Mental Health: Global Challenges Journal

https://reference-global.com/journal/MHGCJ

ISSN 2612-2138

FROM DISTRESS TO SYSTEMIC RESILIENCE:

STRENGTHENING MHPSS IN CONFLICT SETTINGS –

INSIGHTS FROM UKRAINE

Nataliia Nalyvaiko1, Viktor Vus2,3, Liliya Zotova1, Nadiya Kreydun1, Olena Ronzhes4, Oleksii Nalyvaiko1, Serhii

Proskuriakov5, Kostiantyn Levytskyi5

1V. N. Karazin Kharkiv National University, Ukraine

2Ukrainian Institute of Art and Science, Bucha, Ukraine

3Iinstitute for Social and Political Psychology, National Academy of Educational Sciences of Ukraine

4Creative Studio Cologne, Germany

5Ivan Ziazun Institute Of Pedagogical And Adult Education, Kyiv, Ukraine Ukraine

Abstract

Introduction: The full-scale war in Ukraine has significantly increased the need for coordinated

and accessible mental health and psychosocial support (MHPSS) services. However, there

remains limited empirical evidence on how civilians experience psychosocial distress during

conflict and how institutions are responding to these needs across different service sectors.

Purpose: This study assesses the psychosocial well-being of civilians and the institutional capacity

to deliver MHPSS in conflict-

affected such as the Kharkiv region. The research seeks to inform

both national and international actors on existing gaps and opportunities for strengthening

support systems in wartime contexts.

Methodology: A cross-sectional survey was conducted in July 2023 across Kharkiv oblast. Data

were collected from 13,343 service recipients and 3,183 service providers working in the

healthcare, education, social protection, and NGO sectors. Quantitative analysis focused on

indicators of emotional well-being, coping strategies, service satisfaction, institutional capacity,

staff well-being, and information trust.

Results:

Findings revealed high levels of psychological distress among civilians, including

symptoms of panic, apathy, and hopelessness. Service satisfaction varied by sector, with non-

governmental organizations receiving higher ratings. While basic MHPSS services were

moderately available, primary and specialized care remained limited. Institutional staff

reported significantly increased workloads and limited access to psychological support or

supervision. Most respondents trusted official government sources and professionals for mental

health information.

Conclusion: The results indicate an urgent need to expand low-threshold, community-based

psychosocial services and to improve institutional readiness across sectors. Strengthening

workforce well-being, integrating MHPSS into sector-

specific practices, and aligning

communication strategies with trusted channels are key to building a sustainable response. The

proposed conceptual framework offers a multilevel roadmap for MHPSS system development in

conflict-affected settings.

Keywords

Mental Health, Psychosocial Support, War-affected Populations, Institutional Capacity, Ukraine,

Humanitarian Response

Address for correspondence:

Dr. Nataliia Nalyvaiko, V. N. Karazin Kharkiv National University, Ukraine

E-mail: nataliia.nalyvaiko@karazin.ua

This work is licensed under a Creative Commons Attribution- 4.0 International

License (CC BY 4.0).

©Copyright: Nalyvaiko, 2026

Publisher: Sciendo (De Gruyter)

DOI: https://doi.org/10.56508/mhgcj.v9i1.305

Submitted for

publication: 05 July

2025

Revised: 18 November

2025

Accepted for

publication: 30

December 2025

Mental Health: Global Challenges Journal

https://reference-global.com/journal/MHGCJ

ISSN 2612-2138

Introduction

Armed conflicts have well-documented,

severe, and enduring impacts on the mental

health of affected populations, frequently

resulting in elevated prevalence rates of

conditions such as post-traumatic stress disorder

(PTSD), depression, and anxiety (Miller, &

Rasmussen, 2017). Studies have consistently

demonstrated that exposure to war-related

stressors violence, displacement, and loss

exacerbates psychological distress across diverse

settings (Murthy & Lakshminarayana, 2006; Steel

et al., 2009). The war in Ukraine, which escalated

markedly in February 2022 following Russia’s full-

scale invasion, has imposed profound

psychological burdens on its population. Kharkiv

Oblast, a northeastern region bordering Russia,

has been particularly affected due to its proximity

to active combat zones. As of July 2023, when

the survey informing this study was conducted,

Kharkiv Oblast had endured over a year of

sustained military activity, including shelling,

occupation, and widespread displacement,

contributing to a significant mental health crisis

among its residents (United Nations, 2023).

