Section snippets

Executive summary

The Russian invasion and annexation of eastern Ukraine and Crimea in 2014, along with the ongoing war since February, 2022, have inflicted incalculable damage to Ukraine with many deaths and injuries, massive population displacement, and extensive physical and emotional trauma. These events put an immense strain on the general health-care and mental health-care systems. For many years the mental health-care system in Ukraine was dominated by large psychiatric hospitals and residential

Introduction: History and vision for change

Ukraine, the largest democratic country in Europe, has been faced with a perfect storm of challenges. From 1922 to 1991, it was part of the Soviet Union where the mental health-care system was dominated by large psychiatric hospitals and residential institutions focusing almost exclusively on biological therapies. The system was well known for neglect, abuses, and human rights violations.1, 2 As Ukraine emerged from the Soviet era into independence, it underwent massive political, economic, and

Part 1: Community-based mental health care and a vision for a new network of Ukrainian mental health-care services

The Commission developed a consensus that Ukraine should develop a network of community-based mental health-care services. A sequence of incremental steps of change should be designed to facilitate progression from the current system towards a community-based mental health-care system.Before 2017, the Ukrainian mental health-care system focused on treatment and tracking (called dispanserisation) of people with severe mental disorders. This strategy was delivered through a network of inpatient

Part 2: Training and education of the mental health workforce

A 21st century mental health-care system requires an enabled and skilled multidisciplinary workforce that meets the immediate and emerging needs of the settings in both primary care and specialist mental health-care systems. Nurses, psychologists, allied health professionals, family doctors, and specialists in psychiatry are the core of this mental health workforce. This diverse group requires broad, overlapping capabilities and discipline-specific competencies to function as an integrated and

Part 3: Rebuilding mental health research capacity and infrastructure

Historically, Soviet models have dominated Ukrainian mental health research, leaving the country lagging behind European, US, and other models. Since Ukraine gained independence, with the assistance of international colleagues, creative leaders in Ukrainian psychiatry have initiated efforts to remedy these problems. However, the Russian invasion of eastern Ukraine and Crimea in 2014, and the full-scale war in 2022, led to the massive destruction of Ukrainian universities and research

Part 4: Reform of advocacy and legal principles regarding mental health

Mental health regulations in Ukraine are steeped in outdated concepts. These include a deficit focus, limitations on legal capacity, and criminalilisation of mental disorders. These all serve to reinforce stigma and promote the image of those with mental disorders as being second class citizens. Although Ukraine's First Lady and many NGOs, among others, are raising awareness about the prevention of mental health impairments during the war, the likelihood of war-related serious trauma is growing

Part 5: Resourcing the future of mental health

Similar to many mental health-care systems inherited from the Soviet era, mental health-care services in Ukraine have been delivered using a predominantly biomedical approach that relied on a specialist, institution-based model of care. The Ukrainian Government's Concept Note (2017)⁷ and Action Plan (2021)¹⁰⁷ for mental health set out a very different, more contemporary vision for Ukraine, including legislation that aligns with international human rights, new mental health promotion and

Commission conclusion

The Lancet Psychiatry Commission on mental health in Ukraine offers recommendations for further development of the Ukrainian mental health-care system that ensure relevant interventions and services can be provided for all population groups, at all stages of life, in health and disease. The envisioned network of services includes: basic psychosocial support and brief psychological interventions provided by non-specialised staff in the community; management of common mental disorders in primary

Declaration of interests

MCD declares support from the Commission for travel expenses to attend research group meetings; she is President of the European Union of Medical Specialists Section of Psychiatry, a European Exam Board member, Secretary of the European Psychiatric Association Section on Women's Mental Health, and a Member of the European Psychiatric Association Publications Committee. NS declares being a member of Executive Board and Secretary for Education and Scientific Publications of the World Psychiatric

Acknowledgments

We thank Tsuyoshi Akiyama, Geert Dom, Semen Gluzman, Helen Herrman, Christina W Hoven, Afzal Javed, Vinay Lakra, Norman Sartorius, Danuta Wasserman, and Oksana Zbitnieva for their valuable suggestions and participation as Advisory Board members. We thank Marianne Schulze for the valuable contribution to the Legal and Advocacy group. We also thank Devora Kestel and Jarno Habicht for their leadership and administrative support.

