healthcare – Institute of Global Health Innovation

Julia Anderson Careers Event 2024: Inspiring sixth formers with career insights and opportunities to transform global health

11 March 2024

In February we hosted the Julia Anderson Training Programme (JATP) Careers Event 2024 at Institute of Global Health Innovation (IGHI), a fantastic evening for sixth form students to learn more about our Julia Anderson programme and the IGHI, and get inspired for their future careers.

JATP trainees with IGHI staff — Credit: Rolando Charles

Sixth formers from different London state-funded schools travelled to The Invention Rooms, at Imperial College London’s White City Campus, to participate in the event. They got the chance to learn more about the opportunities at IGHI, hear some of our staff members’ career journeys, as well as interact with some of the fantastic workstreams we work on to improve people’s health.

About the Julia Anderson Programme and next cohort recruitment

The evening started with Sophie Pieters, IGHI Operations Officer and JATP Programme Lead, welcoming the attendees and introducing the JATP programme, including the eligibility criteria and the new trainee roles available in the summer.

The Julia Anderson Training Programme gives people with limited or no work experience the opportunity to join an impactful stream of work at IGHI, Imperial College London’s. The paid programme gives trainees the opportunity to grow their network, boost their CV and develop applicable workplace skills and knowledge.

Sophie announced the three upcoming roles for the next cohort in July, specifically Analytics and Events Trainee, Public Involvement Trainee and Educational Research Trainee (the first two are open to those with no university). On 14 March, a webinar will be held to provide people with more information on the programme, the training positions on offer and useful advice for the application. Students were highly encouraged to sign up for the webinar.

Career talks from IGHI staff and trainees

Next, some of the IGHI staff and current trainees delivered individual presentations highlighting their career journey, challenges, and other valuable insights from their experience.

“I found the job I loved although didn’t know it existed. It’s okay if you don’t know what you want to do.’’, said Eleni Daniels, Patient Safety Research Centre (PSTRC) Manager at IGHI, who has a background in biomedical sciences and worked in advertising before finding her dream job in a patient safety field.

Image: Eleni Daniels giving a presentation about her career journey. Credits: Rolando Charles

Amish Acharya, Scientific Advisor to Professor Ara Darzi at IGHI, talked about his ‘unconventional’ career path from medicine, followed by PhD in Behavioural Science, to his current role, where he is contributing to creating research projects and supporting the progress of scientific work. Amish advised:

“Exams don’t represent who you are and what you can do. It’s never too late to change your path, don’t be afraid to try different things – this can often make you more adaptable and rounded as a person.’’

One of our current Julia Anderson Trainees, Tania Domun, a graduate of Population Health and Medical Sciences with a Master’s degree in Public Health, shared her experience so far as a JATP trainee in Behavioural Science and the benefits of joining the programme:

Tania Domun sharing her experience as a current JATP trainee. Credits: Rolando Charles — Tania Domun sharing her experience as
a current JATP trainee. Credits: Rolando Charles

“JATP allows you to develop your skills and support you with the next steps in your career. It’s challenging when you don’t have a mentor or people to help you navigate your professional path. The programme does exactly that, by focusing on you as an individual. It’s a lot about your passions and not your previous work experience. This makes it a unique programme.’’

She also talked about the Imposter syndrome: ‘’I’ve realised many people, including me, deal with this syndrome – don’t let these feelings stop you from applying for the programme. This is the best time to explore possibilities and build new skills.’’

Lastly, Clarissa Gardner, Senior Design Researcher at TPXimpact and Honorary Research Fellow, spoke about her career journey as a ‘learning process’ and how she came about setting the JATP programme, after doing a MSc in Health and Design at IGHI:

‘‘Your job title doesn’t matter as much as your ability to help others and inspire positive change. I recognised the diversity of people at IGHI, so I proposed this programme to create work experiences for people.’’

Interactive activities showcasing IGHI Centres’ work

After these inspiring talks, we organised interactive activities led by each of the IGHI Centres. During these sessions, attendees had the opportunity to engage with the different workstreams at IGHI in small groups and interact with IGHI staff members.

