Decentralisation and community engagement for better mental health services development in the conflict-affected regions of Ukraine

<h4>Purpose: </h4> The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The main interest focuses on communities' perception of their problems and solutions that communities can create to achieve better mental health coverage. <h4>Design: </h4> /methodology/approach Series of roundtables (4 roundtables, 62 participants overall), accompanied by interactive brainstorming techniques, were conducted with communities' representatives from the East of Ukraine (Lugansk region, government-controlled area). Participants were provided with the opportunity to discuss mental health services development challenges and create affordable solutions for their communities. Results of discussions were submitted to qualitative analysis and offered to review by participants. <h4>Findings: </h4> Decentralisation in Ukraine led to allocating funds alongside responsibilities for developing the services to communities. Most of the communities appear not to be ready to acknowledge the role of mental health services, entirely relying on the existing weak psychiatric hospital-based system. Rising-awareness interactive capacity-building activities for the community leaders and decision-makers effectively promote community-based mental health services development. Five clusters of challenges were identified: leadership, coordination, and collaboration problems; infrastructure, physical accessibility, and financial problems; mental health and primary healthcare workforce shortage and lack of competencies; low awareness in mental health, available services, and high stigma; war, crises, and pandemic-related problems. Communities foresaw seven domains of actions: increasing the role of communities and service users in the initiatives of governmental bodies; establishing in the communities local coordination/working groups dedicated to mental health service development; developing the community-based spaces (hubs) for integrated services provision; embedding the mental health services in the existing services (social, administrative, healthcare); mental health advocacy and lobby lead by local leaders and service users; increasing capacity of communities in financial management, fundraising; developing of services by combining efforts and budgets of neighbouring communities. Originality The paper is original in terms of its topic (connecting decentralisation and community engagement for understanding the challenges of mental health services development) and research strategy (engagement of Ukrainian communities, qualitative analysis of the discussion results and applying the best practices and international recommendations to the local context).