中文翻译：

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柳叶刀精神病学委员会关于乌克兰心理健康

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 摘要

俄罗斯于 2014 年入侵和吞并乌克兰东部和克里米亚，以及自 2022 年 2 月以来持续的战争，对乌克兰造成了不可估量的破坏，造成许多人死伤，大量人口流离失所，以及广泛的身心创伤。这些事件给一般的医疗保健和心理健康保健系统带来了巨大的压力。多年来，乌克兰的精神卫生保健系统以大型精神病院和住宅为主

简介：历史和变革愿景

乌克兰是欧洲最大的民主国家，面临着一场完美的挑战风暴。从 1922 年到 1991 年，它是苏联的一部分，那里的精神卫生保健系统由几乎完全专注于生物疗法的大型精神病医院和寄宿机构主导。该系统以忽视、虐待和侵犯人权而闻名。1， 2 随着乌克兰从苏联时代走向独立，它经历了大规模的政治、经济和

第 1 部分：以社区为基础的精神卫生保健和乌克兰精神卫生保健服务新网络的愿景

委员会达成共识，认为乌克兰应该建立一个以社区为基础的精神卫生保健服务网络。应设计一系列渐进的变革步骤，以促进从当前系统向以社区为基础的精神卫生保健系统的发展。2017 年之前，乌克兰的精神卫生保健系统专注于对严重精神障碍患者的治疗和跟踪（称为分散化）。该策略是通过住院患者网络提供的

第 2 部分：心理健康工作者的培训和教育

21 世纪的精神卫生保健系统需要一支有能力且技术娴熟的多学科劳动力，以满足初级保健和专业精神卫生保健系统环境中的即时和新兴需求。护士、心理学家、专职医疗专业人员、家庭医生和精神病学专家是这支心理健康劳动力的核心。这个多元化的群体需要广泛、重叠的能力和特定学科的能力，才能作为一个综合的和

第 3 部分：重建心理健康研究能力和基础设施

从历史上看，苏联模式在乌克兰的心理健康研究中占据主导地位，使该国落后于欧洲、美国和其他模式。自乌克兰独立以来，在国际同行的协助下，乌克兰精神病学的创意领导者开始努力解决这些问题。然而，俄罗斯在 2014 年入侵乌克兰东部和克里米亚，以及 2022 年的全面战争，导致乌克兰的大学和研究被大规模摧毁

第 4 部分：关于心理健康的倡导和法律原则的改革

乌克兰的心理健康法规充斥着过时的概念。这些挑战包括关注赤字、限制法律执行能力以及将精神障碍定罪。这些都加剧了耻辱感，并提升了精神障碍患者作为二等公民的形象。尽管乌克兰第一夫人和许多非政府组织等正在提高对战争期间预防心理健康损害的认识，但与战争相关的严重创伤的可能性正在增加

第 5 部分：为心理健康的未来提供资源

与许多从苏联时代继承下来的精神卫生保健系统类似，乌克兰的精神卫生保健服务主要采用生物医学方法提供，该方法依赖于基于机构的专业护理模式。乌克兰政府的心理健康概念说明 （2017）⁷ 和行动计划 （2021）¹⁰⁷ 为乌克兰提出了一个非常不同、更现代的愿景，包括与国际人权保持一致的立法、新的心理健康促进和

 委员会结论

乌克兰柳叶刀精神病学委员会为进一步发展乌克兰心理健康保健系统提供了建议，以确保能够为所有人群、生命各个阶段的健康和疾病提供相关的干预措施和服务。设想的服务网络包括：由社区的非专业人员提供的基本社会心理支持和简短的心理干预;原发性常见精神障碍的管理

 利益申报

MCD 宣布委员会支持参加研究小组会议的差旅费;她是欧洲医学专家联盟精神病学分会主席、欧洲考试委员会成员、欧洲精神病学协会女性心理健康分会秘书以及欧洲精神病学协会出版物委员会成员。NS 宣布成为世界精神病学执行委员会成员兼教育和科学出版物秘书

 确认

我们感谢 Tsuyoshi Akiyama、Geert Dom、Semen Gluzman、Helen Herrman、Christina W Hoven、Afzal Javed、Vinay Lakra、Norman Sartorius、Danuta Wasserman 和 Oksana Zbitnieva 作为顾问委员会成员的宝贵建议和参与。我们感谢 Marianne Schulze 对法律和宣传小组的宝贵贡献。我们还要感谢 Devora Kestel 和 Jarno Habicht 的领导和行政支持。