The Hamlyn centre hosted a ‘create your own surgical robot’ activity. Sixth formers were challenged to conceptualise the design of a robot, then turn their drawings into 3D images using specialised software. Hamlyn centre representatives also explained the benefits of surgeons using surgical robots compared to traditional surgery methods, highlighting how they enhance precision during procedures. The participating team included Brandon Davies, Learning Technologist, Nazia Bharde, Project Officer, Robert Merrifield, Medical Design Associate and Salzitsa Anastasova-Ivanova, Facilities Manager.

Brandon Davies briefing students on how to design a surgical robot. Credits: Rolando Charles

At one of the Helix Centre stands led by Jodie Chan, Patient and Public Involvement and Engagement Officer, and Clare McCrudden, Policy Fellow from the Change Lab, students had the opportunity to discover how the public can influence research priorities, methodologies, and dissemination for healthcare improvement. They were encouraged to brainstorm alternative names for ‘antimicrobial resistance’ and open the ‘can of worms’ around healthcare data through an interactive activity, sparking further discussions on its benefits and risks.

Image: Clare McCrudden talking about antimicrobial resistance with sixth formers. Credits: Rolando Charles — Image: Clare McCrudden talking about antimicrobial
resistance with sixth formers. Credits: Rolando Charles

They also learned about one of the upcoming JATP roles – Public Involvement Trainee – who will help to involve local youth groups and schools in a project aimed at better understanding the mental health needs of children across the UK and identifying how services can better support them.

The second Helix Centre stand was led by Matthew Harrison, Senior Design Associate, Alex Dallman-Porter, Designer Healthcare Products, and current JATP trainee, Andrew Watt. People were invited to participate in a grip strength assessment activity, during which they were asked to squeeze a ball-shaped dynamometer (‘squegg’) in their hand to measure their frailty levels and compare with their peers. Additionally, the stand showcased a sleeping mat used for measuring heart rate and respiratory rate, along with other environmental sensors designed for individuals with dementia.

Jessica Newberry Le Vay, Climate Change and Health Policy Fellow at the Climate Cares Centre, hosted an interactive session about exploring climate emotions and imagining what future they want to see. The students were challenged to think about the following questions: ‘’How does climate change make you feel?, What stories do you hear about the future?, What would you want the future to look like?’’

People were able to discuss their responses to these questions and see what other people have put. They explored actions that can improve both mental health and the climate, building hopeful and constructive narratives around climate change.

Eleni Daniels from PSRC also had a stand on patient journey. She encouraged students to reflect on healthcare experiences of themselves, their family members, or friends, and to consider how these experiences could be further improved. People shared their thoughts and experiences, engaging in a dialogue that allowed them to open up and explore patient journeys from the GP to hospital settings.

Feedback from sixth formers

We were impressed by the amount of positive feedback we received from the sixth formers. Some examples below:

“I’ve discovered that you don’t need to know exactly what you want to do at this age. It’s more important to be open to learning and taking on new opportunities and experiences.”

“Many internships and training programmes require individuals to meet specific minimum requirements. It’s fantastic to discover that the JATP program doesn’t have such requirements, giving people the chance to gain those skills and build experience.”

Sophie Pieters, JATP Lead, and Holly Merton, JATP trainee, chatting with the sixth formers. Credits: Rolando Charles

“I found the event very engaging and fun. It made me think about my future career, the steps I want to take next and the sort of support I should be seeking. I am keen to apply for this programme!’’

On the day feedback indicated that, among our participants, 90% were inspired for their career after attending the event. According to our post-event online survey, 92% of our participants expressed their willingness to recommend JATP to a friend, while 83% of respondents indicated their intention to apply for JATP in the future.

We are looking forward to seeing people applying for the JATP programme and taking advantage of the tremendous opportunities at IGHI to advance in their careers. The event was made possible by the EDI Seed Fund and we are very grateful for their support.

Ukraine: Better care for children with complex long-term health needs

Alexandra Shaw

29 February 2024

Our third blog post for the two-year anniversary of the invasion of Ukraine addresses the importance of prioritising better care for children with complex long-term health needs.

This is part of a series of blog posts sharing insights from our Ukraine Health Summit, hosted in partnership with the British Red Cross to further efforts in supporting the delivery and restoration of health services in Ukraine. This piece is written by Alexandra Shaw, Institute of Global Health Innovation, Imperial College London, with colleagues.

