Access to mental health services in wartime Ukraine: regional inequalities and financing gaps

Background

The war in Ukraine has sharply increased mental health needs, but it is unclear whether contracted service capacity matches regional burden. We assessed regional inequalities in contracted mental health services and examined whether wartime burden corresponded to access and financing.

Methods

We used National Health Service of Ukraine (NHSU) open data on active Programme of Medical Guarantees contracts for psychiatric packages 19, 22 and 72, provider-location data, and Ukrstat oblast populations (1 January 2022). We calculated providers, service locations and contracted financing per 100,000 population, package mix, and Q90/Q10 inequality ratios across 25 administrative units. For a burden-linked sub-analysis, we used 2025 DALY estimates for depression, anxiety and PTSD from the published MAP-U/GBD-based study for 10 oblasts in three clusters, and compared burden with contracted financing and access indicators. We also tested an IDP-adjusted denominator sensitivity analysis.

Results

Active psychiatric contracting covered 384 provider entities, 474 service locations and UAH 5.86 billion. Q90/Q10 ratios were 3.24 for providers per 100,000, 3.68 for locations and 7.11 for financing. Inpatient package 19 absorbed 88.1% of contracted value, while community package 72 accounted for 9.4%. In the burden-linked sample, the south-east cluster carried 19,380 DALYs per 100,000 versus 13,186 in the north-west, but had lower mean financing per 100,000 (UAH 13.3 vs 18.1 million). Khersonska and Kharkivska emerged as high-burden, low-access outliers. The south-east financing gap versus the central cluster persisted after IDP-adjusted re-denomination.

Conclusions

Wartime mental health burden and contracted capacity are only partly aligned across Ukraine. Contracting remains unequal and heavily weighted toward inpatient care. Allocation rules should become burden-, displacement- and frontline-sensitive while accelerating community mental health expansion.

Key messages

• Contracted mental health access is uneven across Ukraine; frontline regions often combine high burden with below-median access or financing.

• Mental health financing remains dominated by inpatient care, while community and psychosocial services still account for a small share.