Mental health as public policy

The scale of psychological need in Ukraine is beyond what any specialist service could meet. That fact shaped the policy response and, in my view, shaped it correctly.

The design principle

Do not build a mental health service. Build mental health capacity inside everything that already exists.

Family doctors trained to recognise and manage common presentations, since a family doctor is who a person sees. Teachers trained to notice a child in difficulty. Social workers, veteran service staff and community organisations given basic skills and a clear referral route.

Specialists sit above that as a referral layer for complex cases rather than as the front door — because a system where the only door is a psychiatrist is a system almost nobody enters.

The workforce problem

Psychologists and psychiatrists cannot be trained quickly, and the inherited system produced few of the kind now needed. Training at scale is a decade-long project, which is why the delegation of first-line work to non-specialists is not a compromise but the only arithmetic that works.

Destigmatisation

Deliberate, sustained, and led substantially by veterans, whose credibility on this subject exceeds any ministry's. The shift in what can be said publicly about seeking help has been faster than I would have predicted.

Why it matters beyond the immediate

Untreated psychological injury shows up years later as unemployment, family breakdown, addiction and physical illness. The spending now is cheaper than the alternative by a wide margin, and the alternative is not optional — it simply arrives in a different budget.

I am not an expert here and I am in no position to comment on the design of a system. The one thing I have seen as an employer is that within four years the reason for absence in my teams changed — it moved from physical illness to exhaustion. That is why building this as a system rather than a set of services strikes me as reasonable.