[Ukraine Health Summit: attendees chatting] — Ukraine Health Summit: attendees chatting

In Ukraine, many children continue to be cared for in institutions. Estimates vary widely and suggest that between 90,000-200,000 children reside in these institutions, and approximately 20,000-50,000 of them have disabilities.^{1 2}

Children have a range of disabilities including congenital abnormalities of the nervous and cardiovascular systems, foetal alcohol spectrum disorders, genetic disorders and chromosomal abnormalities, visual impairments, cerebral palsy and epilepsy.³Factors impacting institutionalisation include poor infrastructure for children with disabilities, including education and community-based therapy services. There is a lack of crucial services, including rehabilitation and palliative care, and support in the community, making caring for a child with complex health needs even more challenging. Social challenges also drive institutionalisation including poverty, social stigma and the lack of support means families are left isolated.³ An estimated 90% of children placed in institutions have parents or family but are placed in institutions because of the challenges of caring for them in the community. Other factors include the inability of parents to care for their children, neglect or substance abuse.²

Impact of institutionalisation

In 2019, the 74th UN General Assembly adopted the resolution on ‘Rights of the child’ which urges that family and community-based care should be promoted over placement in institutions, and that children with disabilities should enjoy all human rights and fundamental freedoms on an equal basis with other children, including access to a family life.4 Children living in institutional environments can suffer significant harm including the impact on their quality of life, their ability to adapt to society, mental health and overall development.5 Facilities often fail to meet basic needs, address individual requirements and provide emotional and social stimulation.

Institutionalisation can lead to poor physical and mental health outcomes, stunting and a lack of development from inadequate nutrition, and infectious disease. Children who have been institutionalised can be left with difficulties processing and integrating sensory information, poor language development, damaging behaviours and significantly shortened life expectancy.6 Staff to child ratios are often inadequate, leading to inappropriate methods of restraint, and a lack of supervision means children are not provided with adequate sanitary care, or assistance with feeding.²

Reform and impact of war

Before the war, the government had adopted the National Strategy on Reform of the Institutional Care System (2017-2026), however there have been delays in implementation and children with disabilities have been excluded included in these reforms.7 The war has made the situation for children with complex long-term health needs even more desperate. Whilst children with more mild disabilities are being evacuated, many children have been moved from facilities in the east of Ukraine to inadequate facilities in the west. This had led to overcrowding, further reduced staff ratios, and a lack of medical records leaving staff looking after children with no background information about their condition and care needs.8

In some cases, children have been returned to their families without support or guidance to ensure the child’s health needs are adequately met.¹ The European Commission has provided 230 million in humanitarian aid to the Ukrainian government which brings an opportunity to ensure disabled children benefit from the assistance provided to Ukraine.⁹

[Ukraine Health Summit: Dr Ulana Suprun] — Ukraine Health Summit: Dr Ulana Suprun

Moving forward

There is still progress to be made to improve care for children with complex health needs in Ukraine. A unified approach is required which clearly defines the responsibilities and powers of government authorities and local organisations to apply standards to protect children’s rights and care. Key recommendations include:

1. Reform for the provision of community based care

Change of policy and legislation, alongside political commitment, to prevent future institutionalisation and protect the rights of children, particularly those with disabilities.
Implement programmes to develop long-term family-based environments for children currently living in institutions.
Develop services to support children and families in the community including early intervention, social care support systems, family-based care, rehabilitation services, social services and paediatric palliative care.
Enable a holistic approach to care for children with complex health needs, including the role of education, sport, family and culture.

2. Paradigm and cultural change campaign

Launch a comprehensive and sustained campaign to enable a shift in attitudes and paradigms across all professions and the workforce.
Implement policy and a public campaign to encourage a societal shift in the way children with complex long-term health needs are viewed.
Enable the empowerment of families to advocate for their own children and specialist needs.

3. Development of health and social care workforce

Implement educational programmes to increase the size of the workforce in the areas of medical rehabilitation services, paediatric palliative care and social services.
Upskill professionals and expand access to continuing development for staff working across paediatric health and social care.
Develop capability in the community for family members, carers, social workers, rehabilitation staff, and other allied professionals such as speech and language therapists to support children in the community.

4. Strategic allocation of reconstruction funding

Develop a strategic plan to guide the allocation of reconstruction and support funding for children to be cared for outside of institutions.
Enable collaboration across different ministries which oversee education, social care and health to bring a more unified effort towards reducing the number of children living in institutions.
Prevent the reconstruction and rebuilding of institutions and instead invest in foster care, family and community-based services.

