After more than a year of war, Ukraine is looking to revamp its mental health system. Officials are looking at Philly’s VA hospital as an example

Fourteen Ukrainian government officials and doctors arrived at the Philadelphia Veteran’s Affairs Medical Center this week with a mission to find out how to build a more robust mental health system for a population coping with daily trauma from Russia’s invasion in 2022.

Some of their questions were ones David Oslin, the chief of the hospital’s behavioral health division, hears often: How do you encourage primary care physicians to screen for mental health issues? How do you leverage smartphone apps to encourage patients to monitor their own well-being?

Other requests threw the delegation’s unique situation into stark relief. “At one point, they were asking about facility plans — because they have to rebuild some of their hospitals,” Oslin said.

On Wednesday, the Ukraine delegation attended a presentation at the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center in which Oslin and his colleagues laid out their ongoing work to change the perception of mental health care. By integrating services with primary care, they are encouraging doctors across the agency to take mental health concerns just as seriously as they would take a physical injury.

Oksana Zbitnieva, a Ukranian government official coordinating efforts to revamp the country’s mental health treatment system, acknowledged the “ambitious task” ahead of her team.

“Everyone admires our resilience, but we still need to think longer-term,” she said, speaking through a translator. “What happens to us later?”

Zbitnieva and her colleagues are also focusing on offering better mental health care for the country’s civilian population. Ordinary Ukrainians are going about their everyday life amid the echoes of air raid sirens and explosions — and it’s imperative that health officials begin to think about their mental health needs beyond daily survival, she said.

Oslin said the delegation chose to visit the VA because it, unlike many civilian health systems, has integrated behavioral health care into general medical care for its patients. The agency takes an approach he calls “no wrong door,” meaning that anyone who brings up mental health concerns at any point will be directed to treatment. Primary care physicians also regularly assess their patients for mental health issues.

“In the community, mental health care is very fragmented and chopped up and delivered by different people,” Oslin said. “In the VA way, it’s a system of care. Mental health care becomes the responsibility of every employee.”

Zbitnieva said she found that aspect of the VA’s approach most applicable to Ukraine, where much of the population is already dealing with anxiety, stress and emotional burnout.

“We’re trying to form a new culture of self-care,” she said.

Oslin said it was an honor to host the delegation. And he was moved by some of the simplest details from their experience in Philadelphia: One member of the group mentioned to him that she’d been startled when her hotel air-conditioning unit unexpectedly turned on.

At home in Ukraine, sudden noises that startle could be a bomb.

“The trauma that this country is going through, it’s 100% of their population. It’s everybody,” Oslin said. “There’s no corollary for us in the United States, and we’re so blessed to not be in that setting.”