The Kharkiv region exemplifies a setting of

sustained exposure to shelling, mass

displacement and infrastructural damage.

Civilian populations there oscillate between

frontline insecurity and influxes of IDPs from

neighbouring oblasts, aggravating demand for

health, education and social-protection services.

Yet sector-specific data on both user satisfaction

and provider capacity remain sparse. Without

such granularity, humanitarian actors and local

authorities risk misallocating scarce resources or

overlooking systemic bottlenecks especially within

primary health care, schools and social-welfare

institutions that constitute the first line of

psychosocial assistance (UNHCR, 2023; World

Health Organization & UNHCR, 2015).

International guidelines, including the IASC MHPSS

framework, emphasise that situational analyses

should integrate recipients’ perceived needs,

functional coping mechanisms and barriers

faced by service providers in order to inform

layered, context-appropriate interventions (Kang

et al, 2024).

In conflict-affected environments, Mental

Health and Psychosocial Support (MHPSS) services

are vital for addressing the psychological toll of

war and fostering resilience among individuals

and communities. MHPSS encompasses a broad

spectrum of interventions, ranging from

community-based psychosocial support to

specialized clinical care, designed to protect

and promote mental health and psychosocial

well-being (IASC, 2007). The effectiveness of

these services hinges on their accessibility,

quality, and responsiveness to the specific needs

of the population, particularly in crisis settings

where resources are often strained (Kang et al.,

2025; Matiashova et al, 2022).

Beyond the Ukrainian context, these

challenges resonate with broader global

humanitarian experiences. Evidence from Syria,

Afghanistan, and Sub-Saharan Africa

demonstrates that conflict-exposed populations

face similar patterns of psychosocial distress,

service fragmentation, and uneven institutional

readiness (Charlson et al., 2019; Hassan et al.,

2016). This alignment underscores the global

dimension of MHPSS as both a health and human

rights priority. The World Health Organization, the

Inter-Agency Standing Committee, and other

international actors have repeatedly emphasized

that sustainable MHPSS integration is not limited to

local or national benefit, but is critical for

advancing global mental health equity in crises.

Situating Ukraine within this continuum allows for

comparative insights: the case of Kharkiv Oblast

becomes not only a study of one region under

siege, but also a reference point for developing

resilient psychosocial systems in conflict-affected

settings worldwide.

Purpose

This study seeks to comprehensively evaluate

the state of MHPSS services in Kharkiv Oblast,

drawing on perspectives from both service

recipients and providers. Conducted in July 2023,

the research is based on a large-scale survey

involving 13,509 service recipients and 3,208

service providers across multiple sectors,

including healthcare, education, social

protection, and non-governmental organizations

(NGOs). The study examines several critical

dimensions: recipient satisfaction with MHPSS

services, the mental health needs and coping

mechanisms of the population, and the workload

and resource capacity of service providers. By

integrating these dual perspectives, the research

aims to provide a holistic understanding of the

MHPSS landscape in a conflict-affected region.

The significance of this study lies in its potential to

inform policy and practice in humanitarian

settings where mental health is often

overshadowed by immediate physical and

survival needs. A robust MHPSS system is essential

for supporting population well-being, enhancing

resilience, and facilitating long-term recovery in

crisis contexts.

While the study is rooted in Kharkiv Oblast, its

implications extend far beyond Ukraine. The war

has placed the country at the forefront of global

humanitarian concern, making it a unique living

laboratory for understanding the intersection of

Mental Health: Global Challenges Journal

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ISSN 2612-2138

armed conflict, public mental health, and

institutional resilience. By analyzing local needs

and systemic bottlenecks, the findings contribute

to international debates on how to operationalize

MHPSS frameworks in fragile contexts. This

positions the Ukrainian case as part of a broader

dialogue on strengthening global humanitarian

health architecture, offering transferable lessons

for other conflict-affected populations worldwide.

