Due to the full-scale Russian invasion, about 15 million Ukrainians will need psychological assistance. The Ministry of Health stated this in 2023. However, the Ukrainian legislation has not defined the terms "mental health" and "psychological assistance" yet. On November 21, the Verkhovna Rada voted in the first reading for draft law No. 12030 "On the Mental Health Care System of Ukraine", which is aimed to fill the gaps in the legislation. However, both government officials and psychotherapists criticize this draft law.
The Suspilne investigative editorial office decided to figure out how the new law can affect the mental health sector and why experts insist on the revision of the draft law.
The National Commission instead of the Coordination Center
Draft law No. 12030, submitted to the Verkhovna Rada in September 2024, proposes to create a National Commission on Mental Health. It should regulate mental health support programs, as well as register psychotherapy service providers and monitor the quality of the provided services.
Similar regulatory functions are already performed by the Mental Health Coordination Center, established in 2023 and subordinate to the Cabinet of Ministers. This institution acts as a kind of intermediary between ministries, local administrations, and the research community. The Center operates with the support of the WHO international initiatives, USAID projects, etc. A special focus of the center is the promotion of the all-Ukrainian mental health program "How are you?" introduced by the first lady, Olena Zelenska.
The initiator of draft law No. 12030, the "Servant of the People" party MP Lada Bulakh, commented on the need for a National Commission on Mental Health, "Thanks to the leadership of first lady Olena Zelenska, the work is actively underway in Ukraine to create a comprehensive mental health care system. It includes medical, educational, social, and communication components. However, in order for this "orchestra" of different areas of mental health preservation to play synchronously, a conductor is needed".
In comments to the Suspilne investigative editorial office, experts from independent psychotherapy associations expressed concerns that the national commission would duplicate the powers of the coordination center, but the commission members would have broader powers.
The risk of volunteer members
According to the submitted draft law, the National Commission will be a permanent collegial body in the field of management of the Cabinet of Ministers. Its will include representatives of ministries and self-regulatory organizations, such as associations of psychotherapists.
On November 6, MP Lada Bulakh held a meeting on the new draft law. According to the Suspilne source who was present at the meeting, one of the MPs noted that none of the experts from professional associations took a direct part in the development of the bill.
"Laws are not written this way, "under the table". The lack of public discussions with the largest associations representing the interests of specialists raises questions about the transparency of the process of developing the bill," says Yana Ukrainska, the head of the "Dobrobut" mental health centers network. In addition, in her opinion, there are two more problems: the draft does not contain any norms that would regulate the election of the National Commission members, and the National Commission itself will not be an independent body, because it will be subordinate to the Cabinet of Ministers.
Viktoria Kovalevska, the coordinator of the "Her Support" platform, expressed doubts about the impartiality of the members of the future national commission:
"Five ministries (the Ministry of Health, the Ministry of Social Policy, the Ministry of Education and Science, the Ministry of Internal Affairs, and the Ministry of Defense. — Ed.) will provide experts to work in this commission. Together with the representatives of self-regulatory organizations, whose activities will also be regulated by the commission, they will resolve issues of certification of specialists. Will this make the work easier? It is designed in such a way that it will complicate it. A new procedure will appear and will need to be constantly improved. It will be updated by people who do not belong to the field [of mental health] at all."
According to the draft law, the secretariat of the national commission, including its members and a chairperson, will not formally be civil servants. However, half of the staff will consist of the representatives of ministries, that is, civil servants. The other members of the commission, according to Yana Ukrainska, will not have restrictions that would prohibit them from running a private business, which can provoke a potential conflict of interest.
Non-transparent appointment of the commission members, according to Ukrainska, can lead to political influence on its decisions and activities, and create the risk of appointing members who do not have sufficient qualifications.
The path for lobbying groups
The National Commission is planned to be organized and financed as a separate state body. However, the project contradicts the requirements of the Ukrainian legislation, according to the scientific and expert conclusion of the Main Scientific and Expert Department of the Verkhovna Rada. Thus, the members of the National Commission will work "on a voluntary basis", that is, without a salary. For official state bodies, this is illegal, because employees of state institutions receive a salary and have a clear legal status.
The lack of clarity in the provisions on funding and the status of employees may increase corruption risks, the mentioned conclusion states.
The draft law provides that the National Commission on Mental Health will be financed from the state budget and other sources not prohibited by law, such as grants and subsidies from the WHO, the European Commission, the UN, and the World Bank, contributions from charitable organizations, foundations, and private donors interested in supporting mental health programs.
However, the Ministry of Finance, in its expert opinion on the draft law, emphasized that the authors of the draft did not provide calculations on how to cover the additional costs of the commission, and did not indicate the real sources of covering the expenses.
Yana Ukrainska expressed doubts about the appropriateness of such dual funding of the institution, "This body does not coordinate various projects in order to receive international aid funds. It decides the fate of specialists by selecting and entering them into the general register. This has the characteristics of a central executive body, which should be financed exclusively from the budget of Ukraine".
