Representatives of government institutions, the expert community, and the patient community participated in the discussion.

In particular, the following guests participated in the roundtable: Olena Kolobrodova, Representative of the Ukrainian Parliament Commissioner for Human Rights on Social and Economic Rights; Iryna Mykychak, Advisor to the Minister of Health of Ukraine; Iryna Ivanchuk, Head of the Department of Addictions and Mental Health at the State Institution “Center for Public Health of the Ministry of Health of Ukraine”; and Tetiana Tsyba, Member of the Parliament of Ukraine and member of the Committee on Social Policy and Protection of Veterans’ Rights.

An important part of the discussion was the voices of the patients themselves — MH4U mental health ambassadors: Oleksandra Chaika, Oleksii Skrypachenko, Nataliia Yelizarova, and Mariia Tokareva, who shared their personal experiences of interacting with the system, receiving treatment, and overcoming barriers.

A key focus of the dialogue was the presentations by mental health ambassadors, who spoke from personal experience about the moment they became aware of their condition, their first contact with the system, the barriers to treatment, the consequences of delaying help-seeking, and how trust in professionals is built — or broken. It was precisely this logic and sequence of topics that formed the basis of the roundtable program.

That is why the main conclusion of the discussion did not sound like an abstract humanistic principle, but rather a practical requirement for the system: a mental health patient cannot be merely the object of treatment — they must be an active participant in the decision-making process. Otherwise, treatment loses touch with the person’s reality, and the system loses the opportunity to build trust.

During the event, mental health ambassador Oleksandra Chaika raised the issue of the patient’s right to be a full participant in treatment. This highlights one of the most powerful messages of the meeting: a person with a psychiatric diagnosis has a voice, because they know their own medical history better than anyone else.

The experiences of Oleksii Skrypachenko and Nataliia Yelizarova highlighted another important point: one of the challenges of mental health treatment is that when people are in a more stable state, they often convince themselves that they do not need help, but when their condition worsens, they no longer have the resources to go through the entire treatment process. This is a clear illustration of why timely treatment cannot be reduced solely to the patient’s personal responsibility: the system must be understandable, accessible, and welcoming, rather than off-putting.

Ambassador Maria Tokareva also emphasized another topic that is still often underestimated in Ukraine: high adaptability does not eliminate the need for comprehensive treatment. A person can work, study, and function socially while still needing professional psychological support. That is precisely why outward normality should not be used as a criterion for dismissing a mental health condition or denying support. In other words, mental illness does not mean the end of life, and taking away patients’ hope only deepens their isolation.

A separate strand of the discussion focused on how the state and the healthcare system can move beyond talking about patients without actually involving them. Iryna Mykychak, Advisor to the Minister of Health of Ukraine, noted that Ukraine is still overcoming the Soviet legacy in its approaches to mental health, but changes are already underway — particularly through the role of family doctors, early diagnosis, referral pathways, and updates to the Medical Guarantees Program. Iryna Ivanchuk, Head of the Department of Addictions and Mental Health at the State Institution “Center for Public Health of the Ministry of Health of Ukraine,” emphasized the importance of communication between doctor and patient, the need to revise sectoral standards, and also raised the issue of community-led monitoring in the field of mental health.

In this context, the position of the Ombudsman’s Office, articulated by Olena Kolobrodova, Representative of the Ukrainian Parliament Commissioner for Human Rights on Social and Economic Rights, was particularly telling. On-site monitoring visits to facilities providing psychological services are already underway. If this work continues, it will move beyond discussion and may become a practical mechanism for external oversight of how genuinely people-centered Ukraine’s mental health system is.

Another important strand of the discussion was self-medication and delayed help-seeking. In fact, this topic was central to the event from the very beginning: among the key issues addressed were barriers to treatment, experiences with self-medication, trust in specialists, and minimizing the risks of medication misuse. This is fully consistent with the broader international context: the WHO highlights not only the scale of the psychological burden in Ukraine but also a significant gap between the need for support and the actual seeking of it.

Thus, the meeting demonstrated that the problem lies not merely in the presence or absence of services. It lies at the intersection between the individual and the system: whether the patient has the right to be heard; whether the doctor is capable not only of prescribing but also of explaining; whether the system substitutes care with control; whether it distinguishes between “does not want to be treated” and “cannot access treatment independently”; and whether it recognizes that mental health is not a marginal issue, but one of the central conditions for societal resilience during wartime.

The event was moderated by Nataliia Tulinova, Foundress and CEO of the National Agency ZDOROVI, and Valeriia Palii, an expert of the Conscious Choice project, who structured the discussion around patients’ experiences, barriers to accessing care, and issues of trust in the system. Valeriia Sereda, Advocacy Manager at ZDOROVI, presented the findings of the mental health block of the Barometer survey, adding a systemic dimension to the discussion.

The data show that the problem is not only individual but also systemic in nature. On the one hand, 75.4% of healthcare facility directors consider a patient’s psychological and emotional state to be critically important for the effectiveness of treatment, while another 18.4% assess its impact as moderate. On the other hand, actual support practices remain fragmented: only some facilities have clear protocols for identifying psychological stress, and staff training is most often rated as average.

Even more telling is the gap in patients’ own experiences. According to the study, only 17.5% of respondents sought psychological help during the past year, while 42% have never received it and do not plan to seek it. The reasons include not only cost or accessibility, but also issues of trust, confidentiality, and knowing exactly where to turn for help.

These figures reinforce what the roundtable participants discussed: the barrier between the individual and the system arises not at the moment of service delivery, but much earlier — at the level of perception, communication, and trust. It is precisely here that the patient’s voice becomes not an addition, but a necessary condition for change.

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Nataliia Tulinova, Foundress and CEO of ZDOROVI:

“Talking about mental health without the patient’s own voice means building the system from the top down all over again. It is important to us that people’s experiences are not just listened to, but taken into account when making decisions.”

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The Conscious Choice project is implemented with the support of the Askold and Dir Fund as a part of the Strong Civil Society of Ukraine – a Driver Towards Reforms and Democracy Project, implemented by ISAR Ednannia and funded by Norway and Sweden.