References

Ukraine war response: Children with disabilities. UNICEF; 2022 (https://www.unicef.org/emergencies/ukraine-war-response-children-disabilities, accessed 18 February 2024).
No Way Home: The exploitation and abuse of children in Ukraine’s orphanages. Disability Rights International; 2015. (https://www.driadvocacy.org/reports/no-way-home-exploitation-and-abuse-children-ukraines-orphanages, accessed 18 February 2024).
Behind the mask of care: A report based on the results of the situation analysis of baby homes in Ukraine. Hope and Homes for Children, USAID, UK Aid; 2020. (https://www.hopeandhomes.org/publications/a-report-based-on-the-results-of-the-situation-analysis-of-baby-homes-in-ukraine/, accessed 18 February 2024).
Rights of the child: resolution adopted by the General Assembly. 74th UN General Assembly; 2019: United Nations.
Slozanska H, Horishna N. Functioning of boarding schools negative impact on pupils. Social work and education. 2021;8:18-41.
Huseynli A. Implementation of deinstitutionalization of child care institutions in post-soviet countries: The case of Azerbaijan. Child Abuse Negl. 2018;76:160-72.
Rosenthal E, Kurylo H, Ciric Milovanovic D, Ahern L, Rodriguez P. Protection and safety of children and disabilities in the residential institutions of war-torn Ukraine: The UN Guidelines on Deinstitutionalization and the role of International Donors. International Journal of Disability and Social Justice. 2022;2(2).
In Ukraine, children with disabilities live in horrific conditions. Handicap International; 2022 (https://www.hi.org/en/in-ukraine–children-with-disabilities-live-in-horrific-conditions#:~:text=The%20situation%20of%20disabled%20children,risk%20of, accessed 18 February 2024).
The forgotten victims of the war against Ukraine: European Network on Independent Living; 2022 (https://enil.eu/the-forgotten-victims-of-the-war-against-ukraine/, accessed 19 February 2024).

Health in Ukraine: Prioritise health care reform across the Ukraine health system for recovery and stable peace

Niki O'Brien

26 February 2024

Two years on from the invasion of Ukraine, we share a series of blog posts highlighting insights from our Ukraine Health Summit last year, hosted in partnership with the British Red Cross to reflect on and support the delivery and restoration of health services in Ukraine.

The second blog post focuses on the prioritisation of health care reform across the Ukraine health system for recovery and stable peace, and is written by Niki O’Brien, Institute of Global Health Innovation, Imperial College London, with colleagues.

[Ukrainian flag colours. Credits: Tina Hartung/Unsplash]

The war in Ukraine has caused substantial disruption to a health system that was already having to manage complex transitions.1

In 2014 the Ministry of Health of Ukraine initiated a national strategy to improve quality and access to care and sought to address longstanding challenges in strengthening primary health care (PHC), among other reforms.2 Since then, a guaranteed benefit package to reduce out-of-pocket payments was set up and enrolment with contracted PHC providers expanded to cover over 70% of the population as of 2020.

Since 2014, initial armed conflicts in the Donetsk and Luhansk regions have had implications on regional health services. However, the ongoing Russian invasion in 2022 has led to widespread disruption and destruction of infrastructure and resources across the country. Nationwide attacks on civilian infrastructure also target healthcare facilities, with over 1,500 damaged or destroyed as of 15 June 2023.3 The occupied territories have been hit particularly hard and face a severe shortage of health care workers (HCWs), medications, and supplies. For example, in the municipality of Melitopol, half of the doctors were forced to leave in the first months of the war.4 National and regional progress towards health policy ambitions has been drastically curtailed as resources have been reallocated to the immediate needs of the emergency response including frontline medical care.

