Universal Mental Health Training Pilot Trial in Ukraine

General information

The UMHT is a specialised program developed to train frontline professionals on high-quality and evidence-based responses to the mental health needs of the population they serve. Police officers, emergency responders, social services workers, educators, pharmacists, priests, and other professionals daily interact with a substantial number of people. Whereas their professional roles imply working with people in crisis who experience strong emotions and require support, a high level of mental health awareness and skills to manage mental health issues are needed. Therefore, UMHT was developed as an educational instrument for Ukrainian frontline professionals to raise their mental health awareness, reduce stigma toward people with mental disorders and develop particular skills for giving support.

The training is called Universal because its 5-step model offers a standard frame for interaction with people with mental health issues. Also, it is Universal because it is suitable for different types of frontline workers – the general interaction structure is not changing, only the set of relevant mental health conditions. 

The Mental Health Training for Frontline Professionals (UMHT) was developed in 2021 and piloted in 2021-2023 within the context of the Mental Health for Ukraine Project (MH4U), implemented in Ukraine by GFA Consulting Group GmbH (donor - Swiss Confederation). The University of Luxembourg, with the support of the European Commission through the MSCA4Ukraine fellowship scheme by the Alexander von Humboldt Foundation (AvH) for premier investigator Viktoriia Gorbunova, is leading a full-scale efficacy study of the UMHT in 2023-2025. 

Data and file overview

Three efficacy measurements were used in the outcome assessment: readiness to interact with people with mental health issues at work, mental health awareness, and mental health proficiency.

Readiness to interact with people with mental health issues at work

To measure the changes in readiness to interact with people with mental health issues at work (according to the 5-step model), all participants self-assessed their general readiness as well as readiness to do particular actions according to the 5-step model on a five-point scale (from 5 - "absolutely ready" to 1 - "absolutely not ready"). 

In the instruction, participants were asked: "Reading the next statements, please assess your readiness for a different kind of interaction with people with mental health conditions. The scale is from 1 to 5, where 1 is the absolute absence of readiness, and 5 – is the absolute readiness". 

The next set of statements was proposed to participants:

• Readiness to interact with people with mental health issues at work (general readiness).
• Readiness to recognise mental health conditions (readiness for step 1 of the 5-step model).
• Readiness to initiate and lead conversation with a person with mental health issues and his/her caregivers (readiness for step 2).
• Readiness to support a person with mental health issues and his/her caregivers (readiness for step 3).
• Readiness to refer a person with mental health issues, and his/her caregivers, to professional support (readiness for step 4).
• Readiness to ensure that professional help is received by a person with mental health issues and his/her caregivers (readiness for step 5).

Mental health awareness

Mental health awareness assessment was based on the KAP (knowledge, attitudes, and practices) model (Andrade et al., 2020). There is the experience of using such KAP-based surveys in Ukraine (Quirke et al., 2021). Based on the KAP model, a short survey was developed related to the knowledge about mental health issues, attitudes toward people with mental health disorders, and practice of interaction with them. 

Knowledge regarding people with mental disorders was assessed with the query: "Choose the statements that apply to people with mental health disorders" (max = 8 scores, where each score was awarded either for a choice of a correct statement or for a non-selection of a wrong statement):

• They are dangerous to the people around them.
• They are themselves guilty of their condition.
• They are incapable of true friendships.
• They can work.
• By appearance, it is clear that the person is not all right.
• Anyone can have a mental disorder.
• Mental disorders are incurable.
• Most people with mental disorders can recover.

Attitude towards people with mental issues was assessed with the question: "What is the best way of behaviour for people with mental health issues?" (max = 8 scores):

• Do not tell anyone about their condition. 
• Discuss everything with a doctor, but do not inform relatives.
• Hide this information at work/school.
• Tell loved ones and ask for help from specialists.
• Hide it from the family.
• Live among those like themselves.
• Should not marry and have children.

The question for assessment practices of interactions with people with mental disorders: "What is the proper way of interactions with people with mental health disorders?" (max = 9 scores):

• You would better avoid any contact with them.
• You shouldn't allow them to make any decisions.
• You would better avoid working with them in one team or performing tasks together.
• You should be careful about conversations with them.
• You should be ashamed and try to hide the fact you have a relative with a mental health disorder.
• They should have the same rights as anyone else.
• It is normal to have a friend with a mental health disorder.
• It is normal to marry a person with a mental health disorder.
• You should treat them with care and sympathy.

Practices of care about people with mental health issues were analysed with the question: "What is the best way to care about people with mental health issues?" (max = 6 scores):

• In a psychiatric hospital where they are under supervision and control (psychiatrist).
• Outside the hospital in specialised centres or privately (psychologist, psychotherapist).
• Alternative methods of treatment (traditional medicine, homoeopathy, vitamins, massage).
• Normal family relationships is the best treatment.
• Do not waste energy, it is not possible to cure mental disorders.
• At the primary level of health care (family doctor, paediatrician, general practitioner).

Mental health awareness scores were collected as the sum of scores for each scale.

Mental health proficiency

Mental health proficiency, as the ability to recognise mental health disorders' symptoms, was assessed by the tests that include correct and non-correct symptoms. Three true and two false symptoms (based on DSM-5) were offered for selection in each case. Mental health proficiency was estimated as the sum of the correct choices of symptoms for every disorder learned by participants. For instance, the participants who worked during the training with depressive disorders should choose all appropriate parameters among depressed mood, markedly diminished interest or pleasure in almost all activities, excessive or inappropriate feelings of worthlessness or guilt, inattention as, difficulties following instructions and failure to finish tasks, restlessness as fidgeting with or tapping hands or feet or squirming in the seat.

Additional one-month follow-up questions

Additional questions for the one-month follow-up test were: "Did you work after the training with people with mental health issues that you studied?", "What kind of the issues?", "Did you use training knowledge and skills?", "Which knowledge and skills did you use in particular?" 

Sharing and accessing information

Information (raw anonymized data) is openly available through Zenodo. It is possible to use the information with research aims to evaluate UMHT or compare data with other similar programs. Our research team kindly asks to notify the contact person (Viktoriia Gorbunova) about any usage of the dataset.  

Methodological information

The study was quasi-experimental (no complete randomization was possible at this piloting stage). Two groups were involved: the experimental group (received UMHT) and the control group (no training, waiting list).

The pilot trial of UMHTs' efficacy was conducted with 307 frontline professionals divided into 24 training groups (social workers (12 groups, 128 persons), educators (4, 63), police officers (4, 60), priests and clerics (1, 15), military volunteers (1, 12), workers of occupation centres (1, 13), emergency workers (1, 16)). All participants were recruited for training by their team leaders, who were informed about training possibilities by letters sent from the training developers. The only requirement for participation was working in the field with people. 

The control group included 211 persons with the same occupation background who participated in training later (waiting list). The control group consisted of social workers (97 persons), educators (32), police officers (40), priests and clerics (12), military volunteers (13), workers of occupation centres (7), and emergency workers (10).

Data-specific information

Excel file (UMHT_dataset_pilot_trial.xlsx) containing four pages. 

1. Page "Training groups_before UMHT". Contains the answers to questionaries completed by UMHT training participants before the training. 

2. Page "Training groups_after UMHT". Contains the answers to questionaries completed by UMHT training participants immediately after the training. 

3. Page "Training groups_after one month". Contains the answers to questionaries completed by UMHT training participants the month before the training. 

4. Page "Control group_before-after". Contains the answers to questionaries completed by UMHT control group participants (waiting list) before and after the training.