Methodology

Study Design and Objectives

This study employed a cross-sectional,

descriptive design using structured survey

instruments to assess both the psychosocial well-

being of service recipients and the resource

capacity of service providers in the context of the

ongoing war in Ukraine. The overarching aim was

to identify sector-specific needs, coping

strategies, and institutional preparedness for

delivering mental health and psychosocial

support (MHPSS) services in one of the most

conflict-affected regions Kharkiv oblast.

Setting and Participants

The data were collected in July 2023 in Kharkiv

oblast, a frontline region that has experienced

continuous hostilities, population displacement,

and infrastructural disruptions since February

2022. Two distinct participant groups were

surveyed:

Service recipients (n = 13,509) across four

sectors:

•Healthcare (n = 2,767)

•Education (n = 7,733)

•Social protection (n = 1,503)

•Non-governmental and community

organizations (n = 1,506)

Service providers (n = 3,208), representing:

•Healthcare professionals (n = 440)

•Educators (n = 1,783)

•Social workers (n = 853)

•NGO staff and other sectoral personnel (n

= 132)

Participants were recruited through institutional

distribution channels, including schools, clinics,

social protection offices, and community-based

organizations. Participation was voluntary and

anonymous.

Survey Instrument and Structure

The survey was developed in accordance with

principles outlined in the IASC Guidelines on

Mental Health and Psychosocial Support in

Emergency Settings (2007) and adapted for local

application in line with Ukraine’s National MHPSS

Programme (2022–2030). The instrument

consisted of both quantitative and qualitative

components, and was divided into two primary

modules:

For Service Recipients:

•Service Satisfaction: Assessed using a 5-

point Likert scale (1 = completely dissatisfied, 5 =

fully satisfied).

•Mental Health Indicators: Frequency of

symptoms related to panic, anhedonia, and

hopelessness over the preceding two weeks.

•Coping Mechanisms: Multiple-choice list

of strategies used to manage stress.

•Preferred Sources of Support: Preferences

for discussing mental health concerns (e.g.,

psychologist, family, doctor).

•Key Concerns: Open-ended responses to

elicit pressing psychosocial questions (e.g., “When

will the war end?”, “How to plan the future?”).

For Service Providers:

•Changes in Workload: Self-rated scale

from 1 (no change) to 5 (significant increase)

since February 2022.

•Perceived Institutional Capacity: For three

tiers of MHPSS:

•Basic psychosocial support

•Primary-level psychological care (e.g.,

mhGAP-trained general practitioners)

•Specialized care (e.g., psychotherapy,

psychiatry)

•Training History: Whether staff had

received training on mental health or stress

management.

•External Support: Whether psychologists or

mental health specialists had visited their facility

during or prior to the war.

Data Analysis

Quantitative data were analyzed descriptively

using Microsoft Excel and SPSS v26. Frequency

distributions, means, and percentages were

computed to assess central tendencies and

variability across sectors. Where appropriate,

cross-tabulations were performed to compare

satisfaction ratings and capacity indicators

among different service sectors.

Open-ended responses were subjected to

thematic coding using qualitative content

analysis to identify common psychosocial

concerns and information needs. Responses

were grouped into key thematic categories for

interpretation and triangulation with quantitative

findings

Ethical considerations

This study was conducted in accordance with

ethical principles for research in humanitarian

settings, as outlined by the World Health

Organization and the Declaration of Helsinki.

Ethical approval was obtained from the Ethics

Mental Health: Global Challenges Journal

https://reference-global.com/journal/MHGCJ

ISSN 2612-2138

Committee of the Faculty of Psychology, V. N.