Armed conflicts cause both direct and indirect morbidity and mortality with the latter occurring from both communicable and non-communicable diseases (NCDs). As expected, a rapid increase in infections has been reported, and the destruction of the Kakhovka Dam may further affect many thousands of local inhabitants while increasing the risk of the waterborne diseases.5 Moreover, cancers, oncology, and stroke in particularly can occur as a result of or be exacerbated by stress-mediated pathways.6 In Ukraine, cancer mortality was already high, however, recent research suggests that war-related delay in care of four months for five of the most prevalent cancers could lead to an excess of over 3,600 cancer deaths in the coming years.4

The war has also interrupted reform at the patient, health delivery and policy levels which had been initiated through disease-specific lenses in secondary and tertiary care pre-2022. For example, a significant proportion of Ukraine’s radiotherapy is based on Cobalt-60, rather than modern linear accelerators (LINACs) reflecting a wider need not just to increase basic modern technologies (CT, MR scanners etc) but also to upgrade existing hospital infrastructure.7 Volunteer and humanitarian help are essential but currently fulfil only some of the gaps, challenged further by lack of a nationwide coordination to address the needs of healthcare institutions.

Ukraine Health Summit woman in the audience speaking — [Ukraine Health Summit: woman in the audience speaking]

Measures to support Ukraine’s health system both now and in the early recovery period will need to focus on investment in HCWs and working with patient groups. For HCWs, examining and addressing the various push-pull factors, at a policy and systems level are required to support return. Pull factors for return include security and the potential to resume professional advancement and renumeration by re-establishing links between health service delivery and continuing education. Subject to budgetary constraints, the Ministry of Health could consider capitation-based payments and non-financial benefits to encourage relocation to resource-limited geographic areas or specialties.

Research in post-conflict settings highlights the value of indirect financial incentives (e.g., subsidised meals, childcare facilities, support for continuing education) and non-financial incentives (e.g., career development, improved healthcare facility resources and infrastructure).8 Digital learning platforms can further offer HCWs the opportunity to develop their knowledge by undertaking education and training remotely. There is also a need to invest in the PHC workforce (both physician and non-physician) together with substantial investment support and treat patients in the post-war period.

Ukraine is fortunate to have strong physician and patient organizations who can advocate for the needs of patients and communities. Advocating across disease areas and advising on where treatment can be sought, these organizations connect to patients and communities through social media while also working with high-level policymakers to drive change. When ProZorro, an electronic procurement system was launched in 2020 as part of reforms, 100% Life, one of the largest patient organizations in Ukraine used data from the system to fight corruption, with tangible benefits for the Ukrainian health system.9

After one year of war, in 2023 the organisation had collected $968,000 USD for humanitarian aid and provided 4,773,296 packages of medical goods.10 In 2024, the organisation and its partners has continued to support health service delivery by facilitating training and purchasing medical equipment.¹¹¹²Importantly, all individuals, organizations, and groups involved in delivering and receiving health care in Ukraine must come together to through a ground-up, community-led approach to realise a people-centred health system and drive people-centred reforms.

To be successful, efforts must be driven by patient, community, and population needs, led by government, and supported by providers and other stakeholders across the public and private sectors. As further atrocities are reported daily as the war in Ukraine rages on, there may be a reluctance to prioritise the planning of future health services. However, health, and therefore health care, is a prerequisite for recovery and stable peace.

References

1. Roborgh S, Coutts AP, Chellew P, Novykov V, Sullivan R. Conflict in Ukraine undermines an already challenged health system. Lancet. 2022 Apr 9;399(10333):1365-1367. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00485-8/

2. WHO. Health financing reform in Ukraine: progress and future directions. World Health

Organization, 2022. Geneva, Switzerland. Available at: https://www.who.int/ukraine/publications/i/item/WHO-EURO-2022-5639-45404-64974

3. Міністерство охорони здоров’я України. За понад 15 місяців повномасштабної війни росія пошкодила або зруйнувала 1 554 об’єкти медзакладів. Міністерство охорони здоров’я України, 2023. Kyiv, Ukraine. Available at: https://moz.gov.ua/article/news/za-ponad-15-misjaciv-povnomasshtabnoi-vijni-rosija-poshkodila-abo-zrujnuvala-1-554-ob’ekti-medzakladiv-

4. Khanyk N, Hromovyk B, Levytska O, Agh T, Wettermark B, Kardas P. The impact of the

war on maintenance of long-term therapies in Ukraine. Front Pharmacol. 2022;13:1024046. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731218/

5. Pavlenko D, Pavlenko M, Pavlenko R. Advantages and limitations of teleophthalmology during the war in Ukraine. Graefes Arch Clin Exp Ophthalmol. 2023 Jun;261(6):1761-1763. Available at: https://link.springer.com/article/10.1007/s00417-022-05967-1

