A mixed-methods sequential explanatory study to examine the implementation landscape for evidence-based transdiagnostic approaches for mental disorders in primary healthcare in Ukraine.

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Project Summary This project will explore primary healthcare providers (PHCPs) knowledge, attitudes, mental disorders treatment practices (KAP), and implementation landscape for scaling-up mental health evidence-based transdiagnostic treatment approaches in Ukraine. An estimated third of people in Ukraine have at least one- lifetime experience of mental disorder. The most common are depression, anxiety, and substance use disorder, which are frequently comorbid. Ukraine's suicide mortality rate is higher than in the U.S. and most Eastern European countries. These contribute to one of the worst European region country health profiles, with high morbidity, mortality, and disability rates. Due to the Soviet legacies and ineffective approaches during independence, barriers to Ukraine's mental health services include historical and cultural negative connotations of mental health services, lack of current evidence-based mental health training for healthcare providers, and siloed care delivery systems. In the context of lagging mental health and successful primary healthcare reform, PHCPs, given skills and resources, can offer mental health services using evidence-based approaches simultaneously addressing several common disorders and substantially decrease the mental health treatment gap. This five years mixed-methods sequential explanatory study within the Practical, Robust Implementation and Sustainability Model (PRISM) include the following Specific Aims: 1)To examine knowledge, attitudes, and treatment practices for common mental disorders among PHCPs in Ukraine; 2) To assess acceptability, appropriateness, feasibility, adoption, and cost of Common Elements Treatment Approach (CETA) when implemented by PHCPs; 3) To explore stakeholders' perceptions of implementation and sustainability infrastructure for primary healthcare-based mental health services provision. First, I will partner with the National Health Service in Ukraine (NHSU), a national purchasing entity for state medical guarantees program, to create a sampling frame of PHCPs and distribute the KAP (target N=800) (Aim 1). Second, in partnership with the Center for Mental Health and Psychosocial Support (CMHPS), I will assess implementation outcomes among PHCPs trained in CETA (N=50) (Aim 2). Third, based on the findings from Aim 1 & 2, I will conduct consensus panels with stakeholders (N=40-50) to understand different perspectives, their interactions and develop implementation strategies for mental health services scale-up within primary healthcare (Aim 3). This proposal leverages a partnership with the NHSU and builds on previous CETA research in Ukraine conducted by CMHPS and Johns Hopkins Bloomberg School of Public Health (JHBSPH). This study will yield critical evidence for increasing access to mental health services in Ukraine, a necessary component of improving the country's health profile. It will generate evidence for implementation strategies for scaling-up and sustaining mental health evidence-based approaches within primary healthcare worldwide.