Karazin Kharkiv National University (Protocol No. 7,

May 28, 2023). Participation in the survey was

voluntary and anonymous. Informed consent was

embedded in the preamble of the survey, and

no personally identifiable information was

collected. For respondents under the age of 18,

consent was obtained from parents or legal

guardians. Given the non-interventional nature of

the study and its focus on service satisfaction and

institutional capacity, risks to participants were

minimal, and appropriate safeguards were

implemented to ensure confidentiality and

respect for dignity.

Results

Overview

The results are presented in two main

subsections: (1) Service Recipients and (2) Service

Providers. For each group, we provide tabulated

data followed by interpretation. The findings are

based on the responses of 13,509 recipients and

3,208 providers of services across health care,

education, social protection, and non-

governmental sectors in Kharkiv Oblast, July 2023.

To evaluate how individuals perceived the

quality and accessibility of services during

wartime, respondents were asked to rate their

level of satisfaction with the support received

across key sectors. Table 1 presents the mean

satisfaction scores, offering a comparative view

of service delivery performance as perceived by

recipients in healthcare, education, social

protection, and NGO sectors.

Table 1. Satisfaction with Services Received

Sector

Mean Satisfaction

Score (out of 5)

Health care

3.9

Education

4.1

Social protection

4.2

NGOs and other

sectors

3.7

Overall average

4.1

Despite the challenging wartime conditions,

service satisfaction remained relatively high

across sectors. Social protection services

received the highest average rating (4.2), likely

reflecting increased support targeting displaced

and vulnerable populations. NGOs, often under-

resourced, showed slightly lower satisfaction levels

(3.7).

As part of the mental health self-assessment,

individuals reported how frequently they

experienced symptoms of acute anxiety or panic

within the previous two weeks. Table 2

summarizes these findings and provides insight

into the immediate emotional reactivity of the

population under sustained conflict conditions.

Table 2. Frequency of Panic in the Last 2 Weeks

Response Option

% of Respondents

1 – Never

51.0%

19.4%

18.0%

7.0%

5 – Constantly

4.6%

While over half of respondents (51%) did not

experience panic, a combined 29.6% reported

moderate to frequent symptoms, indicating

widespread psychological activation and the

need for stress management interventions.

Participants were also asked to report on their

levels of interest and engagement with previously

enjoyable activities an important marker for

depressive states and psychological

disengagement. Table 3 presents the distribution

of responses, indicating the degree to which

emotional blunting or anhedonia was present in

the sample.

Table 3. Feelings of Apathy/Anhedonia

Response Option

% of Respondents

1 – Never

40.2%

22.3%

22.6%

9.3%

5 – Constantly

5.6%

Nearly one-third (31.9%) of respondents

experienced some degree of emotional

numbness or disengagement, which is consistent

with clinical profiles of chronic stress, depression,

or trauma-related conditions (Kazlauskas et al.,

2022; Schäfer et al., 2018).

Beyond symptoms of anxiety and apathy, the

study examined deeper existential concerns by

asking participants whether they had

experienced persistent hopelessness or thoughts

about the lack of future meaning. Table 4

highlights the frequency of such responses,

offering a glimpse into the population’s

perceived loss of agency and orientation.

Table 4. Existential Despair/Hopelessness

Response Option

% of Respondents

1 – Never

45.0%

19.3%

18.5%

9.4%

5 – Constantly

7.8%

About 35.7% of respondents report at least

moderate levels of despair, with 7.8%

experiencing persistent hopelessness. These

indicators underscore the psychological burden

Mental Health: Global Challenges Journal

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ISSN 2612-2138

of long-term insecurity and displacement (Morina

et al., 2017).

In an effort to understand how civilians

manage stress in the absence or limitation of

formal support, the survey collected qualitative

data on commonly used coping strategies. Table

5 outlines these mechanisms, ranked by their

reported frequency, and captures a broad

spectrum of behavioral responses from adaptive

self-care to less constructive or avoidant

practices.

Table 5. Coping Mechanisms

Coping Strategy

Prevalence

(Qualitative, ranked by

frequency)

Walks, rest

High

Prayer, meditation,

breathing

High

Social connection

(friends, family, hugs)

High

Sports and physical

activity

Moderate

Medications, alcohol,

stimulants (coffee, etc.)

