Community-based mental health centers in Ukraine — protocol for a mixed methods evaluation study using the RE-AIM framework

Background: Russia's full-scale invasion of Ukraine has deepened the strain on an already fragile mental health system, long shaped by Soviet institutionalized psychiatry. In response, Ukraine has started a national reform to modernize mental health services by shifting from an institutional to a community-based mental health care model. Implementation of his transition is supported by the international technical project Mental Health for Ukraine (MH4U). Aims: To generate evidence-based evaluation of the community-based mental health centers as a basis for continued improvement and to guide national scale-up. Methods and analysis: We will conduct a mixed-methods evaluation guided by the RE-AIM framework. First, quantitative data will be collected through (a) questionnaires administered to patient's prospective longitudinal cohort at baseline, three, and six months, (b) questionnaires from providers at the baseline and in the follow-up, and (c) administrative records. Second, qualitative data will be gathered through (a) interviews with subsample of participating patients and all the providers, and (b) focus groups with community stakeholders for each oblast (administrative region). Analyses will follow the RE-AIM framework. Adhering to a learning health systems (LHS) framework, we established continuous feedback loops and workshops to communicate study findings to MH4U implementers and stakeholders in Ukraine and Switzerland. Conclusion: Evaluation will provide unique evidence on not only whether the community-based Mental Health Center model works, but also how and why it works in real-world conditions. Findings will also inform national policy on mental health reform and offer lessons for global mental health systems operating under crisis conditions. Clinical trial registration: https://www.isrctn.com/ISRCTN61471084, ISRCTN61471084.