The WPA responds rapidly to a mental health crisis: the Ukrainian example

On April 1, 2020, the Ukrainian govern­ment implemented the second phase of a health reform plan restructuring the funding of specialized health care, including­ psy­chiatric services ¹ . As a result, many psychiatric services in the country reported serious levels of under‐financing, leading to the discharge of many patients, dismissal of large numbers of personnel and closure of several departments.

This sudden reduction in financial support for services was worryingly reminiscent of recent crises in other parts of the world, with grave consequences for life, health and service responses ² . It arose in the context of limited communication in recent years between the psychiatric profession and government departments. It also coincided with the COVID‐19 pandemic as it began to take hold in Ukraine, reaching several psychiatric hospitals and social care homes in the country.

In April 2020, the Ukrainian Psychiatric Association (UPA) approached the WPA with a request for assistance in its efforts to resolve the crisis in mental health care, subsequently joined by the Kharkiv‐based Association of Neurologists, Psychiatrists and Narcologists of Ukraine. In early May, the WPA commissioned the formation of an international Expert Committee to assist the two associations, both of them long‐standing Member Societies of the WPA.

The Expert Committee was established in collaboration with the Federation Glob­al Initiative on Psychiatry (FGIP). The main task of the Committee was to analyze the situation in Ukraine following the implementation of the second phase of the health reform plan, advise the associations on how to deal with the situation, and assist the Ministry of Health in finding a solution to the crisis and work towards the successful reform of ­services.

This paper documents the manner in which the Expert Committee was formed and functioned, and the outcomes and results of its work. This can serve as a model for future requests of a similar nature. It also exemplifies how organizations of a different profile, in this case a multinational association of psychiatric societies such as the WPA and a human rights based foundation such as the FGIP, can work together successfully to help improve treatment and care for people living with mental disorders.

E. Chkonia of the Georgian Psychiatric Association was invited to chair the Expert Committee. She had been involved in the reform process in Georgia (which has the same historical legacy as Ukraine, having been part of the Soviet Union) and speaks both English and Russian fluently. Other members of the Committee were chosen because of a combination of specific expertise and knowledge of the situation in Ukraine. R. van Voren was selected as Secretary of the Committee because of his contacts with people working in Ukraine and his knowledge of the Ukrainian situation. A small supervisory group was appointed, including the WPA and FGIP leadership, to advise on the process and review the draft document before its finalization.

E. Chkonia and R. van Voren discussed the objectives and strategy of the Expert Committee with members of the supervisory board. A series of conference calls was then arranged between E. Chkonia and R. van Voren with I. Pinchuk, Director of the Institute of Psychiatry at the Taras Shevchenko Nation University of Ukraine in Kyiv and Vice‐President of the UPA. The data needed for the Committee to function were gathered by I. Pinchuk and her colleagues in Ukraine, based on reports from mental health facilities from all parts of the country. These were sourced by I. Pinchuk and subsequently translated into English.

The Expert Committee met weekly by videoconference. Several of the meetings were joined by members of the supervisory board. In addition, E. Chkonia and R. van Voren continued their communication with I. Pinchuk between these meetings, sometimes joined by other members of the Committee.

The situation in Ukraine continued to unfold. New persons were appointed to the Ministry of Health, including a new First Deputy Minister of Health, who was commissioned to solve the crisis in psychiatry, and a new Minister of Health, who was determined to avoid a collapse of the psychiatric system. As a result, it was vital that the outcome of the Expert Committee’s work be delivered as soon as possible, and that the recommendations be such that they could immediately contribute to the mitigation of the existing situation. It was also important that these recommendations be consistent with those of other advisory bodies, including the World Health Organization. In order to assure this, constant communication was maintained with other parties in the mental health field.

An extensive and comprehensive policy brief was produced in the course of several weeks and subsequently reviewed by the supervisory board and several other selected experts. Once finished, the document was translated into the Ukrainian and Russian languages. Russian was chosen not only because many professionals in the eastern part of the country have it as their mother tongue, but also because the document could subsequently be used as an example for other countries in the region.

On June 29, 2020, the policy brief was sent to the two WPA Member Societies and the Ministry of Health in Ukraine. The next day the document was handed over to the First Deputy Minister of Health of Ukraine by I. Pinchuk. The President of the UPA, S. Gluzman, sent the document electronically to the Minister of Health M. Stepanov.

The Ukrainian associations are using this policy brief as a basis for discussion with the Ministry of Health. The recommendations include the necessity to enhance collaboration with all stakeholders within the country and restore the relationship between the Ministry and the psychiatric profession. The Ministry of Health is leading the dialogue about the reform process with engagement of the psychiatric associations as well as civil society and other ministries. The UPA adopted the recommendation to approach inter­national bodies that monitor the implementation of Ukraine's obligations as a signatory to international conventions. In July 2020, the UPA sent letters to the United Nations (UN) Special Rapporteurs on the Right to Health and the Rights of Persons with Disabilities, hoping that their involvement will strengthen the motivation of the Ukrainian authorities to solve the current psychiatric crisis.

The work of the Expert Committee illustrates the way in which the WPA can help to develop an effective and rapid response to a request for support from its Member Societies. The work of the Committee also exemplifies the collaboration between the WPA and the FGIP, which facilitated responding to a crisis with the help of leading experts.

The experience gained on this occasion will be helpful in responding to similar ­crises. It will also help in design of a training program to provide skills for addressing such situations. Success in these circumstances requires working in partnership with policy makers and community groups. Among the skills are those essential in advocacy, communication with media, the management of professional organizations, the application of the basic principles of the UN Convention on the Rights of Persons with Disabilities ³ , and the implementation of alternatives to coercion in mental health care4, 5, 6.