Moderate

Music, art, hobbies

Moderate

Household work

Moderate

Animals

Moderate

Reading, watching

films

Moderate

Sleep

High

Helping others,

donations

Noted by many

Isolation ("being

alone")

Mentioned but less

frequent

Coping behaviors were diverse, ranging from

adaptive (exercise, prayer, social bonding) to

potentially harmful (alcohol, medication without

supervision). The inclusion of altruism ("helping

others") highlights community solidarity as a

resilience factor.

Recognizing the importance of trust and

accessibility in seeking mental health assistance,

the study explored whom individuals would most

prefer to approach when coping with stress.

Table 6 displays the ranking of preferred support

figures, indicating public inclination toward

psychological services and informal support

networks.

Table 6. Preferred Sources of Psychosocial Support

Preferred Person to Talk To

Rank

Psychologist

Family/friends

Family doctor

The preference for psychologists reflects high

mental health awareness and growing

destigmatization, particularly in urban and

conflict-affected settings (Roberts et al., 2019).

Service providers were asked to assess the

degree of change in their work demands since

the onset of full-scale war. Table 7 presents the

average self-reported increase in workload by

sector, reflecting the pressures placed on frontline

personnel responding to growing psychosocial

needs under resource-constrained conditions.

Table 7. Perceived Increase in Workload (1 = No

change; 5 = Major increase)

Sector

Mean Score

Health care

3.6

Education

3.0

Social protection

3.7

NGOs and other sectors

3.5

Overall average

3.3

Service providers, particularly in social

protection and health sectors, reported a

substantial increase in workload, largely due to

the growing number of internally displaced

persons (IDPs), staff shortages, and increased

psychosocial needs.

To evaluate institutional readiness to deliver

mental health and psychosocial support,

providers were asked to assess their organization’s

capacity across three levels of intervention: basic

psychosocial support, primary-level care, and

specialized services. Table 8 captures these self-

assessments and highlights capacity disparities

across sectors.

Table 8. Institutional Capacity for MHPSS

Service Level

% with Full Capacity

(5/5)

Basic psychosocial

support

19.1% – 33.8%

(sector-dependent)

Primary-level support

(e.g., mhGAP-trained)

25.8% – 36.8%

Specialized care (e.g.,

psychotherapy)

19.7% – 25.3%

While basic and primary-level MHPSS services

are present in some institutions, less than one-third

of facilities are equipped to deliver specialized

care. This mirrors broader challenges in scaling

psychological and psychiatric services during

protracted emergencies (Charlson et al., 2019).

The survey further examined whether institutions

had equipped their staff with appropriate training

and whether external mental health professionals

had visited their facilities to provide additional

support. Table 9 summarizes provider responses

to these questions, shedding light on the

operational reinforcement of MHPSS capacity

during wartime.

Despite growing awareness, training gaps

persist, particularly among education and

healthcare staff. Only about half of institutions

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ISSN 2612-2138

had external psychological support during or

before the war.

Table 9. Training and Specialist Support Access

Indicator

% of Providers Reporting

‘Yes’

Staff received training in

MHPSS

54.5% – 71.7% (by sector)

Received visits from

mental health specialists

36.1% – 57.3% (by sector)

In addition to assessing emotional well-being

and service satisfaction, the study explored the

informational landscape surrounding mental

health in wartime conditions. Understanding

which communication channels are perceived

as credible is critical for shaping effective

awareness campaigns and public health

interventions particularly in contexts of mass

displacement, digital misinformation, and

reduced access to in-person services. To this end,

respondents were asked to identify the sources of

mental health information they trusted most. The

responses, summarized in Table 10, reveal a dual

reliance on official governmental sources and

trusted professionals, with comparatively lower

confidence in social media platforms. These

patterns provide actionable insights for targeting

MHPSS messaging through platforms already

viewed as legitimate by affected populations.