Psychoanalyst Roman Kechur, the member of the European Association for Psychotherapy, assumes that extra-budgetary funding for the institution can pave the way for lobbying groups and the inclusion of "needed" people in the register of psychotherapists.
The attempt to control the market and the risk of corruption
The certification of psychotherapists in Ukraine is currently carried out by professional associations, such as the National Psychological Association, which represents Ukraine in the European Federation of Psychological Associations, the Association of Psychotherapists and Psychoanalysts of Ukraine, the Ukrainian Union of Psychotherapists, and the Ukrainian Psychotherapeutic University. Each of them has its own characteristics and standards.
Roman Kechur believes that if the certification is put in the hands of the future national commission, which will include not only psychotherapy specialists but also officials, it can negatively affect the industry:
"If the regulatory body includes state administrators, not specialists [in psychotherapy], we will get excessive standardization in the field where it is impossible and unnecessary. For example, today there are several dozen scientifically grounded psychotherapy methods that have their own educational standards and their own specialists who can assess the quality of work. No civil servant is able to assess this.
In our opinion, the certification and accreditation of specialists should be performed by professional organizations that receive self-regulatory status from the state. And the state reserves for itself the last word. If an organization violates a certain educational standard, the state can simply take away the self-regulatory status and specialists will be forced to be certified in another way. This is an effective mechanism, but the essence and content of certification should be given to professional associations.
If we take away the certification functions and decentralize them, and leave the national commission only with supervisory functions, we will get much more leverage. If we limit the composition of the commission itself to specialists, and the technical staff will be civil servants, then there will be a more open dialogue. For example, let us take 15-20 associations and none of them will have a monopoly, let us introduce the principle of changeability of leadership and membership, and transparency in the publication of all decisions, a ban on closed decisions," says Kechur.
"It is an interesting attempt to transfer this heterogeneous market into the hands of the state," says Viktoria Kovalevska, coordinator of the "Her Support" platform. "We have specialists who have developed all therapeutic areas, invested a large amount of their own funds. It is logical that these people at the head of their areas have enough competence to decide who in their area can be a certified psychotherapist [in the register]."
Alla Lykova is a katathym-imaginative psychotherapist who also practices EMDR, one of the most popular areas of psychotherapy in Ukraine. In her opinion, if the state decides to promote and protect several psychotherapy methods, others will remain in the shadows, and specialists may be deprived of access to free work in their area.
To work as a psychologist, she says, it is currently sufficient to have a higher education diploma. However, this diploma can indicate different levels of training. In many cases, it does not guarantee that the specialist has the necessary practical skills for the job.
Lykova notes that the situation with the training of psychotherapists in Ukraine requires major changes — much more detailed than in the draft law, which focuses mainly on controlling the activities of psychotherapists. The draft, the expert says, lacks transparent conditions for the work of psychotherapists and clear steps for the development of the industry.
The Ministry of Internal Affairs is also concerned with the fact that the national commission will be engaged in the certification of mental health specialists. In response to an appeal from the head of the Verkhovna Rada Committee on the Protection of Veterans’ Rights, Halyna Tretiakova, the Ministry of Internal Affairs noted that this could lead to monopolization of the certification process and open up opportunities for corruption.
The Ministry recommended clear description of the procedure with which psychotherapists will undergo attestation and certification, as well as identifying the bodies or departments that will be responsible for this procedure.
The shift of the responsibility for mental health to businesses
Draft law No. 12030 also provides for the establishment of mental health services at enterprises employing more than 50 people. Smaller enterprises will be able to engage mental health specialists on a part-time basis. In an enterprise with fewer than 20 people, external specialists with appropriate training may be engaged on a contract basis to perform the functions of a mental health service.
According to the scientific and expert conclusion on the draft law, these changes may lead to an increased financial burden on employers. At the same time, there are doubts about whether even large organizations are able to effectively create such mental health services and whether they will be able to realistically implement the innovations in a year after the law is adopted.
Coordinator of "Her Support" Viktoria Kovalevska assumes that in enterprises with fewer than 50 people, one of the employees will handle the implementation of a mental health policy part-time, "I think that the person responsible for occupational health and fire safety will also take on mental health protection".
What is next?
Yana Ukrainska says that the draft law that has passed the first reading requires significant revision, "The mental health system includes both psychiatric care and the provision of psychological services in schools, social centers, and for people with drug addiction. All these issues are not outlined."
If the law is adopted, its implementation may take 5-6 years.
We addressed the initiator of the draft law, Lada Bulakh, and the head of the parliamentary Committee on National Health, Mykhailo Radutskyi, for the comments on the experts’ remarks. Lada Bulakh never responded, and Mykhailo Radutskyi decided to refrain from commenting.
