In Ukraine, the demand for psychotropic drugs is growing rapidly, and with it, the scale of self-medication. Full-scale war, constant stress, loss, exhaustion, and limited access to medical care have created a new reality: more and more people are trying to cope with anxiety, insomnia, or panic attacks on their own — without consulting a doctor.

This was the topic of the fourth roundtable discussion of the ZDOROVI advocacy project “Conscious Choice” — “Conscious Choice Between the Availability of Psychotropic Drugs and Patient Safety: Challenges for the Healthcare System and Intersectoral Responsibility.” The event brought together representatives of government bodies, the WHO, doctors, pharmacists, the public sector, mental health experts, and the patient community.

Olena Kolobrodova, Representative of the Ukrainian Parliament Commissioner for Human Rights on Social and Economic Rights, emphasized that mental health issues today are directly linked to the availability of care and the sustainability of the healthcare system.

“18 out of the 26 mental health centers we monitored reported a number of systemic problems. However, this is normal, as we are discussing reform. The main thing is to respond in a timely manner,” she noted.

Among the key challenges, Olena Kolobrodova named a shortage of specialists, insufficient funding, weak integration between services, a lack of material and technical support, and limited accessibility for people with reduced mobility. She especially focused on the social dimension of the problem.

“This is a matter of social responsibility, education, and upbringing within the family,” she added.

The participants in the discussion repeatedly emphasized that the Ukrainian context differs significantly from the European one. While in many countries consulting a psychiatrist is common practice, in Ukraine, the topic of mental health has remained stigmatized for years.

Doctor of Medical Science Maksym Khaustov drew attention to the fact that Ukrainian society is gradually developing a culture of “quick solutions,” where people try to eliminate symptoms immediately — often based on advice from social media, advertising, or the experiences of acquaintances.

“People share their experiences, native advertising of drugs appears, and a culture of quick solutions is formed, which encourages self-medication,” the expert explained.

Additionally, he emphasized the importance of strengthening primary healthcare.

“There are already programs for family doctors so that they can work with borderline conditions and partially reduce the burden on psychiatrists,” said Dr. Khaustov.

Special attention at the roundtable was dedicated to the role of pharmacists. Because of the war, especially in frontline regions and small towns, pharmacies often become the only places where people can receive at least some form of assistance.

Yulia Klymenyuk, an expert in pharmaceutical policy at the NGO “Association of Pharmacists of Ukraine,” noted:

“We have many locations where there are no hospitals, but pharmacies have already taken on the role of the first point of contact. However, it is necessary to develop a culture of proper use of these medications.”

At the same time, pharmacists often find themselves under enormous pressure.

“A person comes with a real problem. But a pharmacist has a problem as well, because he is also a human being. A Shahed drone fell in their city, and a person asks for Gidazepam without a prescription — these are difficult moral situations, especially in frontline cities,” emphasized Yulia Klymenyuk.

Representatives of government bodies and international organizations also spoke about the need to balance accessibility and control.

WHO representative Oleg Shults emphasized that excessive restrictions on access to psychotropic drugs are no less dangerous than their uncontrolled use.

“Control must be proportionate to the risk and should not block access to treatment,” he emphasized.

According to Mr. Shults, the problem of mental health cannot remain exclusively within the field of psychiatry.

“50% of people have some kind of mental disorder, including mild forms. Psychiatry as a separate field cannot cope with this on its own,” the WHO representative noted.

He also emphasized that psychotropic drugs should not be the only treatment tool.

“We want it to get better immediately. But it doesn’t work that way,” said Oleg Schultz, adding that even regular physical activity can be part of therapy: “A 45-minute walk every other day is like one ‘dose’ of an antidepressant.”

The WHO representative also drew attention to the issue of polypharmacy — the simultaneous use of a large number of medications.

According to him, WHO is actively supporting the development of mental health services at the primary healthcare level.

“We have already trained every fifth doctor to work with mental health issues,” he said.

Former head of the State Service of Ukraine on Medicines and Drug Control in Rivne region, Serhii Lebed, emphasized that the issue of controlling psychotropic drugs always requires a delicate balance.

“The issue of overregulation continues to exist, and a balance must be ensured,” he noted.

Serhii Lebed gave examples of misuse in the field of substitution therapy and emphasized that the system still does not have sufficient regulation of pharmaceutical care.

“We still do not have a clear definition or algorithm of what pharmaceutical care is,” he said.

At the same time, Serhii Rudy, Honored Worker of Pharmacy of Ukraine, emphasized that the problem of self-medication in Ukraine has existed for decades, and that the state has been trying to create a system of control over psychotropic substances since the 1990s.

“The work in this area was carried out, but self-medication was, is, and will be. What has already been created needs to be adapted to new conditions,” he noted.

During the discussion, the following issues were also raised:

– the spread of “pharmacy advice” on social media;

– native advertising of medications;

– the exchange of medicines between patients;

– problems with electronic prescriptions;

– the rise in new psychoactive substances;

– lack of educational campaigns;

– burnout among pharmaceutical workers;

– difficulties in accessing treatment for the military and people with addictions.

Additionally, participants discussed the need for intersectoral cooperation between doctors, pharmacists, the state, educational institutions, and the public sector. According to experts, the lack of clear coordination often leads to a loss of control over the patient routes — from first contact to further support.

The moderator of the event, Valeriia Palii, reminded participants that this roundtable was the fourth within the “Conscious Choice” project. Previous meetings focused on experts in mental health, behavioral sciences, advertising, and patient experience. This fourth stage focused specifically on the pharmacy sector and the role of pharmacists in shaping a culture of responsible use.

Summing up the discussion, Nataliia Tulinova reported that ZDOROVI is planning a large-scale information campaign for healthcare professionals and patients.

“Yesterday, I read a study by the Bohdan Hawrylyshyn Foundation on responsibility. Only 48% of people in Ukraine understand that they are responsible for their own health. And where are the other 52%? It is our information campaign that should change this situation,” she noted.

ZDOROVI also reported that the next stage of the project could involve creating educational opportunities for medical professionals, including formats with continuing professional development (CPD) points.

“Education must be continuous. Without it, we will not be able to change the culture of responsible consumption,” the participants concluded.

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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.

Roundtable recording: https://youtu.be/jAXvDj28bAE?si=M4fuqgMDul5d92rg