Table 10. Trusted Information Sources on

Mental Health

Source

% Trusting This Source

Most

Government websites

(national/local)

34.4%

Known professionals

(psychologists, etc.)

34.0%

Telegram channels

14.9%

Instagram

7.3%

Facebook

5.3%

Trust in official and professional sources

significantly outweighs reliance on social media.

However, the popularity of Telegram suggests it

could be a viable channel for delivering

evidence-based mental health content.

Discussion

The findings of this study offer a

multidimensional snapshot of mental health and

psychosocial needs, service satisfaction, and

institutional capacity in the Kharkiv region amid

the ongoing war in Ukraine. By integrating

perspectives from both service recipients and

providers across multiple sectors, the study

contributes to a growing body of evidence on the

realities of delivering MHPSS during protracted

conflict. The results confirm both the magnitude

of psychological distress in civilian populations

and the uneven preparedness of institutional

systems to meet this demand.

Consistent with prior research on conflict-

affected populations, a significant portion of

respondents reported experiencing symptoms of

panic, anhedonia, and hopelessness hallmarks of

psychological trauma and chronic stress

(Charlson et al., 2019; Morina et al., 2017). While

51% of respondents did not report panic

episodes, nearly one in three experienced these

symptoms to some degree. Similarly,

approximately 36% reported persistent feelings of

emotional detachment or despair. These patterns

mirror other findings from Ukraine in 2022–2023,

including a national survey that identified

probable PTSD in 14% of adults and depressive

symptoms in over 40% of adolescents in frontline

areas (Lushchak et al., 2023; Zavalevskyi,

Berezhna, & Blashkova, 2025).

Importantly, emotional hardship was not

restricted to passive suffering; many respondents

articulated active concerns about the future,

including existential questions (“What will happen

to us?”) and practical challenges (“How to plan

life during war?”). These findings align with calls

from the Inter-Agency Standing Committee (IASC)

to treat hope, meaning-making, and future

orientation as core elements of psychosocial

programming (IASC, 2007).

The diversity of coping mechanisms reported

reflects a mix of adaptive (e.g., exercise, prayer,

hobbies) and maladaptive (e.g., alcohol,

medication without supervision) behaviors. The

prominence of sleep, rest, social bonding, and

spirituality as preferred strategies resonates with

findings from other humanitarian settings, where

culturally resonant and low-threshold practices

are often the most accessible and protective

(Hassan et al., 2016). However, the presence of

pharmacological or substance-based coping

also highlights the risk of self-medication,

particularly in areas where access to formal

psychological care is limited.

Encouragingly, many respondents identified

helping others through donations or social

support as a meaningful way to manage stress.

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Such prosocial behavior has been recognized as

a protective factor for psychological well-being in

disaster contexts and should be harnessed in

community-based MHPSS interventions (Hobfoll et

al., 2007).

One of the most important findings is the gap

between high civilian demand for psychological

support and the limited capacity of institutions to

meet these needs. Although psychologists were

the preferred source of support, fewer than one-

third of providers reported full readiness to offer

even basic psychosocial care, and fewer still had

the capacity for specialized interventions (e.g.,

psychotherapy or psychiatric care). This shortfall is

especially acute in the education and NGO

sectors, despite their pivotal role in frontline MHPSS

delivery.

The disparity between sectors is also evident in

reported workload increases. Workers in the social

protection and healthcare sectors experienced

the steepest surges, with nearly 35% of social

protection staff noting a significant rise. These

findings underscore the dual burden faced by

providers: while delivering essential services under

extreme conditions, they are themselves exposed

to chronic stress and potential burnout.

Although over half of institutions had

conducted training on psychological health, the

lack of consistent professional supervision or

specialist visits further compounds the risk of

inadequate or unsustainable care. These trends

echo broader critiques of humanitarian MHPSS

systems, which often prioritize training over

structural support or long-term integration (Tol et

al., 2011).