6. Jawad M, Hone T, Vamos EP, et al. Estimating indirect mortality impacts of armed conflict in civilian populations: panel regression analyses of 193 countries, 1990–2017. BMC Med, 2020; 18, 266. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487992/

7. Price P, Sullivan R, Zubarev M, Zelinskyi R. Radiotherapy in conflict: lessons from Ukraine. Lancet Oncol. 2022 Jul;23(7):845-847. Available at: https://www.sciencedirect.com/science/article/pii/S1470204522002984?via%3Dihub

8. Witter S, Tulloch O, Martineau T. Health workers’ incentives in post-conflict settings – a review of the literature and framework for research. ReBUILD RPC, 2012. London, United Kingdom. Available at: https://assets.publishing.service.gov.uk/media/57a08a7be5274a31e0000614/rebuild_hwi_lit_review.pdf

9. Hrytsenko, Y. Fight for life: how Ukraine is fixing medical procurement and serving patients better. Open Contracting Partnership, 2021. Available at: https://www.open-contracting.org/2021/02/22/fight-for-life-how-ukraine-is-fixing-medical-procurement-and-serving-patients-better/

10. 100% Life. 100% LIFE, A Year Of Courage. 100% Life, 2023. Available at: https://network.org.ua/en/100-life-a-year-of-courage/

11. 100% Life. With the USAID support, 100% Life covered all primary care physicians in Lviv the training. Available at: https://network.org.ua/en/with-the-usaid-support-100-life-covered-all-primary-care-physicians-in-lviv-the-training/

12. 100% Life. Japanese Ministry of Foreign Affairs funds purchase of equipment for Ukrainian hospitals. Available at: https://network.org.ua/en/japanese-ministry-of-foreign-affairs-funds-purchase-of-equipment-for-ukrainian-hospitals/

Mental health services must be a priority in post-conflict Ukraine

Melanie Leis

22 February 2024

Two years on from the invasion of Ukraine, we publish a series of blog posts sharing insights from our Ukraine Health Summit, hosted in partnership with the British Red Cross to further efforts in supporting the delivery and restoration of health services in Ukraine.

The first post addresses the importance of mental health services in post-conflict Ukraine, and is written by Melanie Leis, Institute of Global Health Innovation, Imperial College London, with colleagues.

On April 25^th 2023, Imperial College London hosted the first Ukraine Health Summit. This event presented an opportunity to discuss how Ukraine’s health system must be re-built to ensure it addresses the needs of its population in a post-conflict setting. A focal point of the discussion was around the provision of mental health services.

The WHO projects that, of populations affected by conflict at any time during the prior 10 years, 22% will develop a mental health condition. Applying these estimates to the population of Ukraine (44M), this would lead to approximately 10M who will have a mental health condition such as depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia, in addition to existing mental health cases1. Estimates by Ukraine’s government suggest that over 60% of its soldiers are affected by post-traumatic stress disorder, and approximately 50% of the population needs mental health services to cope with the impact of the war^2.

Mental health experts at the Ukraine Health Summit agreed that post-conflict mental health service provision should be planned and coordinated across three key themes: policy and regulation, training and education, and family support.

Policy and regulation

The healthcare system in Ukraine, including its mental health services, is a legacy of its Soviet past. Prior to the war, there had been a trend towards reform of the mental health system to address challenges such as limited social services for people with mental health disorders, large institutionalised psychiatric populations (at times associated with human rights violations), and public stigma around mental health^3.

In December 2022, Ukraine’s First Lady launched the Ukrainian Prioritized Multisectoral Mental Health and Psychosocial Support Actions During and After the War: Operational Roadmap^4.This roadmap, informed by international and national policies and best practice, aims to provide an overview of mental health and psychosocial priorities to stakeholders involved in the immediate response and the recovery efforts in Ukraine.

One of the issues in the provision of healthcare services in the current conflict setting is the lack of coordination between Government, international organisations and NGO activities. To effectively deliver mental health and psychosocial support in a post-conflict setting the Government must coordinate service delivery. This includes providing greater clarity on service availability, treatment pathways and enforcing regulation to ensure that the services that are delivered meet the highest quality standards. At the same time, non-public sector mental health providers must follow the Government’s leadership.

