Developing And Integrating mobile community mental health Services In Ukraine (DAISI Ukraine)

The war in Ukraine is having a devastating impact on the country’s healthcare. Ukraine’s strategic plan is to modernise its institutions in line with European standards both during and after the war. DAISI Ukraine aims to support the development of innovative community mental health services in Ukraine.

The objectives are to evaluate, fine-tune, enhance and embed a new model of care, the Mobile Community Mental Health Team (MCMHT) that is currently being implemented in Ukraine and could be available in the entire country. The service model has been developed locally and is funded by the government of Ukraine, building on pilot MCMHTs established by a WHO-supported initiative.

MCMHTs are multidisciplinary, linked with primary care and provide home treatment, using principles of European models of community care and addressing local challenges: the destruction of mental health services during the war, the vast geographical area and stigma linked with attending mental health services. One feasibility Randomised Controlled Trial (RCT) and other non-controlled studies will be undertaken to evaluate MCMHTs.

This program is essential to ensure that MCMHTs are embedded in Ukraine within the period funded by this project, that there are quality improvement mechanisms and that MCMHTs can deliver care both during and after the war.

RESEARCH PLAN Y1-2 A. Map the existing MCMHTs in Ukraine (already started). B.

Conduct a focused systematic review to clarify the existing evidence on community services in Low and Middle-Income Countries. C. Psychometrically test selected outcome measures (Clinical Global Impression, Manchester Short Assessment of Quality of Life, EuroQol-5 Dimension-5 Level Scale, WHO Disability Assessment Schedule 2.0, Social Outcomes Index and Client Satisfaction Questionnaire, DIALOG) and determine if some of them could be adapted for routine clinical use by MCMHTs.

D. Carry out initial assessments of MCMHTs, from operational, healthcare workers and service users' perspectives. Y2-3 Medium-term intervention development and piloting A.

Address specific service needs for each region of Ukraine by building on the initial assessments of MCMHTs and by further co-developing and improving MCMHTs, with managers, healthcare workers and service users. B. Fine-tune the model in iterative studies assessing feasibility, acceptability, fidelity, and implementation facilitators/ barriers, using The Consolidated Framework for Implementation Research and establishing the National Service Standard for MCMHTs.

Y2-4 A. Complete a feasibility RCT comparing MCMHTs with hospital treatment for service users who might require acute hospital care. B.

Start a long-term MCMHT evaluation in the context of rebuilding mental health services in Ukraine. C. Create a global network of researchers interested in developing and evaluating community mental health care.

Working with Ukrainian partners (National Health Service of Ukraine , the Ministry of Health, Kyiv National University, WHO Country Office, Ukrainian Psychiatric Association, Psychabiliti, a service users’ group, RIMON, an educational NGO), our capacity-building program will aim at the existing academics and educators to deliver a high-quality curriculum, addressing needs for research training and forming the foundation for the establishment of a Clinical Trials Unit in Kyiv. Implementation plans will be guided by 'Theory of Change' workshops, using participatory methodology involving all stakeholders.