The study also reveals that information trust

plays a key role in shaping MHPSS access and

engagement. Official government websites and

personal contacts with mental health

professionals were the two most trusted sources,

far outpacing social media. However, platforms

like Telegram, with 14.9% trust, still present viable

opportunities for disseminating validated self-help

resources, psychoeducation, and referral

pathways. As misinformation remains a significant

barrier to mental health service uptake, designing

evidence-informed campaigns through trusted

digital channels is an urgent priority (World Health

Organization, 2022).

Implications

The present study highlights several critical

considerations for the future development and

implementation of mental health and

psychosocial support (MHPSS) systems in conflict-

affected regions of Ukraine (Matiashova et al.,

2022). The data reveal not only a high

prevalence of distress among service recipients

but also substantial variation in institutional

readiness to meet this demand. These results

point to a necessary shift from fragmented

interventions to integrated, multi-level strategies

that respond both to individual psychological

needs and systemic service gaps.

The widespread symptoms of anxiety, apathy,

and hopelessness suggest that the civilian

population is experiencing chronic psychological

strain with limited opportunities for professional

support. In this context, the expansion of

community-based psychosocial services

emerges as an essential priority. Interventions

grounded in WHO’s mhGAP framework, such as

psychological first aid and structured group-

based self-help, offer practical pathways for

scaling care through trained non-specialists.

These models are particularly relevant in rural or

under-resourced settings where access to

professional mental health care remains limited.

Equally important is the need to address the

psychosocial well-being of service providers. The

increase in workload across all sectors, especially

in health and social protection, places personnel

at risk of burnout and vicarious trauma. While

many institutions have offered some form of

training, few have formal mechanisms for

psychological supervision, peer support, or stress

mitigation. Incorporating structured staff care

including supervision, reflective practice, and

referral access should be considered a core

element of institutional resilience.

The study also documents sectoral disparities

in MHPSS capacity. Health care institutions

reported relatively higher preparedness to deliver

both basic and primary-level services, yet

education and NGO sectors remained under-

resourced despite their central role in reaching

vulnerable populations. This highlights the

necessity of sector-specific adaptation of MHPSS

tools and integration into routine service delivery

for example, through school-based psychosocial

education or NGO-coordinated peer support

networks.

Another significant implication concerns the

dissemination of mental health information. The

strong trust in official governmental sources and

personal contacts with mental health

professionals provides a strategic foundation for

public education campaigns. Efforts to counter

misinformation and improve health literacy

should prioritize these channels while

simultaneously extending outreach through

moderated digital platforms such as Telegram

and Facebook.

Ultimately, the effectiveness of any MHPSS

response depends on its integration into long-

term recovery frameworks. Ukraine’s National

MHPSS Programme offers a valuable structural

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basis, but its success will require consistent

intersectoral coordination, adequate funding,

and robust monitoring mechanisms. This is

especially pertinent for regions like Kharkiv, where

frontline conditions persist and humanitarian aid

remains central to service delivery.

To operationalize these findings, we propose a

conceptual framework for integrated MHPSS

strengthening in conflict-affected regions, as

outlined in Fig. 1.

Fig.1. Conceptual Framework for Strengthening MHPSS in Conflict-Affected Regions

This model emphasizes that effective MHPSS is

not the responsibility of mental health

professionals alone. Rather, it requires

coordinated investment across sectors and levels

from community engagement to policy

alignment. The integration of these efforts is

crucial for ensuring both immediate

psychological support and the foundation for

long-term psychosocial recovery.

Limitations

Several limitations should be acknowledged.

First, the study employed a cross-sectional

design, which restricts causal inference and limits

the ability to track changes in psychosocial well-

being over time. Second, although the survey

included a large sample size across multiple

sectors, responses relied on self-report measures,

which may be subject to recall bias, social

desirability bias, and differences in interpretation

of psychosocial concepts. Third, the study was

limited to Kharkiv Oblast, a region experiencing

intense conflict; findings may not be fully

generalizable to less-affected regions of Ukraine

or other conflict settings. Finally, despite efforts to

include diverse institutions, some groups

(particularly smaller NGOs and rural facilities) may

be underrepresented.

