in2mentalhealth

This is the sixth interview in the Global Mental Health Inside Stories series.
In this series I want to collect and spread information/ideas from people active in mental health from all over the world and specially from low resource settings or fragile countries.

I hope this series contributes to more insight in the challenges and wishes from people active in these settings and adds to a more bottom up movement in global mental health.

Olena Zhabenko answered the 10 interview questions as follows:

Work location and some background information:
My name is Olena Zhabenko. I am a psychiatrist at the Railway Clinical Hospital #1, consulting psychiatrist at the American Medical Centers and a researcher at the Ukrainian Research Institute of Social and Forensic Psychiatry and Drug Abuse.

Brief country profile:
Ukraine is a country in Eastern Europe. The country is home to 46 million people (august 2012). Ukraine became independent again in 1991 when the Soviet Union dissolved. It is a unitary state composed of 24 regions oblasts (provinces), one autonomous republic (Crimea), and two cities with special status: Kiev, its capital and the largest city, and Sevastopol, which houses the Russian Black Sea Fleet under a leasing agreement. Ukraine has an area of 603 628 km², making it the largest country entirely within Europe (information from wikipedia).
The Worldbank indicates Ukraine as a lower-middle income country. According to Index Mundi, 2009 35% of the Ukraine population lives below the poverty line.

Ukraine has the most risky pattern of drinking score given the same level of consumption, the higher the pattern of drinking score, the greater the alcohol-attributable burden of disease for the country.
Compared with other European surveys, Ukraine has the highest rates of alcohol abuse (20%) among men and major depression (20%) among women.

Ukraine as a newly independent state inherited its national health system from the USSR time. The basis of the current Ukrainian health service provision is a system of highly specialized secondary care. There is also a network of general doctors (called district physicians and pediatricians) responsible for a given urban catchment area. Services are delivered by a network of acute hospitals and polyclinics that provide primary and secondary out-patient services.
In 2009 there were roughly 5000 psychiatrists and substance misuse specialists (who have separate training in Ukraine) and over 500 child psychiatrists. Each of twenty-four regions oblasts and autonomous republic (Crimea) has at least one psychiatric hospital and one outpatient unit. Most Ukrainian psychiatric clinics are still officially called ‘neuro-psychiatric’ (info from an article in International Psychiatry, 2009).
In 2012 the number of public psychiatric beds was 39251, which means 86.4 per 100 000 population (Mental health and psychiatric care in Ukraine (review 2008-2012). Kiev, 2013). Average length of stay in hospital was 53.5 days for adults, and 26,7 days for children.

Overview of work activities:

Railway Clinical Hospital #1 consists of children outpatient unit, emergency room, psycho-neurological department, laboratory, children & adolescent department, surgery department, traumatology department, X-Ray department, resuscitation department, and physiotherapy department.
The psycho-neurological department was created in 2002 with 15 inpatient beds, but since 2004 it has been working with 30 inpatient beds. The department is opened 7 days per week and takes care about in- and out- patients. Doctors work every day from 8am to 3.12pm. The department consists of two floors. There are physicians’ and psychologists’ rooms and rooms for psychotherapy on the first floor. The second floor has patients’ rooms (from 1 to 4 patients per room, separately for men and women), a procedure room (for injections) and a dining room.
The chairman of the department is Professor Oleg Chaban, MD, PhD. You can read a recent interview with him in Innovations in Clinical Neuroscience, 2013.
The department has 3 part-time and one full-time psychiatrists and 3 psychologists. Every day one chief nurse (8 hours), one nursing assistant and one cleaning woman (24 hours) take care about the patients.
In addition to biological psychiatric treatment (almost all psychotropic drugs are available in Ukraine), we offer individual psychotherapy and a variety of group activities like group psychotherapy, physical activity, art-therapy, dance/movement therapy and relaxation.
Most of our clients are people with organic mental disorders, mood disorders, disorders of adult personality and behavior, neurotic, stress-related and somatoform disorders. Most of the patients work at the Railway Station.

The primary goal of my current research is to develop and examine the effectiveness of the online, computer-based cognitive-behavioral therapy program for insomnia in alcohol-dependent (СBTI-AD) patients in the Ukrainian population. This project is funded by the ‘Fogarty International Substance Abuse Research Training Program’. Details of the online program were presented at the 2013 Research Society on Alcoholism meeting and the 6th Scientific Meeting of the International Society for Research on Internet Interventions (both in the USA).

The main challenges personally in work/study/life:
-Sharing office with colleagues
-Low salary

The main challenges for the organization(s)/colleagues/clients:

The main challenge is the price for medication. Only limited amount of patients have insurance that covers medication, psychotherapy and additional medical procedures. The amount of insurance is small and not enough for all above. When the patient discharges, he/she needs to buy all medicines by himself/herself.
-The salary of physicians and other medical staff is small.

The main challenges for the country regarding mental health care:
-Stigmatization of patients
-Lack of psychotherapeutical help, especially in small cities
-The medical insurance is almost absent in Ukraine. The patients very often do not have money to cover medications
-Lack of social support
-Absence of the peer-support (self-group therapy)
-Lack of psycho-education
-Anti-psychiatric propaganda
-Lack of evidence-based medicine

What should be changed in mental health care on a local or national level:
-Involving social workers in the daily life of patients
-Increasing of psycho-social support of patients

What is the right direction for the global mental health movements:
-Collaboration between different countries
-Exchange programs for professionals
-Volunteer work from developed countries to developing ones

What can ICT, mhealth and e-learning contribute to mental health care:
-Online trainings in English and native languages
-Distribution information among professionals

Other links and contact information:
More information about Olena Zhabenko at her professional profile page
Mail address: olena.zhabenko@gmail.com
website Railway Clinical Hospital #1 in Kiev
website American Medical Centers

With many thanks to Olena Zhabenko!
Roos Korste, psychologist, international trainer and blogger