Chervonohrad (now Sheptytskyi) LIT

Following Implemental’s recommendations, Chervonohrad (officially renamed Sheptytskyi in 2024) became the first city in Ukraine to establish a LIT in the mental health field. ^{Reference Power and Suvalo4} At the time the team was established, the city was officially named Chervonohrad; however, in September 2024, Ukraine renamed it Sheptytskyi. As noted in the title, the team comprised intersectoral bodies, this term referring to collaborative groups of stakeholders from various sectors that are relevant to mental health, including healthcare, social services, education and police. The LIT’s purpose was to plan, implement, monitor and improve services in the field of mental health.

The regulation stipulated that the LIT should:

1. (a) Assess mental health needs in the community.

2. (b) Determine the priorities and risks, then plan and implement activities to improve community services.

3. (c) Arrange meetings to draw people’s attention to, and solve the problems related to, planning and providing mental health services.

4. (d) Make and follow yearly activity plans aimed at developing, implementing and providing community mental health services. These should be informed by professional recommendations, as well as by the specific needs of the local population with mental health needs. Learning should derive from other districts, communities and regions in Ukraine.

5. (e) In the planning stages, measures should aim to improve practice within regional administrative bodies, social service providers and other interested parties.

Formation of the LIT was guided by the City Governance and approved by the City Council; chosen participants came from a range of sectors, and members included the following:

1. (a) the deputy mayor as head of the LIT

2. (b) the head of the Chervonohrad Centre for Primary Medical and Sanitary Care

3. (c) the deputy head of the Labour and Social Protection Administration

4. (d) an education specialist

5. (e) an addiction specialist from the Municipal Enterprise Central District Hospital

6. (f) the head of Chervonohrad City Organisation of Disabled Youth

7. (g) public representatives.

Outcomes and activities

The LIT identified gaps and needs in Chervonohrad’s (now Sheptytskyi’s) mental health services, as outlined in Table 1.

Table 1 Identified needs in Chervonohrad (now Sheptytskyi) mental health services

mhGAP, World Health Organization Mental Health Gap Action Programme.

Among the key activities delivered, the LIT:

1. (a) Facilitated World Health Organization Mental Health Gap Action Programme (mhGAP) training, in cooperation with local non-governmental organisations (NGOs), for health and mental healthcare specialists.

2. (b) Facilitated knowledge exchange meetings for experts and residents in the community, with support from NGOs.

3. (c) Members took part in leadership training in mental health.

4. (d) Established organised training within a psychiatric hospital: ‘An educational and mentoring project for the formation of teamwork with a rehabilitation approach’.

5. (e) Conducted a social media-based information campaign on the topic of mental health, with support from the city council.

6. (f) Another notable outcome of the LIT was the situational analysis of mental health services in the city of Chervonohrad (now Sheptytskyi). For this, the WHO methodology ‘mhGAP methodology for situational analysis: a minimum data set for the implementation of mhGAP at the level of primary care’ was used.

Challenges and lessons

The activities of the LIT took place during periods of difficulties experienced by the country. Challenges included the second stage of the transformation of healthcare system financing on 1 April 2020, decentralisation and the COVID-19 pandemic. Consequently, the regularity of LIT meetings was disrupted. Despite this, LIT participants noted the importance of the previous work done and declared the need for further joint activities.

In addition, Russia’s full-scale invasion of Ukraine in February 2022 caused a humanitarian crisis and dramatically increased mental health needs. Despite these challenges, the LIT provided a dedicated platform in the field of mental health, enabling more flexible and effective responses to these challenges. Consequently, trained professionals better understood mental health needs and knew where to look for resources to meet them. There were high level levels of understanding of mental health and local needs, as well as pre-established referral routes and processes of interaction among participants in the field of mental health. Subsequently, the presence of local coordination bodies was shown to be relevant and effective under these new crisis conditions.

Participants also shared their own challenges encountered during LIT activities. First, the level of stigma and prejudice surrounding mental health hindered the development of services and interaction among the various parties involved. Moreover, at national and regional levels, there was a reported lack of community understanding of mental health policies, intersectoral coordination and flexibility in the provision of services, which affected problem-solving. As might be expected with Ukraine being a middle-income country, there was also a notable lack of funding, human resources, material resources and local leadership within the field of mental health. ^{Reference Metreau, Young and Eapen5} These challenges were tackled through a combination of training, meetings with service users and decisions made by the local city council.

Recommendations about the activities of local mental health teams included the following:

1. (a) LITs should be created at a regional district level or in the district centre, and should involve representatives from these communities.

2. (b) LIT members should have roles in various employment departments (healthcare, social sphere, education, employment, police). There should also be civil society members (representatives of religious communities, NGOs working in mental health, etc.).

3. (c) The group should be open to the public sector, especially community organisations representing people with mental health disorders and their families.

4. (d) Involvement of service users is crucial for the promotion of the group’s activities, advocating for better care and overcoming stigma and prejudice.

5. (e) Regular meetings are an essential element of routine work, planning and lobbying.

6. (f) All decisions should be documented in order to influence budget-setting processes and funding of agreed activities.

7. (g) Gaps identified in mental healthcare should be presented in the form of requests to the relevant structures, in order to secure funding and tackle needs.

8. (h) Leadership and vision in the local community/district is a key element.

9. (i) Professional training in different fields is key to raising awareness and ensuring the implementation of human-centred and evidence-based practices.

10. (j) Support from an external facilitating organisation is very helpful for LIT members. This role can include raising of awareness, psychoeducation and explanation of evidence-based, recovery- and human rights-oriented mental health frameworks.

11. (k) Willingness to learn and be open to innovations to improve services in the local community is essential.