Practical and Social Value

This research carries significant practical and

social value for both Ukraine and the global

humanitarian community. At the national level, it

provides data-driven evidence to inform the

implementation of Ukraine’s National MHPSS

Programme (2022–2030), supporting more

Mental Health: Global Challenges Journal

https://reference-global.com/journal/MHGCJ

ISSN 2612-2138

effective resource allocation across healthcare,

education, social protection, and NGO sectors.

At the institutional level, the findings highlight

urgent needs for workforce support, training, and

supervision, emphasizing that provider well-being

is essential for sustainable service delivery. At the

community level, the identification of coping

strategies and trusted information channels offers

actionable insights for designing culturally

appropriate interventions and awareness

campaigns.

Globally, the study contributes to the

understanding of how MHPSS systems function

under conditions of protracted armed conflict,

offering lessons relevant to other humanitarian

crises. The proposed multilevel framework

illustrates how community, institutional, sectoral,

and policy interventions can be coordinated to

address both immediate distress and long-term

resilience. By documenting both gaps and

protective factors, this study underscores the

necessity of embedding psychosocial support as

a core component of humanitarian response

and recovery strategies, ensuring that mental

health is not marginalized but recognized as

central to global health and human security.

Conclusions

This study offers a comprehensive assessment

of the mental health and psychosocial support

(MHPSS) landscape in one of Ukraine’s most

heavily affected regions Kharkiv oblast amid

protracted armed conflict. Through the

integration of data from over 13,000 service

recipients and more than 3,000 service providers

across healthcare, education, social protection,

and non-governmental sectors, the analysis

reveals both the scale of psychological need

and the systemic limitations in service delivery.

The findings confirm that psychological distress

is widespread and persistent. A substantial

proportion of respondents reported symptoms

consistent with anxiety, emotional numbness, and

existential despair patterns that mirror those found

in other conflict-affected populations. At the

same time, the population demonstrates diverse

coping mechanisms, including both adaptive

(e.g., physical activity, spirituality, helping others)

and potentially harmful strategies (e.g., self-

medication, withdrawal). The desire to speak with

a psychologist, ranked highest among preferred

support options, underscores the growing

recognition of mental health as a vital

component of well-being, even in contexts

historically marked by stigma and limited access.

Equally significant are the insights from service

providers, who report heightened workloads,

insufficient resources, and uneven institutional

capacity to respond to increasing MHPSS

demands. While there are encouraging signs

such as the availability of basic support and

training in some sectors specialized services

remain scarce, and support for frontline workers is

inconsistent. These structural vulnerabilities pose

risks not only to individual care but also to the

sustainability of broader support systems.

The study contributes to the emerging body of

evidence on war-related mental health in Ukraine

by highlighting the need for coordinated,

scalable, and context-sensitive interventions. The

proposed conceptual framework for integrated

MHPSS delivery provides a strategic outline for

addressing current gaps across community,

institutional, sectoral, and policy levels.

Implementing this model requires a multi-actor

response, supported by national leadership,

international partnerships, and local

engagement.

In light of ongoing hostilities and long-term

recovery planning, MHPSS must be regarded not

as a secondary or auxiliary service, but as a

foundational element of Ukraine’s humanitarian,

health, and educational response. The capacity

to provide psychological care is inseparable from

the country’s ability to rebuild human capital,

restore institutional trust, and foster resilience at

both the individual and societal levels.

Further research should focus on longitudinal

outcomes, the effectiveness of specific MHPSS

modalities, and the role of digital interventions in

increasing access to care. As Ukraine continues

to navigate the overlapping challenges of

conflict and reform, a data-driven, human-

cantered approach to psychosocial support will

be critical to ensuring that no one is left behind.

Funding statement

The authors declare that this research did not

receive any specific grant from funding agencies

in the public, commercial, or not-for-profit

sectors. The publication fee was covered by the

authors personally.

Conflict of interest

The authors declare that they have no known

competing financial interests or personal

relationships that could have appeared to

influence the work reported in this paper.

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