Training and education

Raising public awareness about mental health issues in the Ukraine is of paramount importance. This includes launching information campaigns and educating the general public about PTSD, depression, panic attacks, and other mental health conditions likely to affect the population.

Crucially, the conflict will have decreased the number of staff available to deliver mental health and psychosocial services. Effective psychosocial support can be delivered by professionals who do not necessarily have to be mental health specialists, but they must be adequately trained. Volunteers who are deployed with no training and are exposed to traumatic events risk developing their own mental health disorders. Furthermore, the impact of inadequately delivered mental health interventions can range from ineffective to ultimately harmful5.

Additionally, those providing mental health and psychosocial support services must have their own mental health needs adequately supported to deliver these services effectively and sustainably. One approach to do this is through mental health providers becoming “trauma informed organisations”, where safeguards are in place to provide physical and emotional safety to staff and avoid re-traumatisation^6.

[Ukraine Health Summit 2023 – IGHI Centre for Health Policy Banner]

Family support

Mental health needs vary significantly across different population groups. People with pre-existing mental health conditions may have deteriorated during the war, both due to the direct impact of the conflict and to the decrease in access to care. Additional groups that require mental health services include active military personnel and their families, veterans and their families, bereaved families, children exposed to war, and relocated/displaced families. An individual may be part of several of these groups at once.

There is an opportunity to leverage digital mental health interventions to support families. A scoping review7.identified 36 studies of these interventions, the majority of which targeted young people and parents/carers. These were self-guided, potentially improving access to psychological support without increasing demand on limited clinical services. Most of the interventions tested were associated with improved psychopathology.

Mental wellbeing is strongly associated with a person’s basic needs being met. This is even more the case in a post-conflict setting. One study that looked at the use of healthcare and community-based services in war-affected regions of Croatia found that, although a variety of services were put in place to help the affected population, only the solution of housing (accommodation support) significantly predicted traumatic stress recovery^8.

The importance of safety and stability for the affected populations cannot be overstated, as these are crucial to people’s mental well-being. For some specific populations, a key factor in mental health recovery will the passage of time and the return to a safe and predictable routine.

Government leadership, well supported frontline mental health workers and a focus on wider societal support will create the conditions for successful mental health service in post-conflict Ukraine.

References

1. World Health Organization. (2022, December). Scaling-up mental health and psychosocial services in war-affected regions: best practices from Ukraine. Retrieved from https://www.who.int/news-room/feature-stories/detail/scaling-up-mental-health-and-psychosocial-services-in-war-affected-regions–best-practices-from-ukraine#:~:text=In%20applying%20these%20estimates%20to,have%20a%20mental%20health%20condition (Accessed 2023/07/28)

2. Euronews. (2023, February). War in Ukraine having a devastating impact on people’s mental health. Retrieved from https://www.euronews.com/2023/02/20/war-in-ukraine-having-a-devastating-impact-on-peoples-mental-health (Accessed 2023/07/28)

3. World Health Organization. (2020, July). Ukraine WHO Special Initiative for Mental Health Situational Assessment.Retrieved from https://cdn.who.int/media/docs/default-source/mental-health/who-special-initiative-country-report—ukraine—2020.pdf?sfvrsn=ad137e9_4 (Accessed 2023/07/28)

4. World Health Organization. (2022, December). Ukrainian Prioritized Multisectoral Mental Health and Psychosocial Support Actions During and After the War: Operational Roadmap. Retrieved from https://reliefweb.int/report/ukraine/ukrainian-prioritized-multisectoral-mental-health-and-psychosocial-support-actions-during-and-after-war-operational-roadmap-enuk (Accessed 2023/07/28)

5. Jarrett, C. (2008, January). When therapy causes harm. The Psychologist. Retrieved from https://www.bps.org.uk/psychologist/when-therapy-causes-harm (Accessed 2023/07/28)

6. Office for Victims of Crime Training & Technical Assistance Center (not dated). Building trauma-informed organizations. Retrieved from https://www.ovcttac.gov/views/TrainingMaterials/NVAA/ASI/index.cfm?nm=nvaa&ns=asi&nt=sgo&nf=btio (Accessed 2023/07/28)

7. Danese et al. Digital mental health interventions for children and adolescents affected by war: a scoping review. The Global Resources for War-affected youth (GROW) Network. Currently under review at JAACAP.

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