The urgent global problem is the lack of timely and affordable mental health and rehabilitation services. Approximately 13% of the world's population suffers from mental health issues.
At the same time, statistically, one third lives with a disease significantly affecting their physical health, while a high quality rehabilitation can improve their life standards (World Mental Health Report: Transforming Mental Health for All. Geneva: World Health Organization; 2022. License: CC BY-NC-SA 3.0 IGO). This figure is steadily growing, partly due to the long-term neglect of mental health and rehabilitation services in most countries, with the majority of healthcare funding going to physical health.
These global statistics are impressive, yet even they fail to consider the consequences of the war daily faced by contemporary Ukraine. Based on these figures, you can get an idea of the approximate number of people in your municipality in need of mental health services. Early detection and prevention of mental disorders, as well as timely physical rehabilitation, are crucial for effective treatment, maintaining or restoring life quality, and avoiding further costly hospitalisations. This article addresses the issues that local self-government bodies need to consider in order to provide affordable services to the population of their municipalities in the context of limited resources.
To begin with, it is necessary to determine the exact types of mental and physical health recovery services needed and available resources. Identifying the needs of municipal residents should be based on both existing statistics and surveys. For example:
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identifying the main daily factors affecting the psychological state of municipal residents and faced by different population groups: economic factors and/or loss of basic livelihoods, consequences of abuse, trauma, death of relatives, combined medical conditions, significant deterioration, complete or partial loss of health or life quality, stigmatisation of IDPs and military veterans;
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determining the definition of the term “mental health issues” by the residents of the municipality: what are the signs of mental health issues? How do the residents of the municipality deal with it? Do they recognise the symptoms of depression, anxiety disorders, suicidal behaviour? How do municipal residents interact with those who might experience mental health issues?
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identify barriers in using mental health services: logistical barriers, cost, language barriers, misunderstanding of whom to contact, long queues to speciality physicians referred by family doctors.
It is possible to use the same principle to determine the required volume of rehabilitation services, morbidity, hospitalisation and disability rates for the population of different age groups. The following questions are also important:
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Whether you are getting the necessary help (medical, social, psychological, logistical, municipality support, accessibility, etc.)?
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How can you assess your quality of life?
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Can you easily leave your home?
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Can you easily move around the municipality to get to public services (hospitals, social services, schools, kindergartens, ASCs, etc.)?
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Are there enough sidewalks, parks and pedestrian areas within easy reach, places to rest at bus stops, parks and on the way to other places you have to walk to?
This list can obviously be further expanded depending on the needs of the municipality, but answering these questions already provides an understanding of the challenges faced by residents. And then local self-government bodies can analyse the resources in the municipality to overcome them. For example:
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Is there logistical accessibility to rehabilitation services (stroke, heart attack, neurological diseases, injuries, rehabilitation of children aged 0–4 years)?
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Are specialists involved in the provision of mental and physical health rehabilitation services?
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Is there a compiled list of organisations that can or do provide mental and physical health support and recovery services?
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Are local businesses involved in mental and physical health support and recovery activities both in their own facilities and in the municipality?
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Are there awareness-raising and educational activities on recovery and recognising the signs of mental and physical health issues?
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Is there access to information materials about mental health and ways to get immediate and long-term help (hotline numbers, red flags for mental health deterioration, emergency phone numbers and links)?
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Are there facilities for online counselling and for group sessions to improve mental health?
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Are our municipal specialists (social centres, medical institutions, utilities, teachers, ASCs) provided with crisis communication training?
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Are the professionals planning or currently working in our municipality provided with training on rehabilitation and recovery services?
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Is there access to psychological help in schools and kindergartens, including online? Is this scope of services sufficient?
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Does the provision of services in remote locations involve online or on-site teams?
The next step, after analysing responses to these questions, as well as assessing priority challenges and available resources, is to implement at least one, the most realistic component. However limited the municipality's resources, creating a list of organisations working in the field of mental health support and recovery, keeping this list up-to-date and distributing it through existing communication channels (e.g. local media, messenger channels, store printouts, leaflets) has a significant positive impact. Providing rehabilitation of patients after surgery or illness directly in the municipality reduces the need for care, which in turn decreases the level of psychological stress and relieves the family of the financial burden of supporting them. Awareness of the signs of mental health disorders and information on resources for their recovery reduces the level of violence, suicide, alcoholism and drug addiction in the family, and improves the local crime situation. Establishing separate supporting groups also plays a positive role, as it requires relatively small financial investments to organise and train relevant specialists. For example: Povchanska municipality (Rivne oblast) — established a support group for women whose husbands are at war; Lviv — a support group for single parents raising their children; Mykolaiv — an online support group for adults experiencing loss; Saratsk settlement council (Odesa oblast) — a support group for displaced girls and women suffering from psychological trauma and internal fears related to their experiences during hostilities and staying in the temporary occupation, etc.
In summary, even a small step towards restoring and improving the quality of life of residents significantly contributes to the mid- and long-term development of municipal capacity and human capital. Therefore, it is essential that local self-governments pay attention to identifying these steps and gradually implementing them now.