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EXECUTIVE SUMMARY
1. MHPSS service availability is structurally imbalanced across the assessed communities. While basic psychosocial support (IASC Level 1) is present in all four hromadas and primarily delivered by state and municipal providers (46% of KIIs), these services remain fragmented and limited in scope. Higher level interventions are largely absent: Level 3 services (e.g. SH+, PM+) are missing in 67%of communities, and Level 4 services (psychiatry and psychotherapy) are unavailable in 3 out of 4 hromadas, with most specialized care concentrated in Dnipro city. As a result, service coverage remains well below estimated population needs (20–40%), particularly in rural and hard to reach areas where entire settlements function as service “white spots”.
2. Access to services remains limited and uneven. Across KIIs, 81% of respondents rated overall MHPSS accessibility as average or below, reflecting not only service gaps but also structural barriers such as weak rural outreach, transport constraints, and financial limitations. Internally displaced persons, veterans and their families, families of the deceased, older persons, children and adolescents, and persons with disabilities face the highest levels of exclusion. These gaps are driven not only by limited service availability, but by misalignment between service design and population needs, weak outreach and identification systems, and limited provider competencies. For example, 44% of FGDs reported that specialists lack capacity to work with persons with disabilities, while services for veterans and bereaved families lack tailored protocols and trained staff.
3. Workforce constraints are systemic and directly affect service quality and accessibility. The system is characterised by insufficient staffing (85% of KIIs), low workforce stability (58% reporting low or very low retention), and high workload (38% reporting high caseloads, 4% excessive). Burnout is identified by over 50% of KIIs as a key issue, while structured supervision is largely absent. Technical capacity is also limited, with less than 20% of providers familiar with advanced interventions such as SH+ and PM+, and weak inclusive competencies across the system.
4. Coordination and referral mechanisms are fragmented and lack accountability. Only 31% of respondents reported formal referral SOPs, often only partially functional, while 31% rely on informal personal networks, and 15% report a complete absence of coordination pathways. Additionally, 46% of KIIs reported referrals without systematic follow up, and only 12% indicated functioning case management or coordination mechanisms. These gaps create “closed loops,” unclear responsibility, and a high risk of clients being lost between services.
5. The system remains highly dependent on external funding and lacks sustainability. Most Level 2–4 services are provided by INGOs and local charity funds, often through short term projects. Limited integration into public systems and budgets creates significant sustainability risks, as service availability and workforce capacity decline when external funding ends, leaving already underserved communities with only basic support.
